Document text
Where There Is No Doctor 2010
Wfiere Tfiert Is No Doctor
a viCCaqe kecdcfi care danewook
-revised edition ~
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VctvicC Werner
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CaroC Tfmman ancC Jane MameCC
witd drawuys dy David Werner
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www. nesperian.org
Where There Is No Doctor 2010
Library of Congress Cataloging-in-Publication Data
The Library of Congress has already cataloged the 10-digit ISBN as follows:
Werner, David, 1934-
Where there is no doctor: a village health care handbook / by David Werner;
with Carol 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-. Ill 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
The original English version of this book was produced in 1977 as a revised translation
of the Spanish edition, Donde no hay doctor.
Hesperian 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 Hesperian.
Please contact Hesperian 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 book has been printed in the USA on 100% recycled paper $ by Worldcolor.
THIS REVISED EDITION CAN BE IMPROVED WITH YOUR HELP.
If you are a community health worker, doctor, mother, or anyone with ideas or
suggestions for ways this book could be changed to better meet the needs of your
community, please write to Hesperian at the above address. Thank you for your help.
Publishing for community
Health and empowerment
*41
Published by:
Hesperian
1919 Addison St., #304
Berkeley, California 94704 • USA
[email protected] • www.hesperian.org
Copyright© 1977, 1992, 2010
by the Hesperian Foundation
First English edition: October 1977
Revised English edition: May 1992
Eleventh printing: July 2010
ISBN: 978-0-942364-15-6
WWW.
1 I (if S+k «r
nespenan.org
Where There Is No Doctor 2010
Thanks to the work and dedication of
many groups and individuals around
the world, Where There Is No Doctor
has been translated into more than 80
languages. The following are some
of the translations and the addresses
where you can obtain them.
SPANISH and ENGLISH
editions are available from:
Hesperian
1919 Addison St., #304 • Berkeley, California 94704 • USA
www.hesperian.org • [email protected]
tel : (5 1 0) 845-4507 •fax: (5 1 0) 845-0539
ARABIC:
Arab Resource Collective
P.O. Box 13-5916
Beirut, LEBANON
www. m a wa r e d . o r g
CHICHEWA:
Umoyo Trust
P.O. Box 30514
Blantyre
MALAWI
www.umoyotrust.org
HAITIAN CREOLE:
4 The World Resource Distributors
171 1-A.N. Barnes
Springfield MO 65803
UNITED STATES
www.4WRD.org
HINDI:
VHAI
40 Institutional Area (South of NT)
Tong Swasthya Bhawan
New Delhi, 110016
INDIA
www.vhai.org
KHMER:
Medicam Office #4
Street 522
Phnom Penh
CAMBODIA
http://wtind-khmer.blogspot.com
PORTUGUESE:
Teaching Aids at Low Cost (TALC)
P.O. Box 49
St. Albans, Herts.
AL15TX
UNITED KINGDOM
www.talcuk.org
SWAHILI:
Rotary Club of Dar es Salaam
PO Box 1520
Dar es Salaam
TANZANIA
URDU:
Pakistan Medical Association
PMA House, Garden Road
Karachi 74400
PAKISTAN
Please write to Hesperian or look on our website at www.hesperian.org/publications_
translations. php for other editions including Albanian, Amharic, Aymara, Bengali, Burmese,
Cebuano, Chinese, Dari, Farsi, French, Fulfide, German, Mongo, Indonesian, Italian,
Japanese, Jinghpaw, Kannada, Karakalpak, Kazakh, Korean, Lao, Malayalam, Marathi,
Marshallese, Nepali, Oriya, Pashto, Quechua, Russian, Shan, Somali, Tamil, Telegu, Thai,
Tibetan, Tigrinya, Uzbek, Vietnamese, and Zulu, as well as other English editions adapted for
specific countries.
We are looking for ways to get this book to those it can serve best. If you are able to
help or have suggestions, please contact Hesperian. We offer this book at a lower price to
persons of low income living in poor countries.
www. nesperian.org
Where There Is No Doctor 2010
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 other researchers of this revised edition: Suellen Miller, Susan Klein, Ronnie
Lovich, Mary Ellen Guroy, Shelley Kahane, Paula Elster, and George Kent. For information 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 Hesperian 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, Elizabeth Babu, Marcos Burgos, Dan
Eisenberg, Pam Fadem, Inaki Fernandez de Retana, Shu Ping Guan, Todd Jailer, Erika Leemann,
Malcolm Lowe, Malini Mahendra, Jane Maxwell, Susan McCallister, Gail McSweeney, Elena Metcalf,
Syema Muzaffar, Leana Rosetti, C. Sienkiewicz, Lora Santiago, Peter Small, Melissa Smith, Fred
Strauss, Michael Terry, Fiona Thomson, Kathleen Vickery, Sarah Wallis, and Curt Wands. Dorothy
Tegeler coordinated this 2010 reprint with help from Deborah Bickel, Kristen Cashmore, Kathy
DeRemier, Jacob Goolkasian, Shu Ping Guan, Todd Jailer, Lisa Keller, Jane Maxwell, Susan
McCallister, Maia Small, Kathleen Tandy, Fiona Thomson, Leah Uberseder, and Lily Walkover.
Artwork for this book was created by David Werner, Kyle Craven, Shu Ping Guan, Susan Klein,
Regina Faul-Doyle, Sandy Frank, Fiona Thomson, and Lihua Wang. 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 Buch, Lynne Coen, George Kent, Jack May, Oliver Bock, Bill Gonda, Ray Bleicher, and
Jesus Manjarrez.
For this 1992 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.
For this 2009 printing, thanks to Flora Family Foundation, Ford Foundation, Grousebeck Family
Foundation, Moriah Fund, and West 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
WORDS TO THE VILLAGE HEALTH WORKER (Brown Pages) wl
Health Needs and Human Needs w2
Many Thing 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
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
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
1
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
What Causes Sickness? 17 Example of Local Names for Sicknesses 22
Different Kinds of Sicknesses and Misunderstanding Due to Confusion
Their Causes 18 of Names 25
Non-infectious Diseases 18 Confusion between Different Illnesses
Infectious Diseases 19 That Cause Fever 26
Sicknesses That Are Hard to Tell Apart 20
Chapter 3
HOWTO EXAMINE A SICK PERSON
Questions 29
General Condition of Health 30
Temperature 30
How to Use a Thermometer 31
Breathing (Respiration) 32
Pulse (Heartbeat) 32
Eyes 33
Ears 34
Skin 34
The Belly (Abdomen) 35
Muscles and Nerves 37
29
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Chapter 4
HOW TO TAKE CARE OF A SICK PERSON
The Comfort of the Sick Person 39
Special Care for a Person Who Is Very III 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
39
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 HOWTO 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
HOWTO MEASURE AND GIVE MEDICINE 59
Medicine in Liquid Form 61 Dosage Instructions for Persons Who
How to Give Medicines to Small Children 62 Cannot Read 63
How to Take Medicines 63
Chapter 9
INSTRUCTIONS AND PRECAUTIONS FOR INJECTIONS
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
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
www.nespenan.org
Chapter 10
FIRST AID
75
Basic Cleanliness and Protection 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
Chapter 1 1
NUTRITION: WHATTO EATTO 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
How to 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
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
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
107
Special Diets for Specific Health
Problems 124
Anemia 124
Rickets 125
High Blood Pressure 125
Fat People 126
Constipation 126
Diabetes 127
Acid Indigestion, Heartburn, and Stomach
Ulcers 128
Goiter
(A Swelling or Lump on the Throat) 130
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 148
Chapter 12
PREVENTION: HOWTO AVOID MANY SICKNESSES
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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
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
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
Seizures (Fits, Convulsions) 178
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 21 1
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 14
SERIOUS ILLNESSES THAT NEED SPECIAL MEDICAL ATTENTION
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Chapter 16
THE EYES
217
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
Urinary Tract Infections 234
Kidney or Bladder Stones 235
Enlarged Prostate Gland 235
Diseases Spread by Sexual Contact
(Sexually Transmitted Infections) 236
Gonorrhea (Clap, VD, the Drip) and
Chlamydia 236
Syphilis 237
Bubos: Bursting Lymph Nodes in
the Groin 238
The Menstrual Period
(Monthly Bleeding in Women) 245
The Menopause
(When Women Stop Having Periods) 246
Pregnancy 247
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
233
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
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
Chapter 18
THE URINARY SYSTEM AND THE GENITALS
Chapter 19
INFORMATION FOR MOTHERS AND MIDWIVES
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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
Medicines to Control Bleeding
After Birth or Miscarriage:
Oxytocin, Ergonovine, Misoprostol 266
Choosing a Method of Family Planning 284
Oral Contraceptives
(Birth Control Pills) 286
Other Methods of Family Planning 290
Combined Methods 292
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 31 1
Chickenpox 31 1
Measles (Rubeola) 311
German Measles (Rubella) 312
Mumps 312
Difficult Births 267
Tearing of the Birth Opening 269
Care of the Newborn Baby 270
Illnesses of the Newborn 272
The Mothers 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
283
Methods for Those Who Never Want to Have
More Children 293
Home Methods for Preventing
Pregnancy 294
295
Whooping Cough 313
Diphtheria 313
Infantile Paralysis (Polio) 314
How to Make Simple Crutches 31 5
Problems Children Are Born With 316
Dislocated Hip 316
Umbilical Hernia
(Belly Button That Sticks Out) 317
A ‘Swollen Testicle’
(Hydrocele or Hernia) 317
Mentally Slow, Deaf, or Deformed
Children 318
The Spastic Child (Cerebral Palsy) 320
Slow Development in the
First Months of Life 321
Sickle Cell Disease 321
Helping Children Learn 322
Chapter 20
FAMILY PLANNING-
HAVING THE NUMBER OF CHILDREN YOU WANT
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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, OVA) 327
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
ADDITIONAL INFORMATION
HIV and 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
VOCABULARY— Explaining Difficult Words
ADDRESSES FOR TEACHING MATERIALS.
INDEX (Yellow Pages)
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
331
The Village Medicine Kit 336
Words to the Village Storekeeper
(or Pharmacist) 338
339
399
Guinea Worm 406
Emergencies Caused by Cold 408
How to Measure Blood Pressure 410
Poisoning from Pesticides 412
Complications from Abortion 414
Drug Abuse and Addiction 416
419
429
433
THE GREEN PAGES — The Uses, Dosage, and Precautions for Medicines
List of Medicines in the Green Pages 341
Index of Medicines in the Green Pages 344
Information on Medicines 350
Dosage Instructions for Persons Who Cannot Read
Patient Reports
Other Books from Hesperian
Information About Vital Signs
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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, 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 80 languages and is used by village health workers in over 100
countries.
www.nespenan.org
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 Hesperian, 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.
www.n6Spcri3.ll.org
Note About This New Edition
In this revised edition of Where There is No Doctor, we have added new
information and updated old information, based on the latest scientific knowledge.
Health care specialists from many parts of the world have generously given advice
and suggestions.
When it would fit without having to change page numbers, we have added new
information to the main part of the book. (This way, the numbering stays the same, so
that page references in our other books, such as Helping Health Workers Learn, will
still be correct.)
The Additional Information section at the end of the book (p. 399) has information
about health problems of growing or special concern: HIV and AIDS, sores on the
genitals, leishmaniasis, complications from abortion, guinea worm, and others.
Here also are topics such as measuring blood pressure, misuse of pesticides, drug
addiction, and a method of caring for early and underweight babies.
New ideas and information can be found throughout the book — medical knowledge
is always changing! For example:
• Nutrition advice has changed. Experts used to tell mothers to give children
more foods rich in proteins. But it is now known that what most poorly nourished
children need is more energy-rich foods. Many low-cost energy foods, especially
grains, provide enough protein if the child eats enough of them. Finding ways to
give enough energy foods is now emphasized, instead of the ‘four food groups'.
(See Chapter 1 1 .)
• Advice for treatment of stomach ulcer is different nowadays. For years doctors
recommended drinking lots of milk. But according to recent studies, it is better to
drink lots of water, not milk. (See p. 129.)
• Knowledge about special drinks for diarrhea (oral rehydration therapy) has
also changed. Not long ago experts thought that drinks made with sugar were
best. But we now know that drinks made with cereals do more to prevent water
loss, slow down diarrhea, and combat malnutrition than do sugar-based drinks or
“ORS” packets. (See p. 152.)
• A section has been added on sterilizing equipment. This is important to prevent
the spread of certain diseases, such as HIV. (See p. 74.)
• We have also added sections on dengue (p. 187), sickle cell disease (p. 321),
and contraceptive implants (p. 293). Page 105 contains revised information
about treatment of snakebite.
• See page 139 for details on building the fly-killing VIP latrine.
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If you have suggestions for improving this book, please
let us know. Your ideas are very important to us!
The Green Pages now include some additional medicines. This is because
some diseases have become resistant to the medicines that were used in the past.
So it is now harder to give simple medical advice for certain diseases — especially
malaria, tuberculosis, typhoid, and sexually spread diseases. Often we give several
possibilities for treatment. But for many infectious diseases you will need local
advice about which medicines are available and effective in your area.
In updating the information on medicines, we mostly include only those on the
World Health Organization’s List of Essential Drugs. (However we also discuss some
widely used but dangerous medicines to give warnings and to discourage their use —
see also pages 50 to 52.) In trying to cover health needs and variations in many parts
of the world, we have listed more medicines than will be needed for any one area. To
persons preparing adaptations of this book, we strongly suggest that the Green Pages
be shortened and modified to meet the specific needs and treatment patterns in your
country.
In this new edition of Where There Is No Doctorwe continue to stress the value of
traditional forms of healing, and have added some more “home remedies.” However,
since many folk remedies depend on local plants and customs, we have added only
a few which use commonly found items such as garlic. We hope those adapting this
book will add home remedies useful to their area.
Community action is emphasized throughout this book. For example, today it
is often not enough to explain to mothers that ‘breast is best'. Communities must
organize to make sure that mothers are able to breast feed their babies at work.
Likewise, problems such as misuse of pesticides (p. 412), drug abuse (p. 416), and
unsafe abortions (p. 414) are best solved by people working together to make their
communities safer, healthier, and more fair.
“Health for all” can be achieved only through the organized demand by
people for greater equality in terms of land, wages, services, and basic rights.
More power to the people!
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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. 338);
• 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 to read a
chapter at a time and discuss it.
THE VILLAGE HEALTH WORKER LIVES AND
WORKS AT THE LEVEL OF HIS PEOPLE. HIS
FIRST JOB IS TO SHARE HIS KNOWLEDGE.
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Dear Village Health Worker,
This book is mostly about people’s health needs. But to help your village be
a healthy place to live, you must also be in touch with their human needs. Your
understanding and concern for people are just as important as your knowledge of
medicine and sanitation.
Here are some suggestions that may
help you serve your people’s human
needs as well as health needs:
1. BE KIND. A friendly word, a smile, a
hand on the shoulder, or some other sign
of caring often means more than anything
else you can do. Treat others as your
equals. Even when you are hurried or
worried, try to remember the feelings
and needs of others. Often it helps to ask
yourself, “What would I do if this were a
member of my own family?”
Treat the sick as people. Be
especially kind to those who are very sick
or dying. And be kind to their families. Kindness often helps more than medicine.
Let them see that you care. Never be afraid t0 show y° u 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
their own homes.
LOOK FOR WAYS TO SHARE YOUR KNOWLEDGE
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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.
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I KNOW ITS A LONG WAY TO THE
health center, out here we
CANNOT G IVE HIM THE TREATMENT
-HE NEEDS. I'LL GO WITH YOU.
4. KNOW YOUR OWN LIMITS.
No matter how great or small your
knowledge and skills, you can do a good
job as long as you know and work within
your limits. This means: Do what you
know how to do. Do not try things you
have not learned about or have not had
enough experience doing, if they might
harm or endanger someone.
But use your judgment.
Often, what you decide to do or not do
will depend on how far you have to go to
get more expert help.
For example, a mother has just given
birth and is bleeding more than you think
is normal. If you are only half an hour
away from a medical center, it may be
wise to take her there right away. 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.
KEEP LEARNING— Do not let
anyone tell you there are things
you should not learn or know.
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.
Your first job is to teach, and unless you
keep learning more, soon you will not have
anything new to teach others.
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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. jrfvA s \ _ , „ -■ * ' 121
Children will work Jwi „ *
hard and enjoy it, if /'
they can turn work ' ,<r '
into play.
You may or may not
be paid for your work. But
never refuse to care, or
care less, for someone who
This way you will win your
people’s love and respect.
These are worth far
more than money.
is poor or cannot pay.
WORK FIRST FOR THE PEOPLE— NOT THE MONEY.
(People are worth more.)
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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
land they have?
• Is it because parents have
more children than they or
their land can provide for,
and keep having more?
• Is it because fathers lose
hope and spend the little
money they have on drink?
• Is it because people do
not look or plan ahead?
Because they do not realize
that by working together and
sharing they can change the
conditions under which they
live and die?
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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.
DEATH
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.
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?
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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.
2. His real need (to correct the problem)
is to give up smoking.
No Than ks
4 . One resource that may help him give up
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.
him and his family (see p. 149). Another is the
support and encouragement of his family, his
friends, and you.
smoking is information about the harm it can do
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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.
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To Help Determine Community Health Needs
And at the Same Time Get People Thinking
Sample Lists of Questions
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? Why?
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
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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 school children 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?
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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 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.
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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
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).
to prevent soil from
ROTATION OF CROPS
This year maize
Next year beans
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MORE WAYS TO WORK TOWARD BETTER NUTRITION
IRRIGATION OF LAND FISH BREEDING
Compost pile
BETTER FOOD
STORAGE
Metal
sleeves to
keep out
rats
SMALLER FAMILIES
THROUGH FAMILY PLANNING
(p. 283 )
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TRYING A NEW IDEA
Not all the suggestions on the last pages are
likely to work in your area. Perhaps some will
work if changed for your particular situation and
resources at hand. Often you can only know
whether something will work or not by trying it.
That is, by experiment.
When you try out a new idea, always start
small. If you start small and the experiment fails,
or something has to be done differently, you will
not lose much. If it works, people will see that it
works and can begin to apply it in a bigger way.
Start small
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:
This experiment shows that a certain amount of manure helps, but that too much
can harm the plants. This is only an example. You experiments may give different
results. Try for yourself!
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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.
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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.
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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 156). 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.
REMEMBER: MEDICINES CAN KILL
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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
NEEDS AN
.INJECTIONS
alT~he HA 5 Ts A \
COLD- HE WILL GET U/ELl'
QY HIMSELF LET HIM
REST. GIVE HIM
6 OOP FOOD AND
LOTS TO DRINK.
STRONG MEDICINE
Won't help and
MIGHT EVEN HARM
V HIM. , - J
WHEN MEDICINES ARE NOT NEEDED, TAKE TIME TO EXPLAIN WHY.
For more information about the use and misuse of medicines, see Chapter 6,
page 49. For the use and misuse of injections, see Chapter 9, page 65. For
sensible use of home remedies, see Chapter 1.
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FINDING OUT WHAT PROGRESS HAS BEEN MADE
(EVALUATION)
From time to time in your health work, it helps to take a careful look at what and how
much you and your people have succeeded in doing. What changes, if any, have been
made to improve health and well-being in your community?
You may want to record each month or year the health activities that can be
measured. For example:
• How many families have put in latrines?
• How many farmers take part in activities to improve their land and crops?
• How many mothers and children take part in an Under-Fives Program (regular
check-ups and learning)?
This kind of guestion 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
guestions 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.
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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
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Tools for Teaching
Flannel-graphs are good for talking with groups
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 flannelbnard
Posters and displays. “A picture is worth a
thousand words.” Simple drawings, with or without a
few words of information, can be hung in the health
post or anywhere that people will look at them. You
can copy some of the pictures from this book.
If you have trouble getting sizes and shapes right,
draw light, even squares in pencil over the picture
you want to copy.
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
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.
because you can keep making new pictures. Cover
subjects.
Now draw the same number of squares lightly,
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Other Ways to Get Ideas Across
Story telling. When you have a hard time explaining something, a story,
especially a true one, will help make your point.
For example, if I tell you that sometimes a village worker can make a better
diagnosis than a doctor, you may not believe me. But if I tell you about a village
health worker called 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.
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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
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.
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.
play. Use imagination.
CHILDREN CAN DO AN AMAZING AMOUNT
OF WORK WHEN IT IS TURNED INTO A GAME!
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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.
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.
TALK WITH PEOPLE
NOT AT THEM
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USE PICTURES TO GET PEOPLE TALKING AND THINKING TOGETHER
Show a group of people a picture similar to this and ask them to discuss it. Ask
questions that get people talking about what they know and can do. Here are some
sample questions:
• Who are the people in the picture and how do they live?
• What was this land like before the people came?
• 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?
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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?
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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, 2, 6, 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 11 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 Hesperian.
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.
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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.
Caring and sharing are the key to health.
Yours truly,
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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.
Where There Is No Doctor 2010 1
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 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
FOR COUGHS, COLDS, AND
COMMON DIARRHEA, HERBAL TEAS
ARE OFTEN BETTER, CHEAPER, AND
SAFER THAN MODERN MEDICINES.
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:
It is often safer to treat very serious illnesses with modern
medicine — following the advice of a health worker if possible.
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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 people
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.
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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, many 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.
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4 Where There Is No Doctor 2010
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.
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Where There Is No Doctor 2010 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.
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6 Where There Is No Doctor 2010
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).
Is it true that mothers
should give birth in a
darkened room?
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.
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Where There Is No Doctor 2010 7
Is it true that a newborn
baby should not be
bathed until the cord
falls off?
True! The stump of the
cord should be kept
dry until it falls off. But
the baby can be gently
cleaned with a clean, soft,
damp cloth.
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.
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).
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8 Where There Is No Doctor 2010
Is it a good idea to
bathe a 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.
Is it true that when
a person has a high
fever, he should be
wrapped up so that
the air will not harm
him?
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.
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Where There Is No Doctor 2010 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.
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10 Where There Is No Doctor 2010
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:
1 . to tie a crab
on the goiter
DON’T
3. to smear the brains of a 4. to smear human
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
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.
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Where There Is No Doctor 2010 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 2. for deafness, putting
(a bright red mushroom) 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
neck
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.
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12 Where There Is No Doctor 2010
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:
ANGELS 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 may help 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.
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Where There Is No Doctor 2010 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
instructions on how to care for wounds and control bleeding on pages
are more
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 overnight, and 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 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.
Even better, 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.
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14 Where There Is No Doctor 2010
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. 98).
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.
1 ill AjlirT ~
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Where There Is No Doctor 2010 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).
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16 Where There Is No Doctor 2010
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
MILK OF MAGNESIA
These are salt purges. Use them only in
low doses, as laxative for constipation.
EPSOM SALTS (magnesium sulfate) Do not use them often and never when
(see p. 382)
there is pain in the belly.
MINERAL OIL
(see p. 382)
This is sometimes used for constipation in
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, 382, and 392).
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.
A BETTER WAY
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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.
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18 Where There Is No Doctor 2010
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 seizures
stroke
migraine headaches
cataract
cancer
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:
Problems that begin in the mind
(mental ‘illnesses’):
harelip
crossed or wall-eyes
(squint)
other deformities
epilepsy (some kinds)
retarded (slow)
children
birthmarks
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:
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Where There Is No Doctor 2010 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
different
antibiotics
► for different
bacteria
(microbes or germs)
pneumonia
(some kinds)
through the air
(coughing)
gonorrhea,
chlamydia, and
syphillis
sexual contact
bacterial
infections
earache
with a cold
infected wounds
contact with dirty things
sores with pus
direct contact (by touch)
j
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
(Medicines like
antibiotics do not
fight viruses effectively)
rabies
animal bites
Vaccinations prevent
some virus infections.
than bacteria)
warts
touch
HIV
body fluids of someone
infected get inside
another person's
body
Antiretroviral
medicines fight HIV.
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
permethrin,
keeping very clean
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.
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).
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20 Where There Is No Doctor 2010
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. 234)
• 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.
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Where There Is No Doctor 2010 21
SICKNESSES THAT ARE OFTEN CONFUSED
OR GIVEN THE SAME NAME
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:
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22 Where There Is No Doctor 2010
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
one side of their belly. Often the pain goes around
to the mid or lower back. Possible causes of this
kind 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)
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Where There Is No Doctor 2010 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:
It is said that la congestion strikes persons who break ‘the diet’ (see p. 123),
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 seizures (fits) or paralysis: see seizures (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 ‘jumping’ 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. 112) — or hunger! Eating enough good food is the only
real treatment (see p. 110 and 111).
the head,
the chest,
the stomach,
or the whole body.
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24 Where There Is No Doctor 2010
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. 112). 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:
• 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.
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Where There Is No Doctor 2010 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:
cancer of the skin
(P- 211)
breast cancer
(p. 279)
\
cancer of the womb or ovaries
(p. 280)
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.
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26 Where There Is No Doctor 2010
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: (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.
HEPATITIS— Usually the fever
TYPICAL FEVER PATTERN is mild.
I ! I ! 1 i I I
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Days of Illness
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Where There Is No Doctor 2010 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
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 — Lever comes in waves. Rises in
TYPICAL LEVER PATTERN the afternoon and falls at night.
Childbirth fever: (see p. 276)
Begins a day or more after
giving birth. Starts with a slight
fever, which often rises later.
Foul-smelling vaginal discharge.
Pain and sometimes bleeding.
CHILBIRTH FEVER — TYPICAL FEVER PATTERN
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 HIV infection
(see p. 399). When possible, seek medical help.
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How To Examine
a Sick Person
CHAPTER
29
3
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, or 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.)
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30 Where There Is No Doctor 2010
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. 179), or kwashiorkor (p. 1 13).
• Darkening of the skin may be a sign of starvation (see p. 112).
• Bluish skin, especially blueness or darkness of the lips and fingernails, may mean
serious problems with breathing (p. 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. 311).
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.
It is important to find out when and how the fever comes, how
lasts, and how it goes away. This may help you identify the disease. Not
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.
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.
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Where There Is No Doctor 2010 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 you High Fever
stops marks the temperature. marks 4Q degrees Q
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
mouth shut)
or
in the armpit if there carefully, in the anus
is danger of biting or of a small child
the thermometer (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 unsually 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.
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32 Where There Is No Doctor 2010
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 illness breathe more quickly than
normal. For example, more than 30 shallow breaths a minute in an adult usually means
pneumonia, as does 60 breaths a minute for a newborn baby.
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.
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.
PULSE (HEARTBEAT)
To take the person’s pulse, If you cannot find the pulse in
put your fingers on the wrist the wrist, feel for it in the neck
as shown. (Do not use your beside the voicebox.
thumb to feel for the nulse.)
or put your ear directly or
the chest and listen for the
heartbeat (or use a stethoscope
if you have one).
NORMAL PULSE FOR PEOPLE AT REST
adults . ,
children
babies .
from 60 to 80 per minute
80 to 100
100 to 140
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Where There Is No Doctor 2010 33
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).
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 and color 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. If there is
a white glow, it can mean cataracts (see p. 225) or cancer.
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.
EYES
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34 Where There Is No Doctor 2010
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 (p. 112)
loss of eyebrows
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Where There Is No Doctor 2010 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 to Then, beginning on the opposite side from the spot
point with one finger where he has pointed, press gently on different
where it hurts. parts 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!
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36 Where There Is No Doctor 2010
These pictures show the areas of the belly that usually hurt when a person has the
following problems:
Gallbladder Liver
Urinary system
Note: For different causes of back pain see
Inflammation or
tumor of the ovaries,
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Where There Is No Doctor 2010 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 thickness of arms or legs.
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.
Have him squeeze your
fingers to compare strength
in his hands
and push and pull with his
feet against your hand.
Also have him hold his arms straight Have him he down and lift one leg
out and turn his hands up and down. and then the other.
Note any
weakness or
trembling.
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.
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38 Where There Is No Doctor 2010
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
• If a child always has some stiff muscles and I meningitis
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 seizures (p. 178). If seizures 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
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 pal
on the body is probably leprosy (p. 1
• Loss of feeling in both hands or feet r
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.
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).
you suspect tetanus, see p. 183.
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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 (see p. 75).
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.
Lukewarm
water
P't C— * i
A SICK PERSON SHOULD
BE BATHED EACH DAY
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40 Where There Is No Doctor 2010
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 11).
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
anemia p. 124
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
high blood pressure p. 125
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.
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Where There Is No Doctor 2010 41
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:
Also write down the amount of liquids the person drinks and
temperature pulse breathing
(how many degrees) (beats per minute) (breaths per minute)
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.
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42 Y Where There Is No Doctor 2009
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
18. 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
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Where There Is No Doctor 2010 43
WHEN AND HOWTO 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
underneath
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 3).
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.
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44 Where There Is No Doctor 2010
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?
How did it begin?
Has the person had the same problem before? When?
Is there fever? How 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:
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nespenan.org
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 all that is needed is to:
keep clean
get plenty of rest
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.
i iff <1 1 ifT
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46 Where There Is No Doctor 2010
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 water spoon. Washing
hands with soap and water after a bowel
movement (shitting) and before eating or
handling foods is also important.
P
R
E
V
E
N
T
I
O
N
T
R
E
A
T
M
E
N
T
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.
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Where There Is No Doctor 2010
47
Times When the Right Use of Water
May Do More Good than Medicines
PREVENTION
to help prevent
1 . diarrhea, worms,
gut infections
2. skin infections
use water see page
boil or filter drinking 135
water, wash hands,
etc.
bathe often 133
3. wounds becoming
infected; tetanus
wash wounds well
with soap and
clean water
84, 89
TREATMENT
to treat
1 . diarrhea,
dehydration
2. illnesses with fever
use water
drink plenty of liquids
drink plenty of liquids
3. high fever remove clothing 76
and soak body
with cool water
4. minor urinary drink plenty of water 235
infections
(common in women)
5. cough, asthma,
bronchitis,
pneumonia,
whooping cough
drink a lot of water 68
and breathe
hot water vapors
(to loosen mucus)
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48 Where There Is No Doctor 2010
to treat
6. sores, impetigo,
ringworm of skin
or scalp, cradle cap,
pimples
7. infected wounds,
abscesses, boils
8. stiff, sore muscles
and joints
9. strains and sprains
10. itching, burning,
or weeping irritations
of the skin
11. minor burns
12. sore throat or tonsillitis
13. acid, lye, dirt, or
irritating substance
in eye
14. stuffed up nose
15. constipation,
hard stools
16. cold sores or
fever blisters
use water
scrub with soap
and clean water
hot soaks
or compresses
hot compresses
the first day: soak
joint in cold water;
then use hot soaks
cold compresses
hold in cold water
at once
gargle with warm
salt water
flood eye with
cool water at once,
and continue for
30 minutes
sniff salt water
drink lots of water
(also, enemas are
safer than laxatives,
but do not overuse)
hold ice on blister
for 1 hr. at first sign
see page
201 , 202, 205,
211, 215
88 , 202
96
309
219
164
15, 126
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.
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49
Right and Wrong Uses
of Modern Medicines
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 parents 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.
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50 Where There Is No Doctor 2010
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. 356)
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), Ergonovine (Ergotrate), and Misoprostol
(Cytotec) (p. 390)
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. 350)
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. 358)
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.
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Where There Is No Doctor 2010 51
6. Anti-diarrhea medicines with hydroxyquinolines (Clioquinol,
di-iodohydroxyquinoline, halquinol, broxyquinoline: Diodoquin, Enteroquinol,
Amicline, Quogyl, and many other brand names) (p. 369)
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, Durabotin, Deca-Durabolin, Orabolin;
stanozolol, Cetabon; oxymetholone, Anapolon; ethylestrenol, Organaboral. 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, Butazolidiri)
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. 378) or ibuprofen (p. 379) is much safer and cheaper. For pain and fever only,
acetaminophen (p. 379) can be used.
10. Vitamin B 12 , liver extract, and iron injections (p. 392)
Vitamin B 12 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).
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52 Where There Is No Doctor 2010
1 1 . Other vitamins (p. 391 )
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 1 , especially pages 1 1 1 and 1 1 8.
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 unnecessary medicines.
Some medicines for HIV come in combination pills (see p. 397). This makes them
easier to take.
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)
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Where There Is No Doctor 2010 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 calcium it
needs from the lime.
14. ‘Feeding’ through the veins (Intravenous or ‘I.V.’ solutions)
In some areas, persons who are anemic or very weak spend their last penny to
have a liter of I.V. solution put into their veins. They believe that this will make them
stronger or their blood richer. But they are wrong! Intravenous solution is nothing
more than pure water with some salt or sugar in it. It gives less energy than a large
candy bar and makes the blood thinner, not richer. It does not help anemia or make
the weak person stronger.
Also when a person who is not well trained puts the I.V. solution into a vein, there
is danger of an infection entering the blood. This can kill the sick person.
Intravenous solution should be used only when a person can take nothing by
mouth, or when she is badly dehydrated (see p. 151).
If the sick person can swallow, give her a liter of water with sugar (or cereal)
and salt (see Rehydration Drink, p. 152). It will do as much for her as injecting
a liter of I.V. solution. For people who are able to eat, nutritious foods do more to
strengthen them than any type of I.V. fluid.
If a sick person is able to swallow and keep down liquids
IiT 4 k ifT ,
54 Where There Is No Doctor 2010
WHEN SHOULD MEDICINE NOT BE TAKEN?
Many people have beliefs about things they should not do or eat when taking
medicines. For this reason they may stop taking a medicine they need. In truth, no
medicine causes harm just because it is taken with certain foods — whether pork, chili
pepper, guava, oranges, or any other food. But foods with lots of grease or spices can
make problems of the stomach or gut worse — whether or not any medicine is being
taken (see p. 128). Certain medicines will cause bad reactions if a person drinks
alcohol (see metronidazole, p. 368).
There are situations when, without a doubt, it is best not to use certain medicines:
1 . Pregnant women or women who are breast feeding
should avoid all medicines that are not absolutely necessary.
(However, they can take limited amounts of vitamins or
iron pills without danger.) Also, pregnant or breast feeding
women with HIV should take medicines to prevent spreading
HIV to the baby, see p. 398.
2. With newborn children, be very careful when using
medicines. Whenever possible look for medical help before
giving them any type of medicine. Be sure not to give too
much.
3. A person who has ever had any sort of allergic reaction —
hives, itching, etc. — after taking penicillin, ampicillin, a
sulfonamide, or other medicines, should never use that
medicine again for the rest of his life because it would
be dangerous (see Dangerous reactions from injections of
certain medicines, p. 70).
4. Persons who have stomach ulcers or heartburn should
avoid medicines that contain aspirin. Most painkillers, and
all steroids (see p. 51) make ulcers and acid indigestion
worse. One painkiller that does not irritate the stomach is
acetaminophen (paracetamol, see p. 379).
5. There are specific medicines that are harmful or dangerous to take when you
have certain illnesses. For example, persons with hepatitis should not be treated
with antibiotics or other strong medicines, because their liver is damaged, and the
medicines are more likely to poison the body (see p. 172).
6. Persons who are dehydrated or have disease of the kidneys should be especially
careful with medicines they take. Do not give more than one does of a medicine that
could poison the body unless (or until) the person is urinating normally. For example,
if a child has high fever and is dehydrated (see p. 76), do not give him more than one
dose of acetaminophen or aspirin until he begins to urinate. Never give sulfa to a
person who is dehydrated.
WWW.
Hesperian.
rg
55
Antibiotics: What They Are
and How to Use Them
When used correctly, antibiotics are extremely useful and important medicines.
They fight certain infections and diseases caused by bacteria. Well-known antibiotics
are penicillin, tetracycline, streptomycin, chloramphenicol, and the sulfa drugs, or
sulfonamides.
The different antibiotics work in different ways against specific infections.
All antibiotics have dangers in their use, but some are far more dangerous than
others. Take great care in choosing and using antibiotics.
There are many kinds of antibiotics, and each kind is sold under several ‘brand
names’ This can be confusing. However, the most important antibiotics fall into a few
major groups:
antibiotic group
examples of
brand names
see
(generic name)
brand names
in your area
page
(write in)
PENICILLINS
Pen-V-K
350
AMPICILLINS*
Penbritin
352
TETRACYCLINES
Terramycin
355
SULFAS (SULFONAMIDES)
Gantrisin
357
COTRIMOXAZOLE
Bactrim
357
STREPTOMYCIN, etc.
Ambistryn
353, 361
CHLORAMPHENICOL
Chloromycetin
356
ERYTHROMYCIN
Erythrocin
354
CEPHALOSPORINS
Keflex
358
*Note: Ampicillin is a type of penicillin that kills more kinds of bacteria than do
ordinary penicillins.
CHAPTER
7
If you have a brand-name antibiotic and do not know to which group it belongs,
read the fine print on the bottle or box. For example, if you have some Paraxin 'S' but
do not know what is in it, read the fine print. It says
‘chloramphenicol’.
Each capsule contains
Chloramphenicol . . . 250 mg.
Look up chloramphenicol in the GREEN PAGES
(p. 356). You will find it must be used only for a
few very serious illnesses, like typhoid, and is
especially dangerous when given to the newborn.
Never use an antibiotic unless you know to what group it belongs, what
diseases it fights, and the precautions you must take to use it safely.
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56 Where There Is No Doctor 2010
Information on the uses, dosage, risks, and precautions for the antibiotics
recommended in this book can be found in the GREEN PAGES. Look for the name of
medicine in the alphabetical list at the beginning of those pages.
GUIDELINES FOR THE USE OF ALL ANTIBIOTICS
1 . If you do not know exactly how to use the antibiotic and what infections it can be
used for, do not use it.
2. Use only an antibiotic that is recommended for the infection you wish to treat.
(Look for the illness in this book.)
3. Know the risks in using the antibiotic and take all the recommended precautions
(see the GREEN PAGES).
4. Use the antibiotic only in the recommended does — no more, no less. The does
depends on the illness and the age or weight of the sick person.
5. Never use injections of antibiotics if taking them by mouth is likely to work as
well. Inject only when absolutely necessary.
6. Keep using the antibiotics until the illness is completely cured, or for at least
2 days after the fever and other signs of infection have gone. (Some illnesses, like
tuberculosis and leprosy, need to be treated for many months or years after the person
feels better. Follow the instructions for each illness.)
7. If the antibiotic causes a skin rash, itching, difficult breathing, or any serious
reactions, the person must stop using it and never use it again (see p. 70).
8. Only use antibiotics when the need is great. When antibiotics are used too
much they begin not to work as well.
GUIDELINES FOR THE USE OF CERTAIN ANTIBIOTICS
1. Before you inject penicillin or ampicillin, always have ready ampules of Adrenalin
(epinephrine) to control an allergic reaction if one occurs (p. 70).
2. For persons who are allergic to penicillin, use another antibiotic such as
erythromycin or a sulfa (see p. 354 and 357).
3. Do not use tetracycline, ampicillin, or another broad-spectrum antibiotic for an
illness that can probably be controlled with penicillin or another narrow-spectrum
antibiotic (see p. 58). Broad-spectrum antibiotics attack many more kinds of bacteria
than narrow-spectrum antibiotics.
4. As a rule, use chloramphenicol only for certain severe or life-threatening illnesses
like typhoid. It is a dangerous drug. Never use it for mild illness. And never give it to
newborn children (except perhaps for whooping cough, p. 313).
5. Never inject tetracycline or chloramphenicol. They are safer, less painful, and do
as much or more good when taken by mouth.
6. Do not give tetracycline to pregnant women or to children under 8 years old. It
can damage new teeth and bones (see p. 355).
www.nesperian.org
Where There Is No Doctor 2010 57
7. As a general rule, use streptomycin, and products that contain it, only for
tuberculosis — and always together with other anti-tuberculosis medicines (see
p. 361). Streptomycin in combination with penicillin can be used for deep wounds to
the gut, appendicitis, and other specific infections when ampicillin is not available
(or is too costly), but should never be used for colds, flu, and common respiratory
infections.
8. All medicines in the streptomycin group (including kanamycin and gentamicin)
are quite toxic (poisonous). Too often they are prescribed for mild infections where
they may do more harm than good. Use only for certain very serious infections for
which these medicines are recommended.
9. Eating yogurt or curdled milk helps to replace necessary bacteria killed by
antibiotics like ampicillin and to return the body’s natural balance to normal (see
next page).
WHAT TO DO IF AN ANTIBIOTIC DOES NOT SEEM TO HELP
For most common infections antibiotics begin to bring improvement in a day or
two. If the antibiotic you are using does not seem to help, it is possible that:
1 . The illness is not what you think. You may be using the wrong medicine. Try to
find out more exactly what the illness is — and use the right medicine.
2. The dose of the antibiotic is not correct. Check it.
3. The bacteria have become resistant to this antibiotic (they no longer are
harmed by it). Try another one of the antibiotics recommended for that illness.
4. You may not know enough to cure the illness. Get medical help, especially if
the condition is serious or getting worse.
These three children had a cold...
What was
the villain?
What took
the toll?
Why did this child
get well again?
He got no
risky medicine —
Penicillin!
(see Allergic
Shock, p. 70)
Chloramphenicol !
(see risks and precautions
for this drug, p. 356)
just fruit juice,
good food, and rest.
Antibiotics do no good for the common cold.
Use antibiotics only for infections they are known to help.
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58 Where There Is No Doctor 2010
IMPORTANCE OF LIMITED USE OF ANTIBIOTICS
The use of all medicines should be limited. But this is especially true of antibiotics,
for the following reasons:
1. Poisoning and reactions. Antibiotics not only kill bacteria, they can also harm
the body, either by poisoning it or by causing allergic reactions. Many people die each
year because they take antibiotics they do not need.
2. Upsetting the natural balance. Not all bacteria in the body are harmful. Some
are necessary for the body to function normally. Antibiotics often kill the good bacteria
along with the harmful ones. Babies who are given antibiotics sometimes develop
fungus or yeast infections of the mouth (thrush, p. 232) or skin (moniliasis, p. 242). This
is because the antibiotics kill the bacteria that help keep fungus under control.
For similar reasons, persons who take ampicillin and other broad-spectrum
antibiotics for several days may develop diarrhea. Antibiotics may kill some kinds of
bacteria necessary for digestion, upsetting the natural balance of bacteria in the gut.
3. Resistance to treatment. In the long run, the most important reason the use
of antibiotics should be limited, is that WHEN ANTIBIOTICS ARE USED TOO MUCH,
THEY BECOME LESS EFFECTIVE.
When attacked many times by the same antibiotic, bacteria become stronger and
are no longer killed by it. They become resistant to the antibiotic. For this reason,
certain dangerous diseases like typhoid are becoming more difficult to treat than they
were a few years ago.
In some places typhoid has become resistant to chloramphenicol, normally the
best medicine for treating it. Chloramphenicol has been used far too much for minor
infections, infections for which other antibiotics would be safer and work as well, or for
which no antibiotic at all is needed.
Throughout the world important diseases are becoming resistant to antibiotics —
largely because antibiotics are used too much for minor infections. If antibiotics
are to continue to save lives, their use must be much more limited than it is at
present. This will depend on their wise use by doctors, health workers, and the people
themselves.
For most minor infections antibiotics are not needed and should not be used.
Minor skin infections can usually be successfully treated with mild soap and water, or
hot soaks, and perhaps painting them with gentian violet (p. 370). Minor respiratory
infections are best treated by drinking lots of liquids, eating good food, and getting
plenty of rest. For most diarrheas, antibiotics are not necessary and may even be
harmful. What is most important is to drink lots of liquids (p. 155), and provide enough
food as soon as the child will eat.
Do not use antibiotics for infections the body can fight successfully
by itself. Save them for when they are most needed.
For more information on learning to use antibiotics sensibly, see Helping Health
Workers Learn, Chapter 19.
www.nesperian.org
How to Measure
and Give Medicine
CHAPTER
59
SYMBOLS:
= means: is equal to or
is the same as
+ means: and or plus
1 + 1=2
One plus one equals two.
HOW FRACTIONS ARE SOMETIMES WRITTEN:
1 tablet = one whole tablet =
1/2 tablet = half of a tablet =
1 1/2 tablet = one and one-half tablets =
1/4 tablet = one quarter
or of a tablet =
one-fourth
1/8 tablet = one-eighth of a tablet (dividing it
into 8 equal pieces and taking 1 piece) =
MEASURING
Medicine is usually weighed in grams (gm.) and milligrams (mg.).
1000 mg. = 1 gm. (one thousand milligrams make one gram)
1 mg. = .001 gm. (one milligram is one one-thousandth part of a gram)
Examples:
One adult aspirin
tablet contains
300 milligrams
of aspirin.
.3 gm.
0.3 gm.
0.300 gm
300 mg.
All these are
different ways
of saying 300
milligrams.
One baby aspirin .075 gm.
contains 75 milligrams 0.075 gm.
of aspirin. 75.0 mg.
75 mg.
All these are
different ways
of saying 75
milligrams.
Note: In some countries some medicines are still weighed in grains; gr. = grain and
1 gr. = 65 mg. This means a 5 gr. aspirin tablet weighs about 300 mg.
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60 Where There Is No Doctor 2010
Many times it is important to know how many grams or milligrams are in a
medicine.
For example, if you want to give a small piece of adult aspirin to a child, instead of
baby aspirin, but you do not know how big a piece to give...
|
^Aspirin ?
read the small print on the labels of each.
It says: aspirin: acetylsalicylic acid .3 gm.
(acetylsalicylic acid = aspirin)
.3 gm. = 300 mg. and .075 gm. = 75 mg. So, you can see that one adult aspirin
<§>
weighs 4
times
75
mg.
&
75
mg.
&
75
mg.
75
mg.
Csi
4 baby aspirin
add up to
If you cut the adult aspirin
into 4 equal pieces,
each quarter = one baby aspirin
300 mg.
1 regular aspirin
Q - ©
So if you cut an adult aspirin into 4 pieces, you can give the child 1 piece in place of
a baby aspirin. Both are equal, and the piece of adult aspirin costs less.
CAUTION: Many medicines, especially the antibiotics, come in different weights and
sizes. For example, tetracycline may come in 3 sizes of capsules:
CD
250 mg. (~J 100 mg. ( IP so
mg.
Be careful to only give medicine in the recommended amounts. It is very
important to check how many grams or milligrams the medicine contains.
For example: if the prescription says: Take tetracycline, 1 capsule of 250 mg. 4 times a
day, and you have only 50 mg. capsules, you have to take five 50 mg. capsules 4 times
a day (20 capsules a day).
50 mg. + 50 mg. + 50 mg. + 50 mg. + 50 mg. = 250 mg.
CD + CD + CD + CD + CD= ( | )
MEASURING PENICILLIN
Penicillin is often measured in units.
U. = unit 1,600,000 U. = 1 gm. or 1,000 mg.
Many forms of penicillin (pills and injections) come in doses of 400,000 U.
400,000 U. = 250 mg.
www. nespenan.org
Where There Is No Doctor 2010 61
MEDICINE IN LIQUID FORM
Syrups, suspensions, tonics, and other liquid medicines are measured in
milliliters:
ml. = milliliter 1 liter = 1000 ml.
Often liquid medicines are prescribed in tablespoons or teaspoons:
1 teaspoon (tsp.) = 5 ml. 1 tablespoon (Tbs.) = 15 ml.
When instructions for a medicine say: Take 1 tsp., this means take 5 ml.
Many of the ‘teaspoons’ people use hold as much as 8 ml. or as little as 3 m.
When using a teaspoon to give medicine, it is important that it measure 5 ml. —
No more. No less.
How to Make Sure that the Teaspoon Used
for Medicine Measures 5 ml.
1. Buy a 5 ml.
measuring spoon.
or
WORK AWAY
2. Buy a medicine that comes with a plastic spoon. This
measures 5 ml. when it is full and may also have a line
that shows when it is half full (2.5 ml.). Save this spoon
and use it to measure other medicines.
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62 Where There Is No Doctor 2010
HOW TO GIVE MEDICINES TO SMALL CHILDREN
Many medicines that come as pills or capsules also come in syrups or suspensions
(special liquid form) for children. If you compare the amount of medicine you get, the
syrups are usually more expensive than pills or capsules. You can save money by
making your own syrup in the following way:
Grind up the
or open the capsule
and mix the
powder with
boiled water
(that has cooled)
and sugar or
honey.
sugar
or
honey
cool boiled
water
You must add lots of sugar or honey
when the medicine is very bitter
(tetracycline or chloroquine).
When making syrups for children from pills or capsules, be very careful not to give
too much medicine. Also, do not give honey to babies under 1 year of age. Though
it is rare, some babies can have a dangerous reaction.
CAUTION: To prevent choking, do not give medicines to a child while she is lying on
her back, or if her head is pressed back. Always make sure she is sitting up or that her
head is lifted forward. Never give medicines by mouth to a child while she is having a
fit, or while she is asleep or unconscious.
HOW MUCH MEDICINE SHOULD YOU GIVE TO CHILDREN
WHEN YOU ONLY HAVE THE INSTRUCTIONS FOR ADULTS?
Generally, the smaller the child, the less medicine he needs. Giving more than
needed can be dangerous. If you have information about the doses for children, follow
it carefully. If you do not know the dose, figure it out by using the weight or age of the
child. Children should generally be given the following portions of the adult dose:
Adults:
132 lbs.
Children
8 to 13 years:
1/2 dose
66 lbs.
Children
4 to 7 years:
1/4 dose
33 lbs.
Children
1 to 3 years:
1/8 dose
17.6 lbs.
Give a child under
1 year old the
dose for a child
of 1 year, but ask
medical advice
when possible.
11 lbs.
1 kilogram (kg.) = 2.2 pounds (lb.)
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Where There Is No Doctor 2010 63
HOW TO TAKE MEDICINES
It is important to take medicines more or less at the time
recommended. Some medicines should be taken only once a
day, but others must be taken more often. If you do not have a
clock, it does not matter. If the directions say ‘1 pill every
8 hours’, take 3 a day: one in the morning, one in the
afternoon, and one at night. If they say ‘1 pill every 6 hours',
take 4 each day: one in the morning, one at midday, one in
the afternoon, and one at night. If the directions are ‘1 every
4 hours', take 6 a day, allowing more or less the same time between pills.
Whenever you give a medicine to someone else, it is a good idea to write the
instructions and also to have the person repeat to you how and when to take the
medicine. Make very sure he understands.
To remind people who cannot read
when to take their medicine, you can
give them a note like this
In the blanks at the bottom draw the
amount of medicine they should take and
carefully explain what it means.
For example:
This means 1 tablet 4 times a day, 1
at sunrise, 1 at noon, 1 at sunset, and
1 in the middle of the night.
o
tO-
o o
This means 1/2 tablet 4 times a day.
This means 1 capsule 3 times a day.
\ / -
~o-
i \
\l 1/
f>
m
CD
1
LLJ
This means 1/4 tablet twice a day.
'9- :
)
a
This means 2 teaspoons twice a day.
w w w. hespenan.org
64 Where There Is No Doctor 2010
WHEN YOU GIVE MEDICINES
TO ANYONE . . .
Always write all the following information
on the note with the medicine — even if the
person cannot read:
• the person’s name ►
• the name of the medicine ►
• what it is for ►
• the dosage ►
*|
PI
B
°o
Name:
7o!r\r\r\y
…[truncated]