Document text
Where There Is No Doctor
a viCCaat heeded cart handbook
-revised edition
%
Vavld Werner
mcfi
Carol Thuman and Jane MaxwdC
mtfv drawings hy David Werner
Compiled by noonya
Library of Congress Cataloging-in-Publication Data
Werner, David, 1934-
Where there is no doctor: a village health care
handbook / by David Werner; with Caro! Thuman and
Jane Maxwell. — Rev. ed.
Includes Index.
ISBN 0-942364-15-5
1. Medicine, Popular. 2. Rural health. I. Thuman, Carol,
1959- . II. Maxwell, Jane, 1941- . III. Title.
[DNLM: 1. Community Health Aides — handbooks.
2. Medicine — popular works. 3. Rural Health — handbooks.
WA 39 W492w]
RC81.W4813 1992 610— dc20
DNLM/DLC 92-1539
for Library of Congress CIP
Published by:
The Hesperian Foundation
1919 Addison St., #304
Berkeley, California 94704
United States of America
Copyright© 1992 by the Hesperian Foundation
First English edition: October 1977
Revised English edition: May 1992
Seventh printing, June 2003
The original English version of this book was produced in 1977 as a revised
translation of the Spanish edition, Donde no hay doctor.
The Hesperian Foundation encourages others to copy, reproduce, or adapt
to meet local needs, any or all parts of this book, including the illustrations,
provided the parts reproduced are distributed free or at cost — not for profit.
Any organization or person who wishes to copy, reproduce, or adapt any or
all parts of this book for commercial purposes, must first obtain permission to
do so from the Hesperian Foundation.
Please contact the Hesperian Foundation before beginning any translation
or adaptation to avoid duplication of efforts, and for suggestions about
adapting the information in this book. The Foundation would appreciate receiving
a copy of any materials in which text or illustrations from this book have been used.
THIS REVISED EDITION CAN BE IMPROVED WITH YOUR HELP.
If you are a village health worker, doctor, mother, or anyone with
ideas or suggestions for ways this book could be changed to better
meet the needs of your people, please write to the Hesperian
Foundation at the above address. Thank you for your help.
OTHER BOOKS FROM THE HESPERIAN FOUNDATION
Where Women Have No Doctor, by A. August Burns, Ronnie Lovich, Jane
Maxwell and Katharine Shapiro, combines self-help medical information with
an understanding of the ways poverty, discrimination, and cultural beliefs limit
women's health and access to care. Clearly written and with over 1000
drawings, this book is an essential resource for any woman who wants to
improve her health, and for health workers who want more information about
the problems that affect only women, or that affect women differently from
men. 584 pages.
A Book for Midwives, by Susan Klein, is written for midwives, traditional birth
attendants, community health workers and anyone concerned about the health
of pregnant women and their babies. The book is an invaluable tool for
midwives facilitating education and training sessions as well as an essential
reference for practice. The author emphasizes helping pregnant women stay
healthy; giving good care and dealing with complications during labor,
childbirth and after birth; family planning; breastfeeding; and homemade, low-
cost equipment. 528 pages.
Where There Is No Dentist, by Murray Dickson, shows people how to care for
their own teeth and gums, and how to prevent tooth and gum problems.
Emphasis is placed on sharing this knowledge in the home, community, and
school. The author also gives detailed and well-illustrated information on using
dental equipment, placing fillings, taking out teeth, and suggests ways to teach
dental hygiene and nutrition. 208 pages.
Disabled Village Children, by David Werner, contains a wealth of information
about most common- disabilities of children, including, polio, xerebral palsy,
juvenile arthritis, blindness, and deafness. The author gives suggestions for
simplified rehabilitation at the village level and explains how to make a variety
of appropriate low-cost aids. Emphasis is placed on how to help disabled
children find a role and be accepted in the community. 672 pages.
Helping Health Workers Learn, by David Werner and Bill Bower, is an
indispensable resource for anyone involved in teaching about health. This
heavily illustrated book shows how to make health education fun and effective.
Includes activities for mothers and children; pointers for using theater, flannel-
boards, and other techniques; and many ideas for producing low-cost teaching
aids. Emphasizing a people-centered approach to health care, it presents
strategies for effective community involvement through participatory education.
640 pages.
Helping Children Who Are Blind, by Sandy Niemann and Namita Jacob, aids
parents and other caregivers in helping blind children from birth through age 5
develop all their capabilities. Topics include: assessing how much a child can
see, preventing blindness, moving around safely, teaching common activities,
and many others. 192 pages.
All titles are available from Hesperian in both English and Spanish. For information regarding other
language editions, prices and ordering information, or for a brochure describing the Foundation's work,
please write to us:
The Hesperian Foundation
1919 Addison, St., #304
Berkeley, California 94704 USA
Telephone: (510) 845-4507
Fax: (510) 845-0539
e-mail: [email protected]
Visit our website: www.hesperian.org
Where l~here Is No Docfor
is more than a book on first aid. It covers a wide range of things that affect the
health of the villager — from diarrhea to tuberculosis, from helpful and harmful
home remedies to the cautious use of certain modern medicines. Special
importance is placed on cleanliness, a healthy diet, and vaccinations. The book
also covers in detail both childbirth and family planning. Not only does it help
readers realize what they can do for themselves, but it helps them recognize
which problems need the attention of an experienced health worker. This new
revised edition includes information about some additional health problems —
AIDS, dengue, complications from abortion, drug addiction, among many
others — and updated advice on topics covered in the first edition.
THIS BOOK IS FOR . . .
THE VILLAGER who lives far from medical
^ centers. It explains in simple words and
drawings what he can do to prevent, recognize,
and treat many common sicknesses.
THE VILLAGE STOREKEEPER OR PHARMACIST
who sells medicines and health-care supplies. The
book explains which medicines are most useful for
specific sicknesses and warns against ones that are
useless or dangerous. Risks and precautions are
carefully explained. Guidelines are given for the
sensible use of both traditional and modern medicines.
THE TEACHER in a rural school. The book will help
him give practical advice and care to the sick
and injured. It also gives guidelines for teaching
children and adults in his community about the
problems of health, cleanliness, and nutrition.
THE VILLAGE HEALTH WORKER, or anyone who
is concerned about the health and well-being
of those in her community. An introductory
section for the village health worker
discusses ways to determine needs, share
knowledge, and involve the community in
activities that can better people’s health.
MOTHERS AND MIDWIVES will find useful
the clear, easy-to-understand information
for home birth, care of the mother, and child health. ISBN □ TM23L4 15 5
THANKS
This revision of Where There Is No Doctor has been a cooperative effort. We thank the
many users of the book around the world who have written us over the years with
comments and suggestions — these have guided us in updating this information.
David Werner is the author of the original Spanish and English versions of the book.
His vision, caring, and commitment are present on every page. Carol Thuman and Jane
Maxwell, share credit for most of the research, 'writing, and preparation of this revised
version. We are deeply grateful for their excellent and very careful work.
Thanks also to others who researched portions of this revised edition: Suellen Miller,
Susan Klein, Ronnie Lovich, Mary Ellen Guroy, Shelley Kahane, Paula Elster, and George
Kent. For information taken from the African edition, our thanks to Andrew Pearson and
the other authors at Macmillan Publishers.
Many doctors and health care specialists from around the world generously reviewed
portions of the book. We cannot list them all here, but the help of the following was
exceptional: David Sanders, Richard Laing, Bill Bower, Greg Troll, Deborah Bickel, Tom
Frieden, Jane Zucker, David Morley, Frank Catchpool, Lonny Shavelson, Rudolph Bock,
Joseph Cook, Sadja Greenwood, Victoria Sheffield, Sherry Hilaski, Pam Zinkin, Fernando
Viteri, Jordan Tapero, Robert Gelber, Ted Greiner, Stephen Gloyd, Barbara Mintzes,
Rainer Arnhold, Michael Tan, Brian Linde, Davida Coady, and Alejandro de Avila. Their
expert advice and help have been of great value.
We warmly thank the dedicated members of the Hesperian Foundation for their help
in preparing the manuscript: Kyle Craven for computer graphic arts and layout, Stephen
Babb and Cynthia Roat for computer graphics, and Lisa de Avila for editorial assistance.
We are also grateful to many others who helped in this book’s preparation: Kathy
Alberts, Mary Klein, Evan Winslow-Smith, Jane Bavelas, Kim Gannon, Heidi Park, Laura
Gibney, Nancy Ogaz, Martin Bustos, Karen Woodbury, and Trude Bock. Our special
thanks to Keith and Luella McFarland for being there when we needed them most.
For help updating this book, we thank Manisha Aryal, Marcos Burgos, Todd Jailer, Erika
Leemann, Malcolm Lowe, Jane Maxwell, Susan McCallister, Gail McSweeney, Elena Metcalf,
Christine Sienkiewicz, Lora Santiago, Peter Small, Melissa Smith, Fred Strauss, Fiona Thomson,
Kathleen Vickery, and Sarah Wallis.
Artwork for the new edition was created by David Werner, Kyle Craven, Susan Klein,
Regina Faul-Jansen, and Sandy Frank. We also thank the following persons and groups
for permission to use their artwork: Dale Crosby, Carl Werner, Macmillan Publishers (for
some of Felicity Shepherd’s drawings in the African edition of this book), the “New
Internationalist” (for the picture of the VIP latrine), James Ogwang (for the drawings on
page 417) and McGraw-Hill Book Company (for drawings appearing on pages 85 and
104 taken from Emergency Medical Guide by John Henderson, illustrated by Niel Hardy).
The fine work of those who helped in the creation of the original version is still
reflected on nearly every page. Our thanks to Val Price, Al Hotti, Rodney Kendall, Max
Capestany, Rudolf Bock, Kent Benedict, Alfonzo Darricades, Carlos Felipe Soto Miller,
Paul Quintana, David Morley, Bill Bower, Allison Orozco, Susan Klein, Greg Troll, Carol
Westburg, Lynn Gordon, Myra Polinger, Trude Bock, Roger Bunch, Lynne Coen, George
Kent, Jack May, Oliver Bock, Bill Gonda, Ray Bleicher, and Jesds Manjarrez.
For this new edition, we are grateful for financial support from the Carnegie
Corporation, Gladys and Merrill Muttart Foundation, Myra Polinger, the Public Welfare
Foundation, Misereor, the W.K. Kellogg Foundation, the Sunflower Foundation, and the
Edna McConnell Clark Foundation.
Finally, our warm thanks to the village health workers of Project Piaxtla in rural Mexico
— especially Martin Reyes, Miguel Angel Manjarrez, Miguel Angel Alvarez, and Roberto
Fajardo— whose experience and commitment have provided the foundation for this book.
CONTENTS
A list of what is discussed in each chapter
INTRODUCTION
NOTE ABOUT THIS NEW EDITION
Health Needs and Human Needs w2
Many Things Relate to Health Care w7
Take a Good Look at Your Community w8
Using Local Resources to Meet Needs w12
Deciding What to Do and Where to
Begin w13
Trying a New Idea w15
A Balance Between People and Land w16
wl
A Balance Between Prevention and
Treatment w17
Sensible and Limited Use of Medicines w18
Finding Out What Progress Has Been
Made w20
Teaching and Learning Together w21
Tools for Teaching w22
Making the Best Use of This Book w28
WORDS TO THE VILLAGE HEALTH WORKER (Brown Pages)
Chapter 1
HOME CURES AND POPULAR BELIEFS
Home Cures That Help 1
Beliefs That Can Make People Well 2
Beliefs That Can Make People Sick 4
Witchcraft — Black Magic — and the Evil Eye 5
_Questions_and Answers 6
Sunken Fontanel or Soft Spot 9
_L
Ways to Tell Whether a Home Remedy
Works or Not 10
Medicinal Plants 12
Homemade Casts — for Broken Bones 14
Enemas, Laxatives, and Purges 15
Chapter 2
SICKNESSES THAT ARE OFTEN CONFUSED 17
Examples of Local Names for Sicknesses 22
Misunderstandings Due to Confusion of
Names 25
Confusion between Different Illnesses That
Cause Fever 26
Chapter 3
HOW TO EXAMINE A SICK PERSON 29
Questions 29
Eyes 33
General Condition of Health
30
Ears 34
Temperature 30
Skin 34
How to Use a Thermometer
31
The Belly (Abdomen)
35
Breathing (Respiration) 32
Muscles and Nerves
37
Pulse (Heartbeat) 32
What Causes Sickness? 17
Different Kinds of Sicknesses and Their
Causes 18
Non-infectious Diseases 18
Infectious Diseases 19
Sicknesses That Are Hard to Tell Apart 20
Chapter 4
HOW TO TAKE CARE OF A SICK PERSON
39
The Comfort of the Sick Person 39
Special Care for a Person Who Is Very ill 40
Liquids 40
Food 41
Cleanliness and Changing Position in Bed 41
Chapter 5
HEALING WITHOUT MEDICINES .
Healing with Water 46
When Water Is Better than Medicines 47
Watching for Changes 41
Signs of Dangerous Illness 42
When and How to Look for Medical Help 43
What to Tell the Health Worker 43
Patient Report 44
45
Chapter 6
RIGHT AND WRONG USE OF MODERN MEDICINES 49
Guidelines for the Use of Medicine 49 When Should Medicine Not Be Taken? 54
The Most Dangerous Misuse of Medicine 50
Chapter 7
ANTIBIOTICS: WHAT THEY ARE AND HOW TO USE THEM 55
Guidelines for the Use of Antibiotics 56
What to Do if an Antibiotic Does' Not Seem to Help 57
Importance of Limited Use of Antibiotics 58
Chapter 8
HOW TO MEASURE AND GIVE MEDICINE
Medicine in Liquid Form 61
How to Give Medicines to Small Children 62
How to Take Medicines 63
Chapter 9
When to Inject and When Not To 65
Emergencies When It Is Important to Give
Injections 66
Medicines Not to Inject 67
Risks and Precautions 68
Dangerous Reactions From Injecting Certain
Medicines 70
59.
Dosage Instructions for Persons Who
Cannot Read 63
65
Avoiding Serious Reactions to Penicillin 71
How to Prepare a Syringe for Injection 72
How to Inject 73
How Injections Can Disable Children 74
How to Sterilize Equipment 74
INSTRUCTIONS AND PRECAUTIONS FOR INJECTIONS
Chapter 10
FIRST AID
75
Fever 75
Shock 77
Loss of Consciousness 78
When Something Gets Stuck in the
Throat 79
Drowning 79
When Breathing Stops: Mouth-to-Mouth
Breathing 80
Emergencies Caused by Heat 81
How to Control Bleeding from a Wound 82
How to Stop Nosebleeds 83
Cuts, Scrapes, and Small Wounds 84
Large Cuts: How to Close Them 85
Bandages 87
Infected Wounds 88
Bullet, Knife, and Other Serious Wounds 90
Emergency Problems of the Gut
(Acute Abdomen) 93
Appendicitis, Peritonitis 94
Burns 96
Broken Bones (Fractures) 98
How to Move a Badly Injured Person 100
Dislocations
(Bones out of Place at a Joint) 101
Strains and Sprains 102
Poisoning 103
Snakebite 104
Other Poisonous Bites and Stings 106
Chapter 11
NUTRITION: WHAT TO EAT TO BE HEALTHY
Sicknesses Caused by Not Eating Well 107
Why It Is Important to Eat Right 109
Preventing Malnutrition 109
Main Foods and Helper Foods 110
Eating Right to Stay Healthy 111
HowTo Recognize Malnutrition 112
Eating Better When You Do Not Have Much
Money or Land 115
Where to Get Vitamins: In Pills or
in Foods? 118
Things to Avoid in Our Diet 119
The Best Diet for Small Children 120
Harmful Ideas about Diet 123
Chapter 12
Cleanliness— and Problems from Lack of
Cleanliness 131
Basic Guidelines of Cleanliness 133
Sanitation and Latrines 137
Worms and Other Intestinal Parasites 140
Roundworm (Ascaris) 140
Pinworm (Threadworm, Enterobius) 141
Whipworm (Trichuris) 142
Hookworm 142
Tapeworm 143
107
Special Diets for Specific Health
Problems 124
Anemia 124
Rickets 125
High Blood Pressure 125
Fat People- J26
Constipation 126
Diabetes 127
Acid Indigestion, Heartburn, and Stomach
Ulcers 128
Goiter
(A Swelling or Lump on the Throat) 1 30
131
Trichinosis 144
Amebas 144
Giardia 145
Blood Flukes
(Schistosomiasis, Bilharzia) 146
Vaccinations (Immunizations) — Simple, Sure
Protection 147
Other Ways to Prevent Sickness and Injury 148
Habits That Affect Health 1 48
PREVENTION: HOW TO AVOID MANY SICKNESSES
Chapter 13
SOME VERY COMMON SICKNESSES
151
Dehydration 151
Diarrhea and Dysentery 153
The Care of a Person with Acute Diarrhea 160
Vomiting 161
Headaches and Migraines 162
Colds and the Flu 163
Stuffy and Runny Noses 164
Sinus Trouble (Sinusitis) 165
Hay Fever (Allergic Rhinitis) 165
Allergic Reactions 166
Asthma 167
Cough 168
Bronchitis 170
Pneumonia 171
Hepatitis 172
Arthritis (Painful, Inflamed Joints) 173
Back Pain 173
Varicose Veins 175
Piles (Hemorrhoids) 175
Swelling of the Feet and Other Parts of the
Body 176
Hernia (Rupture) 177
Fits (Convulsions) 178
Chapter 14
SERIOUS ILLNESSES THAT NEED SPECIAL MEDICAL ATTENTION
Tuberculosis (TB, Consumption) 179
Rabies 181
Tetanus (Lockjaw) 182
Meningitis 185
Malaria 186
Chapter 15
SKIN PROBLEMS
General Rules for Treating Skin Problems 193
Instructions for Using Hot Compresses 195
Identifying Skin Problems 196
Scabies 199
Lice 200
Bedbugs 200
Ticks and Chiggers 201
Small Sores with Pus 201
Impetigo 202
Boils and Abscesses 202
Itching Rash, Welts, or Hives 203
Things That Cause Itching or Burning of the
Skin 204
Shingles (Herpes Zoster) 204
Ringworm, Tinea (Fungus Infections) 205
White Spots on the Face and Body 206
Mask of Pregnancy 207
Pellagra and Other Skin Problems Due to
Malnutrition 208
- • ■ 179
Dengue (Breakbone Fever, Dandy
Fever) 187
Brucellosis (Undulant Fever, Malta Fever) 188
Typhoid Fever 188
Typhus 190
Leprosy (Hansen's Disease) 191
193
Warts (Verrucae) 210
Corns 210
Pimples and Blackheads (Acne) 211
Cancer of the Skin 211
Tuberculosis of the Skin or Lymph
Nodes 212
Erysipelas and Cellulitis 212
Gangrene (Gas Gangrene) 213
Ulcers of the Skin Caused by Poor
Circulation 213
Bed Sores 214
Skin Problems of Babies 215
Eczema
(Red Patches with Little Blisters) 216
Psoriasis 216
Chapter 16
THE EYES
Danger Signs 217
Injuries to the Eye 218
How to Remove a Speck of Dirt from the
Eye 218
Chemical Burns of the Eye 219
Red, Painful Eyes — Different Causes 219
'Pink Eye’ (Conjunctivitis) 219
Trachoma 220
Infected Eyes in Newborn Babies
(Neonatal Conjunctivitis) 221
Iritis (Inflammation of the Iris) 221
Glaucoma 222
Infection of the Tear Sac
(Dacryocystitis) 223
Chapter 17
THE TEETH, GUMS, AND MOUTH
Care of Teeth and Gums 229
If You Do Not Have A Toothbrush 230
Toothaches and Abscesses 231
Pyorrhea, a Disease of the Gums 231
217
Trouble Seeing Clearly 223
Cross-Eyes and Wandering Eyes 223
Sty (Hordeolum) 224
Pterygium 224
A Scrape, Ulcer, or Scar on the Cornea 224
Bleeding in the White of the Eye 225
Bleeding behind the Cornea (Hyphema) 225
Pus behind the Cornea (Hypopyon) 225
Cataract 225
Night Blindness and Xerophthalmia 226
Spots or 'Flies’ before the Eyes 227
Double Vision 227
River Blindness (Onchocerciasis) 227
229
Sores or Cracks at the Corners of the
Mouth 232
White Patches or Spots in the Mouth 232
Cold Sores and Fever Blisters 232
Chapter 18
THE URINARY SYSTEM AND THE GENITALS 233
Urinary Tract Infections 234
Kidney or Bladder Stones 235
Enlarged Prostate Gland 235
Diseases Spread by Sexual Contact
(Sexually Transmitted Diseases) 236
Gonorrhea (Clap, VD, the Drip) and
Chlamydia 236
Syphilis 237
Bubos: Bursting Lymph Nodes in the
Groin 238
Use of a Catheter to Drain Urine 239
Problems of Women 241
Vaginal Discharge 241
How a Woman Can Avoid Many
Infections 242
Pain or Discomfort in a Woman's Belly 243
Men and Women Who Cannot Have Children
(Infertility) 244
Chapter 19
INFORMATION FOR MOTHERS AND MIDWIVES
The Menstrual Period
(Monthly Bleeding in Women) 245
The Menopause
(When Women Stop Having Periods) 246
Pregnancy 247
245
How to Stay Healthy during Pregnancy 247
Minor Problems during Pregnancy 248
Danger Signs in Pregnancy 249
Check-ups during Pregnancy
(Prenatal Care) 250
Record of Prenatal Care 253
Things to Have Ready before the Birth 254
Preparing for Birth 256
Signs That Show Labor Is Near 258
The Stages of Labor 259
Care of the Baby at Birth 262
Care of the Cut Cord (Navel) 263
The Delivery of the Placenta (Afterbirth) 264
Hemorrhaging (Heavy Bleeding) 264
The Correct Use of Oxytocics:
Ergonovine, Oxytocin, Pitocin, etc. 266
Difficult Births 267
Tearing of the Birth Opening 269
Care of the Newborn Baby 270
Illnesses of the Newborn 272
The Mother's Health after Childbirth 276
Childbirth Fever
(Infection after Giving Birth) 276
Care of the Breasts 277
Lumps or Growths in the Lower Part of the
Belly 280
Miscarriage (Spontaneous Abortion) 281
High Risk Mothers and Babies 282
Chapter 20
FAMILY PLANNING-
HAVING THE NUMBER OF CHILDREN YOU WANT
Choosing a method of Family Planning 284
Oral Contraceptives
(Birth Control Pills) 286
Other Methods of Family Planning 290
Combined Methods 292
283
Methods for Those Who Never Want to Have
More Children 293
Home Methods for Preventing
Pregnancy 294
Chapter 21
HEALTH AND SICKNESSES OF CHILDREN
What to Do to Protect Children’s
Health 295
Children's Growth —
and the ‘Road to Health' 297
Child Health Chart 298
Review of Children’s Health Problems
Discussed in Other Chapters 305
Health Problems of Children Not
Discussed in Other Chapters 309
Earache and Ear Infections 309
Sore Throat and Inflamed Tonsils 309
Rheumatic Fever 310
Infectious Diseases of Childhood 311
Chickenpox 311
Measles (Rubeola) 311
German Measles (Rubella) 312
295
Mumps 312
Whooping Cough 313
Diphtheria 313
Infantile Paralysis (Polio) 314
How to Make Simple Crutches 315
Problems Children Are Born With 316
Dislocated Hip 316
Umbilical Hernia
(Belly Button That Sticks Out) 31 7
A 'Swollen Testicle’
(Hydrocele or Hernia) 317
Mentally Slow, Deaf, or Deformed
Children 318
The Spastic Child (Cerebral Palsy) 320
Retardation in the First Months of Life 321
Sickle Cell Disease 321
Helping Children Learn 322
Chapter 22
HEALTH AND SICKNESSES OF OLDER PEOPLE
323
Summary of Health Problems Discussed in
Other Chapters 323
Other Important Illnesses of Old Age 325
Heart Trouble 325
Words to Younger Persons Who Want to
Stay Healthy When Older 326
Stroke (Apoplexy, Cerebro-Vascular
Accident, CVA) 327
Deafness 327
Loss of Sleep (Insomnia) 328
Diseases Found More Often in People over
Forty 328
Cirrhosis of the Liver 328
Gallbladder Problems 329
Accepting Death 330
Chapter 23
THE MEDICINE KIT
How to Care for Your Medicine Kit 332
Buying Supplies for the Medicine Kit 333
The Home Medicine Kit 334
331
The Village Medicine Kit 336
Words to the Village Storekeeper
(or Pharmacist) 338
THE GREEN PAGES — The Uses, Dosage, and Precautions for Medicines . 339
List of Medicines in the Green Pages 341
Index of Medicines in the Green Pages 345
Information on Medicines 351
THE BLUE PAGES— New Information
AIDS 399
Sores on the Genitals 402
Circumcision and Excision 404
Special Care for Small, Early,
and Underweight Babies 405
Ear Wax 405
Leishmaniasis 406
399
Guinea Worm 406
Emergencies Caused by Cold 408
How to Measure Blood Pressure 41 0
Poisoning from Pesticides 412
Complications from Abortion 414
Drug Abuse and Addiction 416
VOCABULARY— Explaining Difficult Words 419
ADDRESSES FOR TEACHING MATERIALS 429
INDEX (Yellow Pages) 433
Dosage Instructions for Persons Who Cannot Read
Making Medical Reports
Information About Vital Signs
INTRODUCTION
This handbook has been written primarily for those who live far from medical
centers, in places where there is no doctor. But even where there are doctors,
people can and should take the lead in their own health care. So this book is
for everyone who cares. It has been written in the belief that:
1. Health care is not only everyone’s right, but everyone’s responsibility.
2. Informed self-care should be the main goal of any health program or
activity.
3. Ordinary people provided with clear, simple information can prevent
and treat most common health problems in their own homes — earlier,
cheaper, and often better than can doctors.
4. Medical knowledge should not be the guarded secret of a select few,
but should be freely shared by everyone.
5. People with little formal education can be trusted as much as those
with a lot. And they are just as smart.
6. Basic health care should not be delivered, but encouraged.
Clearly, a part of informed self-care is knowing one’s own limits. Therefore
guidelines are included not only for what to do, but for when to seek help.
The book points out those cases when it is important to see or get advice from
a health worker or doctor. But because doctors or health workers are not
always nearby, the book also suggests what to do in the meantime — even for
very serious problems.
This book has been written in fairly basic English, so that persons without
much formal education (or whose first language is not English) can understand
it. The language used is simple but, I hope, not childish. A few more difficult
words have been used where they are appropriate or fit well. Usually they are
used in ways that their meanings can be easily guessed. This way, those who
read this book have a chance to increase their language skills as well as their
medical skills.
Important words the reader may not understand are explained in a word list
or vocabulary at the end of the book. The first time a word listed in the
vocabulary is mentioned in a chapter it is usually written in italics.
Where There Is No Doctor was first written in Spanish for farm people in the
mountains of Mexico where, 27 years ago, the author helped form a health care
network now run by the villagers themselves. Where There Is No Doctor has
been translated into more than 50 languages and is used by village health
workers in over 100 countries.
The first English edition was the result of many requests to adapt it for use in
Africa and Asia. I received help and suggestions from persons with
experience in many parts of the world. But the English edition seems to have
lost much of the flavor and usefulness of the original Spanish edition, which
was written for a specific area, and for people who have for years been my
neighbors and friends. In rewriting the book to serve people in many parts of
the world, it has in some ways become too general.
To be fully useful, this book should be adapted by persons familiar with
the health needs, customs, special ways of healing, and local language of
specific areas.
Persons or programs who wish to use this book, or portions of it, in
preparing their own manuals for villagers or health workers are encouraged to
do so. Permission from the author or publisher is not needed — provided the
parts reproduced are distributed free or at cost— not for profit. It would be
appreciated if you would (1) include a note of credit and (2) send a copy of
your production to the Hesperian Foundation, 1919 Addison St., #304, Berkeley,
California 94704, U.S.A.
For local or regional health programs that do not have the resources for
revising this book or preparing their own manuals, it is strongly suggested that
if the present edition is used, leaflets or inserts be supplied with the book to
provide additional information as needed.
In the Green Pages (the Uses, Dosage, and Precautions for Medicines)
blank spaces have been left to write in common brand names and prices of
medicines. Once again, local -programs or -organizations- distributing the book
would do well to make up a list of generic or low-cost brand names and prices,
to be included with each copy of the book.
— —■ .. • —
This book was written for anyone who wants to do something about his or
her own and other people’s health. However, it has been widely used as a
training and work manual for community health workers. For this reason, an
introductory section has been added for the health worker, making clear that
the health worker’s first job is to share her knowledge and help educate
people.
Today in over-developed as well as under-developed countries, existing
health care systems are in a state of crisis. Often, human needs are not being
well met. There is too little fairness. Too much is in the hands of too few.
Let us hope that through a more generous sharing of knowledge, and
through learning to use what is best in both traditional and modern ways of
healing, people everywhere will develop a kinder, more sensible approach to
caring — for their own health, and for each other.
— D.W.
How to Use This Book
When you get this book:
Read the list of CONTENTS at the beginning. This tells what each chapter is
about and gives the page numbers for the different subjects discussed.
To look up an illness or other health subject:
1. Look in the YELLOW PAGES at the end of the book. This is an INDEX that
lists, in the order of the alphabet, all the subjects in this book. Also, if you look
up a particular problem, it refers you to the possible causes (for example, look
up ‘itching’). If you cannot find what you want, look for it under another name.
Or...
2. Check the list of CONTENTS. When you find what you want, turn to the pages
shown.
If you do not understand the meaning
of some of the words in this book:
Look for the word in the VOCABULARY right after the blue pages in the back of
the book. Words explained in the Vocabulary are written in italics the first time
they are used in a chapter.
Before using any medicine:
Always look at the GREEN PAGES for information on uses, dosage, risks, and
precautions. A LIST OF MEDICINES and an INDEX OF MEDICINES can be found
near the beginning of the GREEN PAGES.
To be ready for emergencies:
1. Keep a Medicine Kit like the ones recommended in Chapter 23 handy in the
house or in the village.
2. Study this book before it is needed, especially Chapter 10, FIRST AID, and
Chapter 4, HOW TO CARE FOR A SICK PERSON.
To help keep your family in good health:
Carefully study Chapter 11, on NUTRITION, and Chapter 12, on PREVENTION, and
pay attention to the guidelines and precautions.
To improve health in your community:
Organize a meeting of your neighbors, to study this book and discuss local health
problems. Or ask a teacher to give classes to the children and adults, using the
book. You will find many useful suggestions in the brown pages. WORDS TO THE
VILLAGE HEALTH WORKER, in the first part of this book.
Thanks |y the Wrtrfc and
■Jed i Lillian <.if nijiiy y.r : iU |JS 3 ltd
in(i(vidii£t]i aroiind Lha world,
Where There f.f Nti line tttf
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nunc llian SO languages-
The following arc some
of ih-c- translations and
Lhc addicsscK where
you can obtain (tiarn-
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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. 338V.
• Midwives can counsel parents
about the importance of
eating well during pregnancy,
breast feeding, and family
planning.
This book was written for the
health worker in the larger sense.
It is for anyone who wants to
know and do more for his own,
his family’s or his people’s well-
being.
If you are a community health
worker, an auxiliary nurse, or even
a doctor, remember: this book is
not just for you. It is for all the __
people. Share it!
Use this book to help explain
what you know to others. Perhaps
you can get small groups together THg village health worker lives and
to read a chapter at a time and works at the level of his people, his
discuss it. FIRST JOB IS TO SHARE HIS KNOWLEDGE.
wl
Dear Village Health Worker,
This book is mostly about people's health needs. But to help your village be
a healthy place to live, you must also be in touch with their human needs. Your
understanding and concern for people are just as important as your knowledge
of medicine and sanitation.
Here are some suggestions that may
help you serve your people’s human
needs as well as health needs:
1 . BE KIND. A friendly word, a smile,
a hand on the shoulder, or some other
sign of caring often means more than
anything else you can do. Treat others
as your equals. Even when you are
hurried or worried, try to remember the
feelings and needs of others. Often it
helps to ask yourself, “What would I do
if this were a member of my own family?”
Treat the sick as people. Be have compassion.
especially kind to those who are very Kindness often helps more
sick or dying. And be kind to their than medicine. Never be
families. Let them see that you care. afraid to show you care.
2. SHARE YOUR KNOWLEDGE^ As a health worker; your first job is to teach. “
This means helping people learn more about how to keep from getting sick. It
also means helping people learn how to recognize and manage their illnesses
— including the sensible
use of home remedies
and common medicines.
There is nothing you
have learned that, if
carefully explained,
should be of danger to
anyone. Some doctors
talk about self-care as if
it were dangerous,
perhaps because they
like people to depend on
their costly services. But
in truth, most common
health problems could
be handled earlier and
better by people in
look for ways to share your knowledge. their own homes.
w2
3. RESPECT YOUR PEOPLE'S TRADITIONS AND IDEAS,
Because you learn something about modern medicine does not mean you
should no longer appreciate the customs and ways of healing of your people.
Too often the human touch in the art of healing is lost when medical science
moves in. This is too bad, because ...
If you can use what is best in modern medicine, together with what is best in
traditional healing, the combination may be better than either one alone.
In this way, you will be adding to your people’s culture, not taking away.
Of course, if you see that some of the home cures or customs are harmful
(for example, putting excrement on the freshly cut cord of a newborn baby),
you will want to do something to change this. But do so carefully, with respect
for those who believe in such things. Never just tell people they are wrong. Try
to help them understand WHY they should do something differently.
People are slow to change their attitudes and traditions, and with good
reason. They are true to what they feel is right. And this we must respect.
Modern medicine does not have all the answers either. It has helped solve
some problems, yet has led to other, sometimes even bigger ones. People
quickly come to depend too much on modern medicine and its experts, to
overuse medicines, and to forget how to care for themselves and each other.
So go slow — and always keep a deep respect for your people, their
traditions, and their human dignity. Help them build on the knowledge and
skills they already have.
WORK WITH TRADITIONAL
HEALERS AND MIDWIVES—
NOT AGAINST THEM.
Learn from them
and encourage them
to learn from you.
w3
4. KNOW YOUR OWN LIMITS.
f I KNOW ITS A LONG WAY TO THE
j health center, but here we.
I cannot give him THE TREATMEMT
\HE NEEDS, i'll Go WITH YOU.
No matter how great or small your
knowledge and skills, you can do a good
job as long as you know and work within
your limits. This means: Do what you
know how to do. Do not try things you
have not learned about or have not had
enough experience doing, if they might
harm or endanger someone.
But use your judgment.
Often, what you decide to do or not
do will depend on how far you have
to go to get more expert help.
For example, a mother has just given
birth and is bleeding more than you
think is normal. If you are only half an
hour away from a medical center, it may
be wise to take her there right away.
But if the mother is bleeding very
heavily and you are a long way from the health center, you may decide to
massage her womb (see p. 265) or inject an oxytocic (see p. 266) even if you
were not taught this.
KNOW YOUR LIMITS.
Do not take unnecessary chances. But when the danger is clearly greater if
you do nothing, do not be afraid to try something you feel reasonably sure will
help.
Know your limits — but also use your head. Always do your best to protect
the sick person rather than yourself.
5. KEEP LEARNING. Use every chance
you have to learn more. Study whatever
books or information you can lay your
hands on that will help you be a better
worker, teacher, or person.
Always be ready to ask questions of
doctors, sanitation officers, agriculture
experts, or anyone else you can learn from.
Never pass up the chance to take
refresher courses or get additional
training.
KEEP LEARNING-Do not let
anyone tell you there are things
you should not learn or know.
Your first job is to teach, and unless
you keep learning more, soon you will
not have anything new to teach others.
w4
6. PRACTICE WHAT YOU TEACH.
People. are more likely to pay attention to
what you do than what you say. As a health
worker, you want to take special care in your
personal life and habits, so as to set a good
example for your neighbors.
Before you ask people to make latrines,
be sure your own family has one.
Also, if you help organize a work group —
for example, to dig a common garbage hole —
be sure you work and sweat as hard as
everyone else.
Good leaders do not
tell people what to do.
They set the example.
PRACTICE WHAT YOU TEACH
(or who will listen to you?)
7. WORK FOR THE JOY OF IT.
If you want other people to take part in improving their village and caring for
their health, you must enjoy such activity yourself. If not, who will want to follow
your example?
Try to make community work projects fun. For example, fencing off the public
water hole to keep animals away from where people take water can be hard
work. But 'if the whole village helps do it as a ‘work festival’ — perhaps with
refreshments and music — the job will be done quickly and can be fun.
Children will work
hard and enjoy it, if
they can turn work
into play.
You may or may
not be paid for your
work. But never
refuse to care, or
care less, for some-
one who is poor or
cannot pay.
This way you will
win your people’s
love and respect.
These are worth far
more than money.
WORK FIRST FOR THE PEOPLE-NOT THE MONEY.
(People are worth more.)
w5
8. LOOK AHEAD— AND HELP OTHERS TO LOOK AHEAD.
A responsible health worker does not wait for people to get sick. She tries to
stop sickness before it starts. She encourages people to take action now to
protect their health and well-being in the future.
Many sicknesses can be prevented. Your job, then, is to help your people
understand the causes of their health problems and do something about them.
Most health problems have many causes, one leading to another. To correct
the problem in a lasting way, you must look for and deal with the underlying
causes. You must get to the root of the problem.
For example, in many villages diarrhea is the most common cause of death
in small children. The spread of diarrhea is caused in part by lack of
cleanliness (poor sanitation and hygiene). You can do something to correct this
by digging latrines and teaching basic guidelines of cleanliness (p. 133).
But the children who suffer and die most often from diarrhea are those
who are poorly nourished. Their bodies do not have strength to fight the
infections. So to prevent death from diarrhea we must also prevent poor
nutrition.
And why do so many children suffer from poor nutrition?
• Is it because mothers do not realize what foods are most important (for
example, breast milk)?
• Is it because the family does not have enough money or land to produce
the food it needs?
• Is it because a few rich persons control most of the land and the wealth?
• Is it because the poor do
not make the best use of
* Is it because people do
not look or plan ahead?
Because they do not
realize that by working
together and sharing they
can change the conditions
under which they live
and die?
* Is it because fathers lose
hope and spend the little
money they have on drink?
• Is it because parents
they or their land can
provide for, and keep
having more?
land they have?
have more children than
HELP OTHERS TO LOOK AHEAD.
w6
You may find that many, if not all, of
these things lie behind infant deaths in
your area. You will, no doubt, find other
causes as well. As a health worker it is your
job to help people understand and do
something about as many of these causes
as you can.
But remember: to prevent frequent
deaths from diarrhea will take far more
than latrines, pure water, and 'special
drink’ (oral rehydration). You may find
that child spacing, better land use, and
fairer distribution of wealth, land, and
power are more important in the long run
The causes that lie behind much sickness
and human suffering are short-sightedness
and greed. If your interest is your people's
well-being, you must help them learn to
share, to work together, and to look ahead.
MANY THINGS
RELATE TO HEALTH CARE
We have looked at some of the causes
that underlie diarrhea and poor nutrition.
Likewise, you will find that such things as
food production, land distribution,
education, and the way people treat or
mistreat each other lie behind many
different health problems.
DEATH
__1_
DIARRHEA
SPREAD OF
INFECTION
POOR HYGIENE
AND LACK OF
CLEANLINESS
LARGE FAMILIES
(MANY CHILDREN)
UNFAIR DISTRIBUTION
OF LAND AND WEALTH
GREED AND FAILURE
TO LOOK AHEAD
The chain of causes leading
to death from diarrhea.
If you are interested in the long-term welfare of your whole community, you
must help your people look for answers to these larger questions.
Health is more than not being sick. It is well-being: in body, mind, and
community. People live best in healthy surroundings, in a place where they can
trust each other, work together to meet daily needs, share in times of difficulty
and plenty, and help each other learn and grow and live, each as fully as he or
she can.
Do your best to solve day-to-day problems. But remember that your greatest
job is to help your community become a more healthy and more human place
to live.
You as a health worker have a big responsibility.
Where should you begin? \
w7
TAKE A GOOD LOOK AT YOUR COMMUNITY
Because you have grown up in your community and know your people well,
you are already familiar with many of their health problems. You have an inside
view. But in order to see the whole picture, you will need to look carefully at
your community from many points of view.
As a village health worker, your concern is for the well-being of all the
people — not just those you know well or who come to you. Go to your people.
Visit their homes, fields, gathering places, and schools. Understand their joys
and concerns. Examine with them their habits, the things in their daily lives that
bring about good health, and those that may lead to sickness or injury.
Before you and your community attempt any project or activity, carefully
think about what it will require and how likely it is to work. To do this, you must
consider all the following:
1 . Felt needs — what people feel are their biggest problems.
2. Real needs — steps people can take to correct these problems in a lasting
way.
3. Willingness — or readiness of people to plan and take the needed steps.
4. Resources — the persons, skills, materials, and/or money needed to carry
out the activities decided upon.
As a simple example of how each of these things can be important, let us
suppose that a man who smokes a lot comes to you complaining of a cough
that has steadily been getting worse.
1. His felt need is to get rid of his cough.
3. To get rid of his cough will require his
willingness to give up smoking. For this
he must understand how much it really
matters.
2. His real need (to correct the problem)
is to give up smoking.
4. One resource that may help him give
up smoking is information about the harm
it can do him and his family (see p. 149).
Another is the support and encouragement
of his^family, his friends, and you.
Finding Out the Needs
As a health worker, you will first want to find out your people’s most
important health problems and their biggest concerns. To gather the
information necessary to decide what the greatest needs and concerns really
are, it may help to make up a list of questions.
On the next 2 pages are samples of the kinds of things you may want to ask.
But think of questions that are important in your area. Ask questions that not
only help you get information, but that get others asking important questions
themselves.
Do not make your list of questions too long or complicated — especially a list
you take from house to house. Remember, people are not numbers and do not
like to be looked at as numbers. As you gather information, be sure your first
interest is always in what individuals want and feel. It may be better not even to
carry a list of questions. But in considering the needs of your community, you
should keep certain basic questions in mind.
W9
Sample Lists of Questions
To Help Determine Community Health Needs
And at the Same Time Get People Thinking
FELT NEEDS
What things in your people’s daily lives (living conditions, ways of doing things,
beliefs, etc.) do they feel help them to be healthy?
What do people feel to be their major problems, concerns, and needs— not
only those related to health, but in general?
What are different houses made of? Walls? Floors? Are the houses kept clean?
Is cooking done on the floor or where? How does smoke get out? On what do
people sleep?
Are flies, fleas, bedbugs, rats, or other pests a problem? In what way? What do
people do to control them? What else could be done?
Is food protected? How could it be better protected?
What animals (dogs, chickens, pigs, etc.), if any, are allowed in the house?
What problems do they cause?
What are the common diseases of animals? How do they affect people's
health? What is being done about these diseases?
Where do families get their water? Is it safe to drink? What precautions are
taken?
How many families have latrines? How many use them properly?
Is the village clean? Where do people put garbage? Whv?
How many people live in the community? How many are under 15 years old?
How many can read and write? What good is schooling? Does it teach children
what they need to know? How else do children learn?
How many babies were born this year? How many people died? Of what? At
what ages? Could their deaths have been prevented? How?
Is the population (number of people) getting larger or smaller? Does this cause
any problems?
How often were different persons sick in the past year? How many days was
each sick? What sickness or injuries did each have? Why?
How many people have chronic (long-term) illnesses? What are they?
How many children do most parents have? How many children died? Of what?
At what ages? What were some of the underlying causes?
How many parents are interested in not having any more children or in not
having them so often? For what reasons? (See Family Planning, p. 283.)
HOUSING AND SANITATION
POPULATION
wlO
NUTRITION
How many mothers breast feed their babies? For how long? Are
these babies healthier than those who are not breast fed? Why?
What are the main foods people eat? Where do they come from?
Do people make good use of all foods available?
How many children are underweight (p. ,109) or show signs of poor nutrition?
How much do parents and schoolchildren know about nutritional needs?
How many people smoke a lot? How many drink alcoholic or soft drinks very
often? What effect does this have on their own and their families’ health? (See
p. 148 to 150.)
LAND AND FOOD
Does the land provide enough food for each family?
How long will it continue to produce enough food if families keep growing?
How is farm land distributed? How many people own their land?
What efforts are being made to help the land produce more?
How are crops and food stored? Is there much damage or loss? Why?
HEALING, HEALTH
What role do local midwives and healers play in health care?
What traditional ways of healing and medicines are used?
Which are of greatest value? Are any harmful or dangerous?
What health services are nearby? How good are they? What do they cost? How
much are they used?
How many children have been vaccinated? Against what sicknesses?
What other preventive measures are being taken? What others might be taken?
How important are they?
SELF-HELP
What are the most important things that affect your
people's health and well-being — now and in the future?
How many of their common health problems can people care
for themselves? How much must they rely on outside help and medication?
Are people interested in finding ways of making self-care safer, more effective,
and more complete? Why? How can they learn more? What stands in the way?
What are the rights of rich people? Of poor people? Of men? Of women? Of
children? How is each of these groups treated? Why? Is this fair? What needs
to be changed? By whom? How?
Do people work together to meet common needs? Do they share or help each
other when needs are great?
What can be done to make your village a better, healthier place to live? Where
might you and your people begin?
wl 1
USING LOCAL RESOURCES TO MEET NEEDS
How you deal with a problem will depend upon what resources are available.
Some activities require outside resources (materials, money, or people from
somewhere else). For example, a vaccination program is possible only if
vaccines are brought in — often from another country.
Other activities can be carried out completely with local resources. A family
or a group of neighbors can fence off a water hole or build simple latrines
using materials close at hand.
Some outside resources, such as vaccines and a few important medicines,
can make a big difference in people’s health. You should do your best to get
them. But as a general rule, it is in the best interest of your people to
Use local resources whenever possible.
The more you and your
people can do for yourselves,
and the less you have to
depend on outside assistance
and supplies, the healthier and
stronger your community will
become.
Not only can you count on
local resources to be on hand
when you need them, but
often they do the best job at
the lowest cost. For example,
if you can encourage mothers
to breast feed rather than
bottle feed their babies, this
will build self-reliance through
a top quality local resource —
breast milk! It will also prevent
needless sickness and death
of many babies.
In your health work
always remember:
Encourage people to make
the most of local resources.
BREAST MILK— A TOP QUALITY
LOCAL RESOURCE— BETTER THAN
ANYTHING MONEY CAN BUY!
The most valuable resource for the health of the people
is the people themselves.
w12
DECIDING WHAT TO DO AND WHERE TO BEGIN
After taking a careful look at needs and resources, you and your people
must decide which things are more important and which to do first. You can do
many different things to help people be healthy. Some are important
immediately. Others will help determine the future well-being of individuals or
the whole community.
In a lot of villages, poor nutrition plays a part in other health problems.
People cannot be healthy unless there is enough to eat. Whatever other
problems you decide to work with, if people are hungry or children are poorly
nourished, better nutrition must be your first concern.
There are many different ways to approach the problem of poor nutrition, for
many different things join to cause it. You and your community must consider
the possible actions you might take and decide which are most likely to work.
Here are a few examples of ways some people have helped meet their
needs for better nutrition. Some actions bring quick results. Others work over a
longer time. You and your people must decide what is most likely to work in
your area.
POSSIBLE WAYS TO WORK TOWARD BETTER NUTRITION
FAMILY GARDENS
CONTOUR DITCHES
to prevent soil from
washing away
ROTATION OF CROPS
Every other planting season plant a crop that returns strength to the soil — like beans, peas,
lentils, alfalfa, peanuts or some other plant with seed in pods (legumes).
This year maize
Next year beans
w13
MORE WAYS TO WORK TOWARD BETTER NUTRITION
IRRIGATION OF LAND FISH BREEDING
Compost pile
w14
TRYING ANEW IDEA
Not all the suggestions on the last pages are
likely to work in your area. Perhaps some will
work if changed for your particular situation and
resources at hand. Often you can only know
whether something will work or not by trying it.
That is, by experiment.
When you try out a new idea, always start
small. If you start small and the experiment
fails, or something has to be done differently,
you will not lose much. If it works, people will see
to apply it in a bigger way.
that it works and can begin
Do not be discouraged if an experiment does not work. Perhaps you can try
again with certain changes. You can learn as much from your failures as your
successes. But start small.
Here is an example of experimenting with a new idea.
You learn that a certain kind of bean, such as soya, is an excellent body-building
food. But will it grow in your area? And if it grows, will people eat it?
Start by planting a small patch — or 2 or 3 small patches in different conditions of
soil or water. If the beans do well, try preparing them in different ways, and see if
people will eat them. If so, try planting more beans in the conditions where you
found they grew best. But try out still other conditions in more small patches to see
if you can get an even better crop.
There may be several conditions you want to try changing. For example,
type of soil, addition of fertilizer, amount of water, or different varieties of seed.
To best understand what helps and what does not, be sure to change only one
condition at a time and keep all the rest the same.
For example, to find out if animal fertilizer (manure) helps the beans grow, and how
much to use, plant several small bean patches side by side, under the same
conditions of water and sunlight, and using the same seed. But before you plant, mix
each patch with a different amount of manure, something like this:
5 shovels
manure
This experiment shows that a certain amount of manure helps, but that too
much can harm the plants. This is only an example. Your experiments may
give different results. Try for yourself!
wl 5
WORKING TOWARD A BALANCE BETWEEN
PEOPLE AND LAND
Health depends on many things, but above all it depends on whether people
have enough to eat.
Most food comes from the land. Land that is used well can produce more
food. A health worker needs to know ways to help the land better feed the
people — now and in the future. But even the best used piece of land can only
feed a certain number of people. And today, many of the people who farm
do not have enough land to meet their needs or to stay healthy.
In many parts of the world, the situation is getting worse, not better. Parents
often have many children, so year by year there are more mouths to feed on the
limited land that the poor are permitted to use.
Many health programs try to work toward a balance between people and
land through 'family planning’, or helping people have only the number of
children they want. Smaller families, they reason, will mean more land and
food to go around. But family planning by itself has little effect. As long as
people are very poor, they often want many children. Children help with work
without having to be paid, and as they get bigger may even bring home a little
money. When the parents grow old, some of their children — or grandchildren—
will perhaps be able to help care for them.
For a poor country to have many children may be an economic disaster. But
for a poor family to have many children is often an economic necessity —
especially when many die young. In the world today, for most people, having
many children is the surest form of social security they can hope for.
Some groups and programs take a different approach. They recognize that
hunger exists not because there is too little land to feed everyone, but because
most of the land is in the hands of a few selfish persons. The balance they
seek is a fairer distribution of land and wealth. They work to help people gain
greater control over their health, land, and lives.
It has been shown that, where land and wealth are shared more fairly and
people gain greater economic security, they usually choose to have smaller
families. Family planning helps when it is truly the people’s choice. A balance
between people and land can more likely be gained through helping people
work toward fairer distribution and social justice than through family planning
alone.
It has been said that the social meaning of love is justice. The health worker
who loves her people should help them work toward a balance based on a
more just distribution of land and wealth.
A LIMITED AMOUNT
OF LAND CAN
ONLY SUPPORT A
LIMITED NUMBER
OF PEOPLE.
A LASTING
BALANCE BETWEEN
PEOPLE AND LAND
MUST BE BASED ON
FAIR DISTRIBUTION.
w16
WORKING TOWARD A
BALANCE BETWEEN
A balance between treatment and prevention often comes down to a balance
between immediate needs and long-term needs.
As a health worker you must go to your people, work with them on their
terms, and help them find answers to the needs they feel most. People’s first
concern is often to find relief for the sick and suffering. Therefore, one of your
first concerns must be to help with healing.
But also look ahead. While caring for people’s immediate felt needs, also
help them look to the future. Help them realize that much sickness and
suffering can be prevented and that they themselves can take preventive
actions.
But be careful! Sometimes health planners and workers go too far. In their
eagerness to prevent future ills, they may show too little concern for the
sickness and suffering that already exist. By failing to respond to people's
present needs, they may fail to gain their cooperation. And so they fail in much
of their preventive work as well.
Treatment and prevention go hand in hand. Early treatment often prevents
mild illness from becoming serious. If you help people to recognize many of
their common health problems and to treat them early, in their own homes,
much needless suffering can be prevented.
If you want their cooperation, start where your people are. Work toward a
balance between prevention and treatment that is acceptable to them. Such a
balance will be largely determined by people’s present attitudes toward
sickness, healing, and health. As you help them look farther ahead, as their
attitudes change, and as more diseases are controlled, you may find that the
balance shifts naturally in favor of prevention.
You cannot tell the mother whose child is ill that prevention is more important
than cure. Not if you want her to listen. But you can tell her, while you help her
care for her child, that prevention is equally important.
Use treatment as a doorway to prevention. One of the best times to talk
to people about prevention is when they come for treatment. For example, if a
mother brings a child with worms, carefully explain to her how to treat him. But
also take time to explain to both the mother and child how the worms are
spread and the different things they can do to prevent this from happening
(see Chapter 12). Visit their home from time to time, not to find fault, but to
help the family toward more effective self-care.
Early treatment is a form of preventive medicine.
Work toward prevention— do not force it.
Use treatment as a chance to teach prevention.
SENSIBLE AND LIMITED USE OF MEDICINES
One of the most difficult and important parts of preventive care is to educate
your people in the sensible and limited use of medicines. A few modern
medicines are very important and can save lives. But for most sicknesses no
medicine is needed. The body itself can usually fight off sickness with rest,
good food, drinking lots of liquid, and perhaps some simple home remedies.
People may come to you asking for medicine when they do not need any.
You may be tempted to give them some medicine just to please. But if you do,
when they get well, they will think that you and the medicine cured them.
Really their bodies cured themselves.
Instead of teaching people to depend on medicines they do not need, take
time to explain why they should not be used. Also tell people what they can
do themselves to get well.
This way you are helping people to rely on local resources (themselves),
rather than on an outside resource (medicine). Also, you are protecting their
health, for there is no medicine that does not have some risk in its use.
Three common health problems for which people too often request
medicines they do not need are (1) the common cold, (2) minor cough, and (3)
diarrhea.
The common cold is best treated by resting, drinking lots of liquids, and at
the most taking aspirin. Penicillin, tetracycline, and other antibiotics do not
help at all (see p. 163).
For minor coughs, or even more severe coughs with thick mucus or phlegm,
drinking a lot of water will loosen mucus and ease the cough faster and better
than cough syrup. Breathing warm water vapor brings even greater relief (see
p. 168). Do not make people dependent on cough syrup or other medicines
they do not need.
For most diarrhea of children, medicines do not make them get well. Many
commonly used medicines (neomycin, streptomycin, kaolin-pectin, Lomotil,
chloramphenicol) may even be harmful. What is most important is that the
child get lots of liquids and enough food (see p. 155 to 1 56). The key to the
child’s recovery is the mother, not the medicine. If you can help mothers
understand this and learn what to do, many children’s lives can be saved.
w18
Medicines are often used too much, both by doctors and by ordinary people.
This is unfortunate for many reasons:
• It is wasteful. Most money spent on medicine would be better spent on
food.
% It makes people depend on something they do not need (and often cannot
afford).
% Every medicine has some risk in its use. There is always a chance that an
unneeded medicine may actually do the person harm.
% What is more, when some medicines are used too often for minor
problems, they lose their power to fight dangerous sicknesses.
An example of a medicine losing its power is chloramphenicol. The extreme
overuse of this important but risky antibiotic for minor infections has meant that
in some parts of the world chloramphenicol no longer works against typhoid
fever, a very dangerous infection. Frequent overuse of chloramphenicol has
allowed typhoid to become resistant to it (see p. 58).
For all the above reasons the use of medicines should be limited.
But how? Neither rigid rules and restrictions nor permitting only highly
trained persons to decide about the use of medicines has prevented overuse.
Only when the people themselves are better informed will the limited and
careful use of medicines be common.
To educate people about sensible and limited use of medicines
is one of the important jobs of the health worker.
This is especially true in areas where modern medicines are already in great
use.
/don't YOu\
think he r
needs an \a
IN J ECU ON ?)fj f'\
NO! ALL~HE~HA5 15 A \
COLO ■ HE WILL GET WELL
QY HIMSELF LET HIM
REST GIVE HIM
G OOP FOOD AND
LOTS TO DRINK.
strong medicine
Won't help and
MIGHT EVEN HARM
Vj4lM. J
WHEN MEDICINES ARE NOT NEEDED, TAKE TIME TO EXPLAIN WHY.
For more information about the use and misuse of medicines, see Chapter J3,
page 49. For the use and misuse of injections, see Chapter.9, page 65. For
sensible use of home remedies, see Chapter _1_.
w19
FINDING OUT WHAT PROGRESS HAS BEEN MADE
(EVALUATION)
From time to time in your health work, it helps to take a careful look at what
and how much you and your people have succeeded in doing. What changes,
if any, have been made to improve health and well-being in your community?
You may want to record each month or year the health activities that can be
measured. For example:
• Flow many families have put in latrines?
• How many farmers take part in activities to improve their land and crops?
• How many mothers and children take part in an Under-Fives Program
(regular check-ups and learning)?
This kind of question will help you measure action taken. But to find out the
result or impact of these activities on health, you will need to answer other
questions such as:
• How many children had diarrhea or signs of worms in the past month or
year — as compared to before there were latrines?
• How much was harvested this season (corn, beans, or other crops)— as
compared to before improved methods were used?
• How many children show normal weight and weight-gain on their Child
Health Charts (see p. 297) — as compared to when the Under-Fives
Program was started?
• Do fewer children die now than before?
To be able to judge the success of any activity you need to collect certain
information both before and after. For example, if you want to teach mothers
how important it is to breast feed their babies, first take a count of how many
mothers are doing so. Then begin the teaching program and each year take
another count. This way you can get a good idea as to how much effect your
teaching has had.
You may want to set goals. For example, you and the health committee may
hope that 80% of the families have latrines by the end of one year. Every
month you take a count. If, by the end of six months, only one-third of the
families have latrines, you know you will have to work harder to meet the goal
you set for yourselves.
Setting goals often helps people work harder and get more done.
To evaluate the results of your health activities it helps to count and measure
certain things before, during, and after.
But remember: The most important part of your health work cannot be
measured. It has to do with the way you and other people relate to each other;
with people learning and working together; with the growth of kindness,
responsibility, sharing, and hope. It depends on the growing strength and unity
of the people to stand up for their basic rights. You cannot measure these
things. But weigh them well when you consider what changes have been made.
TEACHING AND LEARNING TOGETHER—
THE HEALTH WORKER AS AN EDUCATOR
As you come to realize how many things affect health, you may think the
health worker has an impossibly large job. And true, you will never get much
done if you try to deliver health care by yourself.
Only when the people themselves become actively responsible for their own
and their community’s health, can important changes take place.
Your community’s well-being depends on the involvement not of one person,
but of nearly everyone. For this to happen, responsibility and knowledge must
be shared.
This is why your first job as a health worker is to teach— to teach children,
parents, farmers, schoolteachers, other health workers— everyone you can.
The art of teaching is the most important skill a person can learn. To teach
is to help others grow, and to grow with them. A good teacher is not
someone who puts ideas into other people’s heads; he or she is someone
who helps others build on their own ideas, to make new discoveries for
themselves.
Teaching and learning should not be limited to the schoolhouse or health
post. They should take place in the home and in the fields and on the road.
As a health worker one of your best chances to teach will probably be when
you treat the sick. But you should look for every opportunity to exchange
ideas, to share, to show, and to help your people think and work together.
On the next few pages are some ideas that may help you do this. They are
only suggestions. You will have many other ideas yourself.
TWO APPROACHES TO HEALTH CARE
w21
Tools for Teaching
Flannel-graphs are good for talking with
groups because you can keep making new
pictures. Cover a square board or piece of
cardboard with a flannel cloth. You can place
different cutout drawings or photos on it. Strips
of sandpaper or flannel glued to the backs of
cutouts help them stick to the flannelboard.
Posters and displays. "A picture is worth a v
thousand words." Simple drawings, with or
without a few words of information, can be hung
in the health post or anywhere that people will
look at them. You can copy some of the pictures
from this book.
If you have trouble getting sizes and shapes right
draw light, even squares in pencil over the picture
you want to copy.
Now draw the same number of squares lightly,
but larger, on the poster paper or cardboard.
Then copy the drawing, square for square.
If possible, ask village artists to draw or paint
posters. Or have children make posters on
different subjects.
Models and demonstrations help get ideas across.
For example, if you want to talk with mothers and
midwives about care in cutting the cord of a
newborn child, you can make a doll for the baby.
Pin a cloth cord to its belly. Experienced midwives
can demonstrate to others.
Color slides and filmstrips are available on
different health subjects for many parts of the
world. Some come in sets that tell a story.
Simple viewers and battery-operated projectors
are also available.
A list of addresses where you can send for teaching materials to use for
health education in your village can be found on pages 429 to 432.
w22
Other Ways to Get Ideas Across
Story telling. When you have a hard time explaining something, a story,
especially a true one, will help make your point.
For example, if 1 tell you that sometimes a village worker can make a better
diagnosis than a doctor, you may not believe me. But if I tell you about a
village health worker called Irene, who runs a small nutrition center in Central
America, you may understand.
One day a small sickly child arrived at the nutrition center. He had been sent by
the doctor at a nearby health center because he was badly malnourished: The child
also had a cough, and the doctor had prescribed a cough medicine. Irene was
worried about the child. She knew he came from a very poor family and that an older
brother had died a few weeks before. She went to visit the family and learned that
the older brother had been very sick for a long time and had coughed blood. Irene
went to the health center and told the doctor she was afraid the child had
tuberculosis. Tests were made, and it turned out that Irene was right. ... So you see,
the health worker spotted the real problem before the doctor — because she knew her
people and visited their homes.
Stories also make learning more interesting. It helps if health workers are
good story tellers.
Play acting. Stories that make important points can reach people with even
more force if they are acted out. Perhaps you, the schoolteacher, or someone
on the health committee can plan short plays
or ‘skits’ with the schoolchildren.
For example, to make the point
that food should be protected
from flies to prevent the spread
of disease, several small children
could dress up as flies and buzz
around food. The flies dirty the
food that has not been covered.
Then children eat this food and
get sick. But the flies cannot get
at food in a box with a wire screen
front. So the children who eat
this food stay well.
The more ways you can find to share ideas,
the more people will understand and remember.
w23
Working and Learning Together for the Common Good
There are many ways to interest and involve people in working together to
meet their common needs. Here are a few ideas:
1. A village health committee. A group of able, interested persons can be
chosen by the village to help plan and lead activities relating to the well-being
of the community — for example, digging garbage pits or latrines. The health
worker can and should share much of his responsibility with other persons.
2. Group discussions. Mothers, fathers, schoolchildren, young people, folk
healers, or other groups can discuss needs and problems that affect health.
Their chief purpose can be to help people share ideas and build on what they
already know.
3. Work festivals. Community
projects such as putting in a water
system or cleaning up the village
go quickly and can be fun if
everybody helps. Games, races,
refreshments, and simple prizes
help turn work into play. Use
imagination.
4. Cooperatives. People can help
keep prices down by sharing tools,
storage, and perhaps land. Group
cooperation can have a big
influence on people’s well-being.
5. Classroom visits. Work with the village schoolteacher to encourage
health-related activities, through demonstrations and play acting. Also invite
small groups of students to come to the health center. Children not only learn
quickly, but they can help out in many ways. If you give children a chance,
they gladly become a valuable resource.
6. Mother and child health meetings. It is especially important that pregnant
women and mothers of small children (under five years old) be well informed
about their own and their babies' health needs. Regular visits to the health
post are opportunities for both check-ups and learning. Have mothers keep
their children’s health records and bring them each month to have their
children’s growth recorded (see the Child Health Chart, p. 297). Mothers who
understand the chart often take pride in making sure their children are eating
and growing well. They can learn to understand these charts even if they
cannot read. Perhaps you can help train interested mothers to organize and
lead these activities.
7. Home visits. Make friendly visits to people’s homes, especially homes of
families who have special problems, who do not come often to the health post,
or who do not take part in group activities. But respect people’s privacy. If
your visit cannot be friendly, do not make it — unless children or defenseless
persons are in danger.
CHILDREN CAN DO AN AMAZING AMOUNT
OF WORK WHEN IT IS TURNED INTO A GAME!
w24
Ways to Share and Exchange Ideas in a Group
As a health worker you will find that the success you have in improving your
people’s health will depend far more on your skills as a teacher than on your
medical or technical knowledge. For only when the whole community is
involved and works together can big problems be overcome.
People do not learn much from what they are told. They learn from what they
think, feel, discuss, see, and do together.
So the good teacher does not sit behind a desk and talk at people. He talks
and works with them. He helps his people to think clearly about their needs
and to find suitable ways to meet them. He looks for every opportunity to share
ideas in an open and friendly way.
TALK WITH PEOPLE
Perhaps the most important thing you can do as a health worker is to
awaken your people to their own possibilities ... to help them gain confidence
in themselves. Sometimes villagers do not change things they do not like
because they do not try. Too often they may think of themselves as ignorant
and powerless. But they are not. Most villagers, including those who cannot
read or write, have remarkable knowledge and skills. They already make great
changes in their surroundings with the tools they use, the land they farm, and
the things they build. They can do many important things that people with a lot
of schooling cannot.
If you can help people realize how much they already know and have done
to change their surroundings, they may also realize that they can learn and do
even more. By working together it is within their power to bring about even
bigger changes for their health and well-being.
Then how do you tell people these things?
Often you cannot! But you can help them find out some of these things for
themselves— by bringing them together for discussions. Say little yourself, but
start the discussion by asking certain questions. Simple pictures like the
drawing on the next page of a farm family in Central America may help. You
will want to draw your own picture, with buildings, people, animals, and crops
that look as much as possible like those in your area.
w25
USE PICTURES TO GET PEOPLE TALKING AND THINKING TOGETHER
Shows group of people apicture similar to this and ask them to discuss it.
Ask questions that get people talking about what they know and can do. Here
are some sample questions:
• Who are the people in the picture and how do they live?
• What was this land like before the people came?
• In what ways have they changed their surroundings?
• How do these changes affect their health and well-being?
• What other changes could these people make? What else could they
learn to do? What is stopping them? How could they learn more?
• How did they learn to farm? Who taught them?
• If a doctor or a lawyer moved onto this land with no more money or tools
than these people, could he farm it as well? Why or why not?
• In what ways are these people like ourselves?
w26
This kind of group discussion helps build people’s confidence in themselves
and in their ability to change things. It can also make them feel more involved
in their community.
At first you may find that people are slow to speak out and say what they
think. But after a while they will usually begin to talk more freely and ask
important questions themselves. Encourage everyone to say what he or she
feels and to speak up without fear. Ask those who talk most to give a chance
to those who are slower to speak up.
You can think of many other drawings and questions to start discussions that
can help people look more clearly at problems, their causes, and possible
solutions.
What questions can you ask to get people thinking about the different things
that lead to the condition of the child in the following picture?
Try to think of questions that lead to others and get people asking for
themselves. How many of the causes underlying death from diarrhea
(see p. w7) will your people think of when they discuss a picture like this?
w27
MAKING THE BEST USE OF THIS BOOK
Anyone who knows how to read can use this book in
her own home. Even those who do not read can learn
from the pictures. But to make the fullest and best use
of the book, people often need some instruction. This
can be done in several ways.
A health worker or anyone who gives out the book should make sure that
people understand how to use the list of Contents, the Index, the Green Pages
and the Vocabulary. Take special care to give examples of how to look things
up. Urge each person to carefully read the sections of the book that will help
her understand what may be helpful to do, what could be harmful or
dangerous, and when it is important to get help (see especially Chapters 1,
JL JL and 8,, and also the SIGNS OF DANGEROUS ILLNESS, p. 42). Point out
how important it is to prevent sickness before it starts. Encourage people to
pay special attention to Chapters H and 12, which deal with eating right
(nutrition) and keeping clean (hygiene and sanitation).
Also show and mark the pages that tell about the most common
problems in your area. For example, you can mark the pages on diarrhea
and be sure mothers with small children understand about ‘special drink’ (oral
rehydration, p. 152). Many problems and needs can be explained briefly. But
the more time you spend with people discussing how to use the book or
reading and using it together, the more everyone will get out of it.
You as a health worker might encourage people to get together in small
groups to read through the book, discussing one chapter at a time. Look at
the biggest problems in your area— what to do about health problems that
already exist and how to prevent similar problems in the future. Try to get
people looking ahead.
Perhaps interested persons can get together for a short class using this
book (or others) as a text. Members of the group could discuss how to
recognize, treat, and prevent different problems. They could take turns
teaching and explaining things to each other.
To help learning be fun in these classes you can act out situations. For
example, someone can act as if he has a particular sickness and can explain
what he feels. Others then ask questions and examine him (Chapter 3), Use
the book to try to find out what his problem is and what can be done about it.
The group should remember to involve the ‘sick’ person in learning more about
his own sickness — and should end up by discussing with him ways of
preventing the sickness in the future. All this can be acted out in class.
Exciting and effective ways to teach about health care are in the book
Helping Health Workers Learn, also available from the Hesperian Foundation.
As a health worker, one of the best ways you can help people use this book
correctly is this: When persons come to you for treatment, have them look up
their own or their child’s problem in the book and find out how to treat it. This
takes more time, but helps much more than doing it for them. Only when
someone makes a mistake or misses something important do you need to step
in and help him learn how to do it better. In this way, even sickness gives a
chance to help people learn.
Dear village health worker — whoever and wherever you are, whether you
have a title or official position, or are simply someone, like myself, with an
interest in the well-being of others — make good use of this book. It is for you
and for everyone.
But remember, the most important part of health care you will not find in this
book or any other. The key to good health lies within you and your people, in
the care, the concern, and appreciation you have for each other. If you want to
see your community be healthy, build on these.
w29
NOTICE
This book is to help people meet most of their common
health needs for and by themselves. But it does not have all
the answers. In case of serious illness or if you are uncertain
about how to handle a health problem, get advice from a
health worker or doctor whenever possible.
Home Cures
and Popular Beliefs
CHAPTER
1
Everywhere on earth people use home remedies. In some places, the older
or traditional ways of healing have been passed down from parents to children
for hundreds of years.
Many home remedies have great value. Others have less. And some may be
risky or harmful. Home remedies, like modern medicines, must be used with
caution.
Try to do no harm.
Only use home remedies if you are sure they are safe
and know exactly how to use them.
HOME CURES THAT HELP
For many sicknesses, time-tested home
remedies work as well as modern medicines
— or even better. They are often cheaper.
And in some cases they are safer.
For example, many of the herbal teas
people use for home treatment of coughs
and colds do more good and cause fewer
problems than cough syrups and strong
medicines some doctors prescribe.
Also, the ‘rice water’, teas, or sweetened
drinks that many mothers give to babies
with diarrhea are often safer and do more
good than any modern medicine. What
matters most is that a baby with diarrhea
get plenty of liquids (see p. ,151).
The Limitations
of Home Remedies
Some diseases are helped by home remedies. Others can be treated better
with modern medicine. This is true for most serious infections. Sicknesses like
pneumonia, tetanus, typhoid, tuberculosis, appendicitis, diseases caused by
sexual contact, and fever after childbirth should be treated with modern
medicines as soon as possible. For these diseases, do not lose time trying to
treat them first with home remedies only.
It is sometimes hard to be sure which home remedies work well and which
do not. More careful studies are needed. For this reason:
FOR COUGHS, COLDS, AND COMMON
DIARRHEA, HERBAL TEAS ARE OFTEN
BETTER, CHEAPER, AND SAFER THAN
MODERN MEDICINES.
It is often safer to treat very serious illnesses with modern
medicines — following the advice of a health worker if possible.
2
Old Ways and New
Some modern ways of meeting health needs work better than old ones. But
at times the older, traditional ways are best. For example, traditional ways of
caring for children or old people are often kinder and work better than some
newer, less personal ways.
Not many years ago everyone thought that mother's milk was the best food
for a young baby. They were right! Then the big companies that make canned
and artificial milk began to tell mothers that bottle feeding was better. This is
not true, but many mothers believed them and started to bottle feed their
babies. As a result, thousands of babies have suffered and died needlessly
from infection or hunger. For the reasons breast is best, see p. 271.
Respect your people’s traditions and build on them.
For more ideas for building on local traditions, see Helping Health Workers
Learn, Chapter 7.
BELIEFS THAT CAN MAKE PEOPLE WELL
Some home remedies have a direct effect on the body. Others seem to work
only because people believe in them. The healing power of belief can be
very strong.
For example, I once saw a man who
suffered from a very bad headache.
To cure him, a woman gave him a
small piece of yam, or sweet potato.
She told him it was a strong painkiller.
Fie believed her — and the pain went
away quickly.
It was his faith in her treatment,
and not the yam itself, that made
him feel better.
Many home remedies work in this
way. They help largely because peopleV
have faith in them. For this reason,
they are especially useful to cure illnesses that are partly in people’s
minds, or those caused in part by a person’s beliefs, worry, or fears.
Included in this group of sicknesses are: bewitchment or hexing,
unreasonable or hysterical fear, uncertain ‘aches and pains’ (especially in
persons going through stressful times, such as teenage girls or older women),
and anxiety or nervous worry. Also included are some cases of asthma,
hiccups, indigestion, stomach ulcers, migraine headaches, and even warts.
For all of these problems, the manner or ‘touch’ of the healer can be very
important. What it often comes down to is showing you care, helping the sick
person believe he will get well, or simply helping him relax.
3
Sometimes a person’s belief in a remedy can help with problems that have
completely physical causes.
For example, Mexican villagers have the following home cures for poisonous
snakebite:
In other lands people have their own snakebite remedies — often many
different ones. As far as we know, none of these home remedies has any
direct effect against snake poison. The person who says that a home remedy
kept a snake’s poison from harming him at all was probably bitten by a
non-poisonous snake!
Yet any of these home remedies may do some good if a person believes in it.
If it makes him less afraid, his pulse will slow down, he will move and tremble
less, and as a result, the poison will spread through his body more slowly. So
there is less danger!
But the benefit of these home remedies for snakebite is limited. In spite of
their common use, may people still become very ill or die. As far as we know:
No home cure for poisonous bites
(whether from snakes, scorpions, spiders, or other poisonous animals)
has much effect beyond that of the healing power of belief.
For snakebite it is usually better to use modern treatment. Be prepared: obtain
‘antivenoms’ or ‘serums' for poisonous bites before you need them (see p.
105). Do not wait until it is too late.
4
BELIEFS THAT CAN MAKE PEOPLE SICK
The power of belief can help heal people. But it can also harm them. If a
person believes strongly enough that something will hurt him, his own fear can
make him sick. For example:
Once I was called to see a woman
who had just had a miscarriage and
was still bleeding a little. There was
an orange tree near her house. So I
suggested she drink a glass of orange
juice. (Oranges have vitamin C which
helps strengthen blood vessels.) She
drank it — even though she was afraid
it would harm her.
Her fear was so great that soon
she became very ill. I examined her,
but could find nothing physically
wrong. I tried to comfort her, telling
her she was not in danger. But she
said she was going to die. At last I
gave her an injection of distilled
(completely pure) water. Distilled
water has no medical effect. But
since she had great faith in
injections, she quickly got better.
Actually, the juice did not harm her. What harmed her was her belief that it
would make her sick. And what made her well was her faith in injections!
In this same way, many persons go on believing false ideas about witchcraft,
injections, diet, and many other things. Much needless suffering is the result.
Perhaps, in a way, I had helped this woman. But the more I thought about it,
the more I realized I had also wronged her; I had led her to believe things that
were not true.
I wanted to set this right. So a few days later, when she was completely well,
I went to her home and apologized for what I had done. I tried to help her
understand that not the orange juice, but her fear had made her so sick. And
that not the injection of water, but her freedom from fear had helped her get
well.
By understanding the truth about the orange, the injection, and the tricks of
her own mind, perhaps this woman and her family will become freer from fear
and better able to care for their health in the future. For health is closely
related to understanding and freedom from fear.
5
Many things do harm only because
people believe they are harmful.
WITCHCRAFT— BLACK MAGIC— AND THE EVIL EYE
If a person believes strongly enough that someone has the power to harm
him, he may actually become ill. Anyone who believes he is bewitched or has
been given the evil eye is really the victim of his own fears (see Susto, p. 24).
A ‘witch’ has no power over
other people, except for her ability
to make them believe that she has.
For this reason:
It is impossible to bewitch
a person who does not believe
in witchcraft.
Some people think that they
are ‘bewitched’ when they have
strange or frightening illnesses
(such as tumors of the genitals or
cirrhosis of the liver, see p. 328).
Such sicknesses have nothing to
do with witchcraft or black magic.
Their causes are natural.
Do not waste your money at ‘magic centers’ that claim to cure
witchcraft. And do not seek revenge against a witch, because it will not
solve anything. If you are seriously ill, go for medical help.
6
QUESTIONS AND ANSWERS ON SOME FOLK BELIEFS
AND HOME REMEDIES
These examples are from the mountains of Mexico, the area that I know best.
Perhaps some of the beliefs of your people are similar. Think about ways to
learn which beliefs in your area lead to better health and which do not.
When people think
someone is bewitched, is it
true that he will get well if
his relatives harm or kill
the witch?
FALSE! No one is ever
helped by harming
someone else.
Is it true that when the ‘soft
spot’ on top of a baby’s
head sinks inward this
means the baby will die
of diarrhea unless he
gets special treatment?
This is often true. The 'soft
spot’ sinks because the
baby has lost too much
liquid (see p. 151). Unless
he gets more liquid soon,
he may die (see p. 152).
Is it true that if the
light of the eclipsing
moon falls on a
pregnant mother,
her child will be born
deformed or retarded?
/
This is not true! But
children may be born
retarded, deaf, or deformed
if the mother does not use
iodized salt, if she takes
certain medicines, or for
other reasons (see p. 318).
It is true that soft light
is easier on the eyes of
both the mother and
the newborn child. But
there should be enough
light for the midwife to
see what she is doing.
7
Is it true that a newborn \\ / X
baby should not be bathed /
. until the cord falls off? / /d~~
^ yf ~ i ■
True! The stump of the
n cord should be kept dry
<n until it falls off. But the
1z baby can be gently
7 cleaned with a clean,
/ soft, damp cloth.
it
How many days after giving A ' ^ j
birth should a mother wait / L*/ J
before she bathes? r j\
A mother should wash with
warm water the day after
giving birth. The custom of
not bathing for weeks
following childbirth can
lead to infections.
Is it true that traditional
breast feeding is better
than 'modern' bottle
feeding?
TRUE! Breast milk is
} better food and also
/ helps protect the baby
/ against infection.
What foods should ^ i£j
women avoid in the ^
first few weeks after ^ A
childbirth? 'XJ JT-
do
In the weeks following
childbirth, women should
not avoid any nutritious
foods. Instead, they
should eat plenty of fruit,
vegetables, meat, milk,
eggs, whole grains, and
beans (see p. 276).
8
Is it a good idea to bathe
sick person, or will it do
him harm?
It is a good idea. Sick
people should be bathed
in warm water every day.
Is it true that oranges,
guavas, and other
fruits are harmful
when one has a
cold or a fever?
NO! All fruits and
juices are helpful when
one has a cold or fever.
They do not cause
congestion or harm of
any kind.
NO! When a person has a
high fever, take off all
covers and clothing. Let
the air reach his body.
This will help the fever
go down (see p. 76).
Is it true that tea made
from willow bark will help
bring fever down and
stop pain?
True. It helps. Willow
bark has a natural
medicine in it very
much like aspirin.
9
SUNKEN FONTANEL OR SOFT SPOT
The fontanel is the soft spot on the top of a
newborn baby's head. It is where the bones of
his skull have not formed completely. Normally it
takes a year to a year and a half for the soft spot
to close completely.
Mothers in different lands realize that when the
soft spot sinks inward their babies are in danger.
They have many beliefs to explain this. In Latin
America mothers think the baby’s brains have slipped
downward. They try to correct this by sucking on the
soft spot, by pushing up on the roof of the mouth, or
by holding the baby upside down and slapping his
feet. This does not help because ... A sunken soft
spot is really caused by dehydration (see p. 151).
This means the child is losing more liquid than he is drinking. He is too
dry — usually because he has diarrhea, or diarrhea with vomiting.
Treatment:
1. Give the child plenty of liquid: Rehydration Drink (see p. 152), breast milk,
or boiled water.
2. If necessary, treat the causes of the diarrhea and vomiting (see p. 152 to
161). For most diarrheas, medicine is not needed, and may do more harm
than good.
TO CURE A SUNKEN SOFT SPOT . . .
Note: If the soft spot is swollen or bulges upward, this may be a sign of
meningitis. Begin treatment at once (see p. 185), and get medical help.
WAYS TO TELL WHETHER A HOME REMEDY
WORKS OR NOT
Because a lot of people use a home cure does not necessarily mean it works
well or is safe. It is often hard to know which remedies are helpful and which
may be harmful. Careful study is needed to be sure. Here are four rules to help
tell which remedies are least likely to work, or are dangerous. (Examples are
from Mexican villages.)
1 . THE MORE REMEDIES THERE ARE FOR ANY ONE ILLNESS, THE LESS
LIKELY IT IS THAT ANY OF THEM WORKS.
For example: In rural Mexico there are many home remedies for goiter, none
of which does any real good. Here are some of them:
Not one of these many remedies works. If it did, the others would not be
needed. When a sickness has just one popular cure, it is more likely to be
a good one. For prevention and treatment of goiter use iodized salt (p. 130).
2. FOUL OR DISGUSTING REMEDIES ARE NOT LIKELY TO HELP— AND ARE
OFTEN HARMFUL.
For example:
1 . the idea that leprosy can be cured
by a drink made of rotting snakes
2. the idea that syphilis can
be cured by eating a vulture
DON’T
These two remedies do not help at all. The first one can cause dangerous
infections. Belief in remedies like these sometimes causes delay in getting
proper medical care.
11
3. REMEDIES THAT USE ANIMAL OR HUMAN WASTE DO NO GOOD AND
CAN CAUSE DANGEROUS INFECTIONS. NEVER USE THEM.
Examples:
1. Putting human feces around the
eye does not cure blurred vision
and can cause infections.
2. Smearing cow dung on the head
to fight ringworm can cause tetanus
and other dangerous infections.
Also, the droppings of rabbits or other animals do not help heal burns. To
use them is very dangerous. Cow dung, held in the hand, cannot help control
fits. Teas made from human, pig, or any other animal feces do not cure
anything. They can make people sicker. Never put feces on the navel of a
newborn baby. This can cause tetanus.
4. THE MORE A REMEDY RESEMBLES THE SICKNESS IT IS SAID TO CURE,
THE MORE LIKELY ITS BENEFITS COME ONLY FROM THE POWER OF
BELIEF.
The association between each of the following illnesses and its remedy is
clear in these examples from Mexico:
1. for a nosebleed, using yesca
(a bright red mushroom)
2. for deafness, putting
powdered rattlesnake’s
rattle in the ear
3. for dog bite, drink tea made
from the dog’s tail
4. for scorpion sting, tying a
scorpion against the stung
finger
5. to prevent diarrhea when a child
is teething, putting a necklace of
snake’s fangs around the baby’s
6. to ‘bring out’ the rash of
measles, making tea from
kapok bark
These remedies, and many other similar ones, have no curative value in
themselves. They may be of some benefit if people believe in them. But for
serious problems, be sure their use does not delay more effective treatment.
12
MEDICINAL PLANTS
Many plants have curative powers. Some of the best modern medicines are
made from wild herbs.
Nevertheless, not all ‘curative herbs' people use have medical value . . . and
those that have are sometimes used the wrong way. Try to learn about the
herbs in your area and find out which ones are worthwhile.
CAUTION! Some medicinal herbs are very poisonous if taken in
more than the recommended dose. For this reason it is often safer
to use modern medicine, since the dosage is easier to control.
Here are a few examples of plants that can be useful if used correctly:
ANGEL’S TRUMPET (Datura arborea)
The leaves of this and certain other members
of the nightshade family contain a drug that helps
to calm intestinal cramps, stomach-aches, and
even gallbladder pain.
Grind up 1 or 2 leaves of Angel’s Trumpet and soak
them for a day in 7 tablespoons (100 ml.) of water.
Dosage: Between 10 and 15 drops every 4 hours (adults only).
WARNING: Angel’s Trumpet is very poisonous if you take
more than the recommended dose.
CORN SILK (the tassels or ‘silk’ from an ear of maize)
A tea made from corn silk makes
a person pass more urine. This can help
reduce swelling of the feet — especially in
pregnant women (see p. 176 and 248).
Boil a large handful of corn silk in water and
drink 1 or 2 glasses. It is not dangerous.
GARLIC
A drink made from garlic can often get rid of pinworms.
Chop finely, or crush, 4 cloves of garlic and mix with 1
glass of liquid (water, juice, or milk).
Dosage: Drink 1 glass daily for 3 weeks.
To treat vaginal infections with garlic, see p. 241 and 242.
13
CARDON CACTUS (Pachycerius pectin-aboriginum)
Cactus juice can be used to clean wounds when there is no
boiled water and no way to get any. Cardon cactus also helps
stop a wound from bleeding, because the juice makes the cut
blood vessels squeeze shut.
Cut a piece of the cactus
with a clean knife and press
it firmly against the wound.
When the bleeding is
under control, tie a piece
of the cactus to the wound
with a strip of cloth.
After 2 or 3 hours, take off , -
the cactus and clean the wound with boiled water and soap. There are more
instructions on how to care for wounds and control bleeding on pages 82 to 87.
ALOE VERA (Sabila)
Aloe vera can be used to treat minor burns and wounds.
The thick, slimy juice inside the plant calms pain and
itching, aids healing, and helps prevent infection. Cut off
a piece of the plant, peel back the outer layer, and apply
the fleshy leaf or juice directly to the burn or wound.
Aloe can also help treat stomach ulcers and gastritis.
Chop the spongy leaves into small pieces, soak them in water
then drink one glass of the slimy, bitter liquid every 2 hours.
PAPAYA
Ripe papayas are rich in vitamins and also aid
digestion. Eating them is especially helpful for weak
or old people who complain of upset stomach when
they eat meat, chicken, or eggs. Papaya makes these
foods easier to digest.
Papaya can also help get rid of intestinal worms,
although modern medicines often work better.
Collect 3 or 4 teaspoons (15-20 ml.) of the ‘milk’ that comes out when the green
fruit or trunk of the tree is cut. Mix this with an equal amount of sugar or honey
and stir it into a cup of hot water. If possible, drink along with a laxative.
Or, dry and crush to a powder the papaya seeds. Take 3 teaspoons mixed
with 1 glass water or some honey 3 times a day for 7 days.
Papayas can also be used for treating pressure sores. The fruit contains
chemicals that help soften and make dead flesh easier to remove. First clean
and wash out a pressure sore that has dead flesh in it. Then soak a sterile cloth
or gauze with ‘milk’ from the trunk or green fruit of a papaya plant and pack
this into the sore. Repeat cleaning and repacking 3 times a day.
14
HOMEMADE CASTS—
FOR KEEPING BROKEN BONES IN PLACE
In Mexico several different plants such as tepeguaje (a tree of the bean
family) and solda con solda (a huge, tree-climbing arum lily) are used to make
casts. However, any plant will do if a syrup can be made from it that will dry
hard and firm and will not irritate the skin. In India, traditional bone-setters
make casts using a mixture of egg whites and herbs instead of a syrup made
from plant juices. But the method is similar. Try out different plants in your area.
For a cast using tepeguaje: Put 1 kilogram
of the bark into 5 liters of water and boil until
only 2 liters are left. Strain and boil until a thick
syrup is formed. Dip strips of flannel or clean
sheet in the syrup and carefully use as follows.
Make sure the bones are in a good position (p. 9£
Do not put the cast directly against the skin.
Wrap the arm or leg in a soft cloth.
Then follow with a layer of cotton or wild kapok.
Finally, put on the wet cloth strips so that
they form a cast that is firm but not too tight.
Most doctors recommend that the cast cover the
joint above and the joint below the break, to keep
the broken bones from moving.
This would mean that, for a broken wrist, the cast
should cover almost the whole arm, like this:
Leave the finger tips uncovered so that
you can see if they keep a good color.
However, traditional bone-setters in China and
Latin America use a short cast on a simple break of
the arm saying that a little movement of the bone-
ends speeds healing. Recent scientific studies
have proven this to be true.
A temporary leg or arm splint can be made of
cardboard, folded paper, or the thick curved stem
of dried banana leaf, or palm leaf.
CAUTION: Even if the cast is not very tight when you put it on, the broken limb
may swell up later. If the person complains that the cast is too tight, or if his
fingers or toes become cold, white, or blue, take the cast off and put on a new,
looser one.
Never put on a cast over a cut or a wound.
D-
15
ENEMAS, LAXATIVES, AND PURGES:
WHEN TO USE THEM AND WHEN NOT TO
Many people give enemas and take laxatives far
too often. The ‘urge to purge’ is world wide.
' Enemas and purges are very popular home
cures. And they are often very harmful. Many
people believe fever and diarrhea can be ‘washed
out’ by giving an enema (running water into the
gut through the anus) or by using a purge, or
strong laxative. Unfortunately, such efforts to
clean or purge the sick body often cause more
injury to the already damaged gut.
Rarely do enemas or laxatives do any good at all.
Often they are dangerous— especially strong laxatives.
CASES IN WHICH IT IS DANGEROUS TO USE ENEMAS OR LAXATIVES
Never use an enema or laxative if a person has a severe stomach-ache or
any other sign of appendicitis or 'acute abdomen’ (see p. 93), even if he
passes days without a bowel movement.
Never give an enema or laxative to a person with a bullet wound or other
injury to the gut.
Never give a strong laxative to a weak or sick person. It will weaken him
more.
Never give an enema or purge to a baby less than 2 years old.
Never give a laxative or purge to a child with high fever, vomiting, diarrhea
or signs of dehydration (see p. 151). It can increase dehydration and kill
the child.
Do not make a habit of using laxatives often (see Constipation, p. 126).
THE CORRECT USES OF ENEMAS
1. Simple enemas can help relieve constipation (dry, hard, difficult stools).
Use warm water only, or water with a little soap in it.
2. When a person with severe vomiting is dehydrated, you can try replacing
water by giving an enema of Rehydration Drink very slowly (see p. 152).
16
PURGES AND LAXATIVES THAT ARE OFTEN USED
CASTOR OIL
SENNA LEAF
CASCARA (cascara sagrada)
These are irritating purges that often do
more harm than good. It is better not to
use them.
MAGNESIUM HYDROXIDE
These are salt purges. Use them only in
MILK OF MAGNESIA
low doses, as laxatives for constipation.
EPSOM SALTS (magnesium sulfate) Do not use them often and never when
(see p. 383)
there is pain in the belly.
MINERAL OIL
This is sometimes used for constipation in
(see p. 383)
persons with piles... but it is like passing
greased rocks. Not recommended.
CORRECT USES OF LAXATIVES AND PURGES
Laxatives are like purges but weaker. All the products listed above are
laxatives when taken in small doses and purges when taken in large doses.
Laxatives soften and hurry the bowel movement; purges cause diarrhea.
Purges: The only time a person should use a strong dose of a purge is when
he has taken a poison and must clean it out quickly (see p. 103). At any other
time a purge is harmful.
Laxatives: One can use milk of magnesia or other magnesium salts in small
doses, as laxatives, in some cases of constipation. People with hemorrhoids
(piles, p. 175) who have constipation can take mineral oil but this only makes
their stools slippery, not soft. The dose for mineral oil is 3 to 6 teaspoons at
bedtime (never with a meal because the oil will rob the body of important
vitamins in the food). This is not the best way.
Suppositories, or bullet-shaped pills that can be pushed up the rectum, can
also be used to relieve constipation or piles (see pages 175, 383, and 392).
A BETTER WAY
Foods with fiber. The healthiest and most gentle way to have softer, more
frequent stools is to drink a lot of water and to eat more foods with lots of
natural fiber, or 'roughage' like cassava, yam, or bran (wheat husks) and other
whole grain cereals (see p. 126). Eating plenty of fruits and vegetables also
helps.
People who traditionally eat lots of food with natural fiber suffer much less
from piles, constipation, and cancer of the gut than do people who eat a lot of
refined 'modern' foods. For better bowel habits, avoid refined foods and eat
foods prepared from unpolished or unrefined grains.
17
Sicknesses That
Are Often Confused
CHAPTER
2
WHAT CAUSES SICKNESS?
Persons from different countries or backgrounds have different ways to
explain what causes sickness.
A baby gets diarrhea. But why?
People in small villages may say
it is because the parents did
something wrong, or perhaps
because they made a god or
spirit angry.
A doctor may say it is because
the child has an infection.
A public health officer may say
it is because the villagers
do not have a good water
system or use latrines.
A social reformer may say the unhealthy conditions that lead to frequent
childhood diarrhea are caused by an unfair distribution of land and wealth.
A teacher may place the blame on lack of education.
People see the cause of sickness in terms of their own experience and point
of view. Who then is right about the cause? Possibly everyone is right, or partly
right. This is because . . .
Sickness usually results from a combination of causes.
“Why my child?”
Each of the causes suggested above may be a part
of the reason why a baby gets diarrhea.
To prevent and treat sickness successfully, it helps
to have as full an understanding as possible about the
common sicknesses in your area and the combination
of things that causes them.
In this book, different sicknesses are discussed
mostly according to the systems and terms of modern
or scientific medicine.
To make good use of this book, and safe use of
the medicines it recommends, you will need some
understanding of sicknesses and their causes
according to medical science. Reading this chapter
may help.
18
DIFFERENT KINDS OF SICKNESSES AND THEIR CAUSES
When considering how to prevent or treat different sicknesses, it helps to
think of them in two groups: infectious and non-infectious.
Infectious diseases are those that spread from one person to another.
Healthy persons must be protected from people with these sicknesses.
Non-infectious diseases do not spread from person to person. They have
other causes. Therefore, it is important to know which sicknesses are infectious
and which are not.
Non-infectious Diseases
Non-infectious diseases have many different causes. But they are never
caused by germs, bacteria, or other living organisms that attack the body. They
never spread from one person to another. It is important to realize that
antibiotics, or medicines that fight germs (see p. 55), do not help cure
non-infectious diseases.
Remember: Antibiotics are of no use for non-infectious diseases.
EXAMPLES OF NON-INFECTIOUS DISEASES
Problems caused by something
that wears out or goes wrong
within the body:
rheumatism
heart attack
epileptic fits
stroke
migraine headaches
cataract
Problems caused by something
from outside that harms or
troubles the body:
allergies
asthma
poisons
snakebite
cough from smoking
stomach ulcer
alcoholism
Problems caused by a lack of
something the body needs:
malnutrition
anemia
pellagra
night blindness and
xerophthalmia
goiter and cretinism
cirrhosis of the liver
(part of the cause)
Problems people are born with:
harelip
crossed or wall-eyes
(squint)
other deformities
epilepsy (some kinds)
retarded (backward)
children
birthmarks
Problems that begin in the mind
(mental ‘illnesses’):
fear that something is harmful when it is not
(paranoia)
nervous worry (anxiety)
belief in hexes (witchcraft)
uncontrolled fear (hysteria)
Infectious Diseases
Infectious diseases are caused by bacteria and other organisms (living
things) that harm the body. They are spread in many ways. Here are some of
the most important kinds of organisms that cause infections and examples of
sicknesses they cause:
19
EXAMPLES OF INFECTIOUS DISEASES
Organism that causes
the sickness
Name of the sickness
How it is spread or
enters the body
Principal medicine
tuberculosis
through the air
(coughing)
tetanus
dirty wounds
some diarrhea
dirty fingers, water, flies
bacteria
(microbes or germs)
pneumonia
(some kinds)
through the air
(coughing)
different
antibiotics
for different
bacterial
infections
gonorrhea,
chlamydia, and
syphillis
sexual contact
earache
with a cold
infected wounds
contact with dirty things
sores with pus
direct contact
(by touch)
virus
(germs smaller
colds, flu, measles,
mumps, chickenpox,
infantile paralysis,
virus diarrhea
from someone who is
sick, through the
air, by coughing,
flies, etc.
aspirin and other
painkillers (There are
no medicines that fight
viruses effectively.
than bacteria)
rabies
animal bites
Antibiotics do not
help.) Vaccinations
warts
touch
help prevent some
virus infections.
fungus
ringworm
athlete’s foot
jock itch
by touch or from
clothing
sulfur and vinegar
ointments: undecylenic,
benzoic, salicylic acid
griseofulvin
internal parasites
(harmful animals
living in the body)
In the gut:
worms
amebas
(dysentery)
feces-to-mouth
lack of cleanliness
different specific
medicines
In the blood:
malaria
mosquito bite
chloroquine (or other
malaria medicine)
external parasites
(harmful animals
living on the body)
lice
fleas
bedbugs
scabies
by contact with
infected persons
or their clothes
insecticides,
lindane
Bacteria, like many of the organisms that cause infections, are so
small you cannot see them without a microscope— an instrument that —
makes tiny things look bigger. Viruses are even smaller than bacteria. j
Antibiotics (penicillin, tetracycline, etc.) are medicines that help ^ ^
cure certain illnesses caused by bacteria. Antibiotics have no effect
on illnesses caused by most viruses, such as colds, flu, mumps, chickenpox,
etc. Do not treat virus infections with antibiotics. They will not help and may
be harmful (see Antibiotics, p. 55).
20
SICKNESSES THAT ARE HARD TO TELL APART
Sometimes diseases that have different causes and require different
treatment result in problems that look very much alike. For example:
1. A child who slowly becomes thin and wasted, while
his belly gets more and more swollen, could have
any (or several) of the following problems:
• malnutrition (see p. 112)
• a lot of roundworms, p. 140,
(usually together with malnutrition)
• advanced tuberculosis (p. 179)
• a long-term severe urinary infection (p. 2341
• any of several problems of the liver or spleen
• leukemia (cancer of the blood)
2. An older person with a big, open, slowly
growing sore on the ankle could have:
• bad circulation that results from varicose
veins or other causes (p. 213)
• diabetes (p. 127)
• infection of the bone (osteomyelitis)
• leprosy (p. 191)
• tuberculosis of the skin (p. 212)
• advanced syphilis (p. 237)
The medical treatment for each of these diseases is different, so to treat
them correctly it is important to tell them apart.
Many illnesses at first seem very similar. But if you ask the right questions
and know what to look for, you can often learn information and see certain
signs that will help tell you what illness a person has.
This book describes the typical history and signs for many illnesses. But be
careful! Diseases do not always show the signs described for them — or the
signs may be confusing. For difficult cases, the help of a skilled health
worker or doctor is often needed. Sometimes special tests or analyses are
necessary.
Work within your limits!
In using this book, remember it is easy to make mistakes.
Never pretend you know something you do not.
If you are not fairly sure what an illness is and how to
treat it, or if the illness is very serious— get medical help.
SICKNESSES THAT ARE OFTEN CONFUSED
OR GIVEN THE SAME NAME
21
Many of the common names people use for their sicknesses were first used
long before anyone knew about germs or bacteria or the medicines that fight
them. Different diseases that caused more or less similar problems — such as
‘high fever’ or 'pain in the side’ — were often given a single name. In many parts
of the world, these common names are still used. City-trained doctors often
neither know nor use these names. For this reason, people sometimes think
they apply to ‘sicknesses doctors do not treat’. So they treat these home
sicknesses with herbs or home remedies.
Actually, most of these home sicknesses or ‘folk diseases’ are the same ones
known to medical science. Only the names are different.
For many sicknesses, home remedies work well. But for some
sicknesses, treatment with modern medicine works much better and may
be life-saving. This is especially true for dangerous infections like pneumonia,
typhoid, tuberculosis, or infections after giving birth.
To know which sicknesses definitely require modern medicines and to
decide what medicine to use, it is important that you try to find out what the
disease is in the terms used by trained health workers and in this book.
If you cannot find the sickness you are looking for
in this book, look for it under a different name or in
the chapter that covers the same sort of problem.
Use the list of CONTENTS and the INDEX.
If you are unsure what the sickness is — especially if it seems serious — try to
get medical help.
The rest of this chapter gives examples of common or traditional names
people use for various sicknesses. Often a single name is given to diseases
that are different according to medical science.
Examples cannot be given for each country or area where this book may be
used. Therefore, I have kept those from the Spanish edition, with names used
by villagers in western Mexico. They will not be the same names you use.
However, people in many parts of the world see and speak of their illnesses in
a similar way. So the examples may help you think about how people name
diseases in your area.
Can you think of a name your people use for the following ‘folk
diseases’? If you can, write it in after the Spanish name, where it says,
Name in Your Area:
22
EXAMPLES OF LOCAL NAMES FOR SICKNESSES
Spanish Name: EMPACHO (STOPPED-UP GUT) Name in Your Area:
In medical terms empacho
(impaction) means that the gut is
stopped up or obstructed (see
p. 94). But in Mexican villages any
illness causing stomach-ache or
diarrhea may be called empacho.
It is said that a ball of hair or
something else blocks a part of
the gut. People put the blame on
witches or evil spirits, and treat
with magic cures and cupping
(see picture). Sometimes folk
healers pretend to take a ball of hair and thorns out of the gut by sucking on
the belly.
Different illnesses that cause stomach pain or discomfort and are sometimes
called empacho are:
• diarrhea or dysentery with cramps (p. 153)
• worms (p. 140)
• swollen stomach due to malnutrition (p. 112)
• indigestion or stomach ulcer (p. 128)
• and rarely, true gut obstruction or appendicitis (p. 94)
Most of these problems are not helped much by magic cures or cupping. To
treat empacho, try to identify and treat the sickness that causes it.
Spanish Name: DOLOR DE IJAR (SIDE PAINS) Name in Your Area:
This name is used for any pain women get in c
side of their belly. Often the pain goes around to
the mid or lower back. Possible causes of this kii
of pain include:
• an infection of the urinary system (the
kidneys, the bladder, or the tubes that
join them, see p. 234)
• cramps or gas pains (see diarrhea, p. 153)
• menstrual pains (see p. 245)
• appendicitis (see p. 94)
• an infection, cyst, or tumor in the womb
or ovaries (p. 243) or an out-of-place
pregnancy (see p. 280)
23
Spanish Name: LA CONGESTION (CONGESTION) Name in Your Area:
Any sudden upset or illness that causes great distress is called la
congestion by Mexican villagers. People speak of congestion of:
the head, the chest, the stomach, or the whole body.
It is said that la congestion strikes persons who break ‘the diet' (see p. 1 23),
by eating foods that are forbidden or taboo after childbirth, while taking a
medicine, or when they have a cold or cough. Although these foods usually
cause no harm and are sometimes just what their bodies need, many people
will not touch them because they are so afraid of getting la congestion.
Different illnesses that are sometimes called la congestion are:
• Food poisoning, from eating spoiled food: causes sudden vomiting
followed by diarrhea, cramps, and weakness (see p. 135).
• A severe allergic reaction, in allergic persons after they eat certain foods
(shellfish, chocolate, etc.), take certain medicines, or are injected with
penicillin. May cause vomiting, diarrhea, cold sweat, breathing trouble,
itchy rash, and severe distress (see p. 166).
• Any sudden upset of the stomach or gut: see diarrhea (p. 153), vomiting
(p. 161}, and acute abdomen (p. 93).
• Sudden or severe difficulty breathing: caused by asthma (p. 167),
pneumonia (p. 171), or something stuck in the throat (p. 79).
• Illnesses that cause fits or paralysis: see fits (p. 178), tetanus (p. 182),
meningitis (p. 185), polio (p. 314), and stroke (p. 327).
• Heart attacks: mostly in older persons (p. 325).
Spanish Name: LATIDO (PULSING) Name in Your Area:
Latido is a name used in Latin America for a pulsing or ‘jumping1 in the pit of
the stomach. It is really the pulse of the aorta or big blood vessel coming from
the heart. This pulse can be seen and felt on a person who is very thin and
hungry. Latido is often a sign of malnutrition (p. 1 12) — or hunger! Eating
enough good food is the only real treatment (see p . 110 and 111).
24
Spanish Name: SUSTO (HYSTERIA, FRIGHT) Name in Your Area:
According to Mexican villagers, susto is caused by a sudden fright a person
has had, or by witchcraft, black magic, or evil spirits. A person with susto is
very nervous and afraid. He may shake, behave strangely, not be able to sleep,
lose weight, or even die.
Possible medical explanations for susto:
1 . In many people, susto is a state of fear or hysteria, perhaps caused by
the ‘power of belief’ (see p. 4). For example, a woman who is afraid someone
will hex her becomes nervous and does not eat or sleep well. She begins to
grow weak and lose weight. She takes this as a sign she has been hexed, so
she becomes still more nervous and frightened. Her susto gets worse and
worse.
2. In babies or small children, susto is usually very different. Bad dreams
may cause a child to cry out in his sleep or wake up frightened. High fevers
from any illness can cause very strange speech and behavior (delirium). A
child that often looks and acts worried may be malnourished (p. 1 12).
Sometimes early signs of tetanus (p. 182) or meningitis (p. 185) are also called
susto.
Treatment:
When the susto is caused by a specific illness, treat the illness. Help the
person understand its cause. Ask for medical advice, if needed.
When the susto is caused by fright, try to comfort the person and help him
understand that his fear itself is the cause of his problem. Magic cures and
home remedies sometimes help.
If the frightened person is breathing very hard and fast, his body may be
getting too much air — which may be part of the problem:
EXTREME FRIGHT OR HYSTERIA WITH FAST HEAVY BREATHING
(HYPERVENTILATION)
Signs:
• person very frightened
• breathing fast and deep
• fast, pounding heartbeat
• numbness or tingling of face,
hands, or feet
• muscle cramps
Treatment:
BEFORE
Keep the person as quiet as possible.
Have her put her face in a paper bag and breathe
slowly. She should continue breathing the same air
for 2 or 3 minutes. This will usually calm her down.
Explain to her that the problem is not dangerous,
and she will soon be all right.
25
MISUNDERSTANDINGS DUE TO CONFUSION OF NAMES
This page shows 2 examples of misunderstandings that can result when
certain names like ‘cancer’ and ‘leprosy’ mean one thing to medical workers
and something else to villagers. In talking with health workers — and in using
this book:
Avoid misunderstanding— go by the signs and history
of a person’s sickness, not the name people give it!
Spanish Name: CANCER (CANCER) Name in Your Area:
Mexican villagers use the word cancer for any severe infection of the skin,
especially badly infected wounds (p. 88) or gangrene (p. 213).
In modern medical language, cancer is not an infection, but an abnormal
growth or lump in any part of the body. Common types of cancer that you
should watch out for are:
Any hard, painless, slowly growing lump in any part of your body may be
cancer. Cancer is often dangerous and may need surgery.
At the first suspicion of cancer seek medical help.
Spanish Name: LEPRA (LEPROSY) Name in Your Area:
Mexican villagers call any open spreading sore
lepra. This leads to confusion, because medical
workers use this term only for true leprosy (Hansen’s
disease, p. 191). Sores commonly called lepra are:
• impetigo and other skin infections (p. 202)
• sores that come from insect bites or scabies (p. 199)
• chronic sores or skin ulcers such as those caused
by poor circulation (p. 213)
• skin cancer (p. 21 1)
• less commonly, leprosy (p. 191) or tuberculosis of
the skin (p. 212)
This child has impetigo,
not leprosy.
26
CONFUSION BETWEEN DIFFERENT ILLNESSES
THAT CAUSE FEVER
Spanish Name: LA FIEBRE { THE FEVER) Name in Your Area:
Correctly speaking, a fever is a body
temperature higher than normal. But in
Latin America, a number of serious
illnesses that cause high temperatures
are all called la fiebre — or ‘the fever’.
To prevent or treat these diseases
successfully, it is important to know
how to tell one from another.
Here are some of the important acute illnesses in which fever is an
outstanding sign. The drawings show the fever pattern (rise and fall of
temperature) that is typical for each disease.
Malaria: (see p. 186)
Begins with weakness, chills and
fever. Fever may come and go
for a few days, with shivering
(chills) as the temperature rises,
and sweating as it falls. Then,
fever may come for a few hours
every second or third day. On
other days, the person may
feel more or less well.
MALARIA-TYPICAL The solid line shows the rise
FEVER PATTERN and fall of temperature.
Typhoid: (see p. 188)
Begins like a cold. Temperature
goes up a little more each day.
Pulse relatively slow. Sometimes
diarrhea and dehydration.
Trembling or delirium (mind
wanders). Person very ill.
Typhus: (see p. 190)
Similar to typhoid. Rash similar to
that Of measles, With tiny bruises. HEPATITIS- Usually the fever
TYPICAL FEVER PATTERN is mild.
Hepatitis: (see p. 172)
Person loses appetite. Does not
wish to eat or smoke. Wants to
vomit (nausea). Eyes and skin turn
yellow; urine orange or brown;
stools whitish. Sometimes liver
becomes large, tender. Mild fever.
Person very weak.
TYPHOID— The fever goes up
TYPICAL FEVER PATTERN a little each day.
27
Pneumonia: (see p. 171)
Fast, shallow breathing.
Temperature rises quickly.
Cough with green, yellow,
or bloody mucus. May be
pain in chest. Person very ill.
PNEUMONIA-TYPICAL FEVER PATTERN
I i bacterial infection
I 1 | (untreated)
Rheumatic fever: (see p. 310)
Most common in children and
teenagers. Pain in joints.
High fever. Often comes after
a sore throat. May be pain in
the chest with shortness of
breath. Or uncontrolled
movements of arms and legs.
RHEUMATIC FEVER-TYPICAL FEVER PATTERN
Brucellosis (undulant fever,
Malta fever): (see p. 188)
Begins slowly with tiredness,
headache, and pains in the
bones. Fever and sweating
most common at night. Fever
disappears for a few days only
to come back again. This may
go on for months or years.
BRUCELLOSIS-
TYPICAL FEVER PATTERN
Fever comes in waves. Rises in
the afternoon and falls at night.
o o
41*1
(?
I
O J)
Weeks of Illness
CHILDBIRTH FEVER-TYPICAL FEVER PATTERN
Childbirth fever: (see p. 276) r
j <5 <r> ^ ^
,J I I 1 I I ! 1
Begins a day or more after giving
■ 1 ! ! I 1 ! 1
_ 40o| j person gets worse
birth. Starts with a slight fever,
1 1 1 and fever rises /i i'-'
which often rises later. Foul-smelling
1 1 | 1 1 J | 1
_ 3a=l i usually begins with 1y i i
vaginal discharge. Pain and
,J jlow fever'V-^] \ |
sometimes bleeding. j
1 I 1 i t l i i
- 36°l l 1 J i III
12 34 56 70
1
| Days following childbirth
All of these illnesses can be dangerous. In addition to those shown here,
there are many other diseases that may cause similar signs and fever. For
example, fevers that last for more than 1 month, or night sweats, may be
caused by the HIV/AIDS virus (see p. 399). When possible, seek medical help.
29
CHAPTER
How to Examine
a Sick Person
■ To find out the needs of a sick person, first you must ask important questions
and then examine him carefully. You should look for signs and symptoms that
help you tell how ill the person is and what kind of sickness he may have.
Always examine the person where there is good light, preferably in the
sunlight — never in a dark room.
There are certain basic things to ask and to look for in anyone who is sick.
These include things the sick person feels or reports (symptoms), as well as
things you notice on examining him (signs). These signs can be especially
important in babies and persons unable to talk. In this book the word ‘signs’ is
used for both symptoms and signs.
When you examine a sick person, write down your findings and keep
them for the health worker in case he is needed (see p. 44).
QUESTIONS
Start by asking the person about
her sickness. Be sure to ask the
following:
What bothers you most right now?
What makes you feel better or
worse?
How and when did your sickness
begin?
Have you had this same trouble
before, or has anyone else in
your family or neighborhood
had it?
Continue with other questions in order to learn the details of the illness.
For example, if the sick person has a pain, ask her:
Where does it hurt? (Ask her to point to the exact place with one finger.)
Does it hurt all the time, o.r off and on?
What is the pain like? (sharp? dull? burning?)
Can you sleep with the pain?
If the sick person is a baby who still does not talk, look for signs of pain.
Notice his movements and how he cries. (For example, a child with an earache
sometimes rubs the side of his head or pulls at his ear.)
30
GENERAL CONDITION OF HEALTH
Before touching the sick person, look at him carefully. Observe how ill or
weak he looks, the way he moves, how he breathes, and how clear his mind
seems. Look for signs of dehydration (see p. 151) and of shock (p. 77).
Notice whether the person looks well nourished or poorly nourished. Has he
been losing weight? When a person has lost weight slowly over a long period
of time, he may have a chronic illness (one that lasts a long time).
Also note the color of the skin and eyes. These sometimes change when a
person is sick. (Dark skin can hide color changes. So look at parts of the
body where the skin is pale, such as palms of the hands or soles of the feet,
the fingernails, or the insides of the lips and eyelids.)
• Paleness, especially of the lips and inside the eyelids, is a sign of anemia (p. 124).
Skin may also go lighter as a result of tuberculosis (p. 1 79), or kwashiorkor (p. 1 13).
• Darkening of the skin may be a sign of starvation (see p. 1 12).
• Bluish skin, especially blueness or darkness of the lips and fingernails, may mean
serious problems with breathing to. 79, 167, and 313) or with the heart (p. 325).
Blue-gray color in an unconscious child may be a sign of cerebral malaria (p. 186).
• A gray-white coloring, with cool moist skin, often means a person is in shock (p. 77).
• Yellow color (jaundice) of the skin and eyes may result from disease in the liver
(hepatitis, p. 172, cirrhosis, p. 328, or amebic abscess, p. 145) or gallbladder (p.
329). It may also occur in newborn babies (p. 274), and in children born with
sickle cell disease (p. 321).
Look also at the skin when a light is shining across it from one side. This can
show the earliest sign of measles rash on the face of a feverish child (p. 31 1).
TEMPERATURE
It is often wise to take a sick person’s temperature, even if
he does not seem to have a fever. If the person is very sick,
take the temperature at least 4 times each day and write it down.
If there is no thermometer, you can get an
idea of the temperature by putting the back
of one hand on the sick person's forehead
and the other on your own or that of another
healthy person. If the sick person has a
fever, you should feel the difference.
It is important to find out when and how the fever comes, how long it lasts,
and how it goes away. This may help you identify the disease. Not every fever
is malaria, though in some countries it is often treated as such. Remember
other possible causes. For example:
• Common cold, and other virus infections (p. 163). The fever is usually mild.
• Typhoid causes a fever that goes on rising for 5 days. Malaria medicine does not help.
• Tuberculosis sometimes causes a mild fever in the afternoon. At night the person often
sweats, and the fever goes down.
31
How to Use a Thermometer
Every family should have a thermometer. Take the temperature of a sick
person 4 times a day and always write it down.
How to read the thermometer (using one marked in degrees centigrade — ° C):
Turn the thermometer until High Fever
The point where the silver line Th is thermometer
stops marks the temperature. marks 40 degrees C.
How to take the temperature:
1. Clean the thermometer well with soap
and water or alcohol. Shake it hard, with
a snap of the wrist, until it reads less than
36 degrees.
2. Put the thermometer . . .
under the tongue
(keeping the or
mouth shut)
in the armpit if there
is danger of biting
the thermometer
carefully, in the anus
or of a small child
(wet or grease it first)
3. Leave it there for 3 or 4 minutes.
4. Read it. (An armpit temperature will read a little lower than a mouth
reading; in the anus it will read a little higher.)
5. Wash the thermometer well with soap and water.
Note: In newborn babies a temperature that is unusually high or unusually low
(below 36°) may mean a serious infection (see p. 275).
♦ To learn about other fever patterns, see p._26 to 27.
♦ To learn what to do for a fever, see p. 75.
32
BREATHING (RESPIRATION)
Pay special attention to the way the sick person breathes — the depth (deep
or shallow), rate (how often breaths are taken), and difficulty. Notice if both
sides of the chest move equally when she breathes.
If you have a watch or simple timer, count the number of breaths per minute
(when the person is quiet). Between 12 and 20 breaths per minute is normal for
adults and older children. Up to 30 breaths a minute is normal for children, and
40 for babies. People with a high fever or serious respiratory illnesses (like
pneumonia) breathe more quickly than normal. More than 40 shallow breaths a
minute in an adult, or 60 in a small child, usually means pneumonia.
Listen carefully to the sound of the breaths. For example:
• A whistle or wheeze and difficulty breathing out can mean asthma (see
p. 167).
• A gurgling or snoring noise and difficult breathing in an unconscious
person may mean the tongue, mucus (slime or pus), or something else is
stuck in the throat and does not let enough air get through.
Look for ‘sucking in' of the skin between ribs and at the angle of the neck
(behind the collar bone) when the person breathes in. This means air has
trouble getting through. Consider the possibility of something stuck in the
throat (p. 79), pneumonia (p. 171), asthma (p. 167), or bronchitis (mild sucking
in, see p. 170).
If the person has a cough, ask if it keeps her from sleeping. Find out if she
coughs up mucus, how much, its color, and if there is blood in it.
PULSE (HEARTBEAT)
To take the person’s pulse,
put your fingers on the wrist
as shown, (Do not use your
thumb to feel for the pulse.)
If you cannot find the pulse
in the wrist, feel for it in the
neck beside the voicebox,
or put your ear directly on
the chest and listen for the
heartbeat (or use a
stethoscope if you have one),
Pay attention to the strength, the rate, and the regularity of the pulse. If you
have a watch or timer, count the pulses per minute.
NORMAL PULSE FOR PEOPLE AT REST
adults from 60 to 80 per minute
children 80 to 100
babies 100 to 140
The pulse gets much faster with exercise and when a person is nervous,
frightened, or has a fever, As a general rule, the pulse increases 20 beats per
minute for each degree (°C) rise in fever.
When a person is very ill, take the pulse often and write it down along with
the temperature and rate of breathing.
It is important to notice changes in the pulse rate. For example:
• A weak, rapid pulse can mean a state of shock (see p. 77).
• A very rapid, very slow, or irregular pulse could mean heart trouble
(see p. 325),
• A relatively slow pulse in a person with a high fever may be a sign of
typhoid (see p. 188).
EYES
Look at the color of the white part of the eyes. Is it normal, red (p. 219), or
yellow? Also note any changes in the sick person’s vision.
Have the person slowly move her eyes up and down and from side to side.
Jerking or uneven movement may be a sign of brain damage.
Pay attention to the size of the pupils (the black ‘window’ in the center of the
eye). If they are very large, it can mean a state of shock (see p. 77). If they are
very large, or very small, it can mean poison or the effect of certain drugs.
Look at both eyes and note any difference between the two, especially in the
size of the pupils:
A big difference in the size of the pupils is almost always a medical
emergency.
• If the eye with the larger pupil hurts so badly it causes vomiting, the
person probably has GLAUCOMA (see p. 222).
• If the eye with the smaller pupil hurts a great deal, the person may have
IRITIS, a very serious problem (see p. 221).
• Difference in the size of the pupils of an unconscious person or a person
who has had a recent head injury may mean brain damage. It may also
mean STROKE (see p. 327).
Always compare the pupils of a person who is unconscious or has had a
head injury.
EARS, THROAT, AND NOSE
Ears: Always check for signs of pain and
infection in the ears — especially in a child with
fever or a cold. A baby who cries a lot or pulls
at his ear often has an ear infection (p. 309).
Pull the ear gently. If this increases pain, the
infection is probably in the tube of the ear (ear
canal). Also look for redness or pus inside the ear.
A small flashlight or penlight will help. But never
put a stick, wire, or other hard object inside the ear.
Find out if the person hears well, or if one side is more deaf than the other.
Rub your thumb and fingers together near the person’s ear to see if he can
hear it. For deafness and ringing of the ears see page 327.
Throat and Mouth: With a torch (flashlight) or sunlight examine the mouth
and throat. To do this hold down tongue with a spoon handle or have the
person say ‘ahhhhh...’ Notice if the throat is red and if the tonsils (2 lumps at
the back of the throat) are swollen or have spots with pus (see p. 309). Also
examine the mouth for sores, inflamed gums, sore tongue, rotten or abscessed
teeth and other problems. (Read Chapter 17.)
Nose: Is the nose runny or plugged? (Notice if and how a baby breathes
through his nose.) Shine a light inside and look for mucus, pus, blood; also
look for redness, swelling, or bad smell. Check for signs of sinus trouble or
hayfever (p. 165).
SKIN
It is important to examine the sick person’s whole body, no matter how mild
the sickness may seem. Babies and children should be undressed completely.
Look carefully for anything that is not normal, including:
• sores, wounds, or splinters
• rashes or welts
• spots, patches, or any unusual markings
• inflammation (sign of infection with
redness, heat, pain and swelling)
• swelling or puffiness
• swollen lymph nodes (little lumps in the
neck, the armpits, or the groin, see p. 88)
Always examine little children between the
buttocks, in the genital area, between the fingers
and toes, behind the ears, and in the hair (for
lice, scabies, ringworm, rashes, and sores).
For identification of different skin problems,
see pages 196-198.
• abnormal lumps or masses
• unusual thinning or loss of hair,
or loss of its color or shine
35
THE BELLY (ABDOMEN)
If a person has pain in the belly, try to find out exactly where it hurts.
Learn whether the pain is steady or whether it suddenly comes and goes,
like cramps or colic.
When you examine the belly, first look at it for any unusual swelling or lumps.
The location of the pain often gives a clue to the cause (see the following
page).
First, ask the person Then, beginning on the opposite side from the spot
to point with one finger where he has pointed, press gently on different parts
where it hurts. of the belly to see where it hurts most.
See if the belly is soft or hard and whether the person can relax his stomach
muscles. A very hard belly could mean an acute abdomen — perhaps
appendicitis or peritonitis (see p. 94).
If you suspect peritonitis or appendicitis, do the test for rebound pain
described on page 95.
Feel for any abnormal lumps and hardened areas in the belly.
If the person has a constant pain in the stomach, with nausea, and has not
been able to move her bowels, put an ear (or stethoscope) on the belly, like
this:
Listen for gurgles in the
intestines. If you hear
nothing after about 2
minutes, this is a danger sign.
(See Emergency Problems of
the Gut, p. 93. )
A silent belly is like a silent dog. Beware!
36
These pictures show the areas of the belly that usually hurt when a person
has the following problems:
Gallbladder
(see p. 329)
the pain
often reaches
to the back
Liver
Urinary system
(see p. 2341
Inflammation or
tumor of the ovaries,
Note: For different causes of back pain see p. 173.
37
MUSCLES AND NERVES
If a person complains of numbness, weakness, or loss of control in part of
his body, or you want to test it: notice the way he walks and moves. Have him
stand, sit, or lie completely straight, and carefully compare both sides of his
body.
Face: Have him smile, frown, open his eyes wide, and
squeeze them shut. Notice any drooping or weakness on
one side.
If the problem began more or less suddenly, think of a
head injury (p. 91), stroke (p. 327), or Bell’s palsy (p. 327).
If it came slowly, it may be a brain tumor. Get medical advice
Also check for normal eye movement, size of pupils (p. 217), and how well
he can see.
Arms and legs: Look for loss of muscle. Notice — or measure — difference in
Watch how he moves and walks. If muscle loss or weakness affects the
whole body, suspect malnutrition (p. 1 12) or a chronic (long-term) illness like
tuberculosis.
If muscle loss and weakness is uneven or worse on one side, in children,
think first of polio (p. 314); in adults, think of a back problem, a back or head
injury, or stroke.
For more information on muscle testing and physical examination of disabled
persons, see Disabled Village Children , Chapter 4,
Also have him hold his arms straight
out and turn his hands up and down.
Have him lie down and lift one leg
and then the other.
38
Check for stiffness or tightness of different muscles:
• If the jaw is stiff or will not open, suspect tetanus (p. 182)
or a severe infection of the throat (p. 309) or of a tooth
(p. 231). If the problem began after he yawned or was
hit in the jaw, he may have a dislocated jaw.
If the neck or back is stiff and bent
backwards, in a very sick child, suspect
meningitis. If the head will not bend
forward or cannot be put between the
knees, meningitis is likely (p. 185).
• If a child always has some stiff muscles and makes strange or jerky
movements, he may be spastic (p. 320).
• If strange or jerky movements come suddenly, with loss of consciousness,
he may have fits (p. 178). If fits
happen often, think of epilepsy.
If they happen when he is ill, the
cause may be high fever (p. 76)
or dehydration (p. 151) or tetanus
(p. 182) or meningitis (p. 185).
To test a person’s reflexes when you suspect tetanus, see p. 183.
To check for loss of feeling in the hands, feet, or other
parts of the body:
Have the person cover his eyes. Lightly touch
or prick the skin in different places. Ask him to say
'yes' when he feels it.
% Loss of feeling in or near spots or patches on the
body is probably leprosy (p. 191 ).
* Loss of feeling in both hands or feet
may be due to diabetes (p. 127)
or leprosy.
* Loss of feeling on one side only could
come from a back problem (p. 174)
or injury.
39
How to Take Care
of a Sick Person
chapter
4
Sickness weakens the body. To gain strength and get well quickly,
special care is needed.
The care a sick person receives is frequently
the most important part of his treatment.
Medicines are often not necessary. But good care is always important.
The following are the basis of good care:
1 . The Comfort of the Sick Person
A person who is sick should
rest in a quiet, comfortable place
with plenty of fresh air and light.
He should keep from getting too
hot or cold. If the air is cold or
the person is chilled, cover him
with a sheet or blanket. But if the
weather is hot or the person has
a fever, do not cover him at all (s<
/
/
pi
2. Liquids
In nearly every sickness, especially when there is
fever or diarrhea, the sick person should drink
plenty of liquids: water, tea, juices, broths, etc.
3. Personal Cleanliness
It is important to keep the sick person
clean. He should be bathed every day.
If he is too sick to get out of bed,
wash him with a sponge or
cloth and lukewarm water. His
clothes, sheets, and covers
must also be kept clean.
Take care to keep crumbs and
bits of food out of the bed,
A SICK PERSON SHOULD
BE BATHED EACH DAY
4. Good Food
If the sick person feels like eating, let him. Most
sicknesses do not require special diets.
A sick person should drink plenty of liquids and
eat a lot of nourishing food (see Chapter 1 1 ).
If the person is very weak, give him as much
nourishing food as he can eat, many times a day.
If necessary, mash the foods, or make them into
soups or juices.
Energy foods are especially important — for
example, porridges of rice, wheat, oatmeal, potato,
or cassava. Adding a little sugar and vegetable oil
will increase the energy. Also encourage the sick person to drink plenty of
sweetened drinks, especially if he will not eat much.
A few problems do require special diets. These are explained on the
following pages:
stomach ulcers and heartburn p. 128
appendicitis, gut obstruction, acute abdomen
(in these cases take no food at all) p. 93
diabetes p. 127
heart problems p. 325
gallbladder problems p. 329
SPECIAL CARE FOR A PERSON
WHO IS VERY ILL
1 . Liquids
It is extremely important that a very sick person drink enough liquid. If he
only can drink a little at a time, give him small amounts often. If he can barely
swallow, give him sips every 5 or 10 minutes.
Measure the amount of liquids the person drinks each day. An adult needs to
drink 2 liters or more every day and should urinate at least a cup (60 cc.) of
urine 3 or 4 times daily. If the person is not drinking or urinating enough, or if
he begins to show signs of dehydration (p. 151), encourage him to drink more.
He should drink nutritious liquids, usually with a little salt added. If he will not
drink these, give him a Rehydration Drink (see p. 152). If he cannot drink
enough of this, and develops signs of dehydration, a health worker may be
able to give him intravenous solution. But the need for this can usually be
avoided if the person is urged to take small sips often.
2. Food
If the person is too sick to eat solid foods, give her soups, milk, juices,
broths, and other nutritious liquids (see Chapter 11). A porridge of cornmeal,
oatmeal, or rice is'also good, but should be given together with body-building
foods. Soups can be made with egg, beans, or well-chopped meat, fish, or
chicken. If the person can eat only a little at a time, she should eat several
small meals each day.
3. Cleanliness
Personal cleanliness is very important for a seriously ill person. She should
be bathed every day with warm water.
Change the bed clothes daily and each time they become dirty. Soiled or
bloodstained clothes, bedding, and towels of a person with an infectious
disease should be handled with care. To kill any viruses or germs, wash these
in hot soapy water, or add some chlorine bleach.
4. Changing Position in Bed
A person who is very weak and cannot turn over alone should be helped to
change position in bed many times each day. This helps prevent bed sores
(see p. 214).
A child who is sick for a long time should be held often on her mother’s lap.
Frequent changing of the person’s position also helps to prevent pneumonia,
a constant danger for anyone who is very weak or ill and must stay in bed for a
long time. If the person has a fever, begins to cough, and breathes with fast,
shallow breaths, she probably has pneumonia (see p. 171).
5. Watching for Changes
You should watch for any change in the sick person's condition that may tell
you whether he is getting better or worse. Keep a record of his ‘vital signs’.
Write down the following facts 4 times a day:
temperature pulse breathing
(how many degrees) (beats per minute) (breaths per minute)
Also write down the amount of liquids the person drinks and how many times
a day he urinates and has a bowel movement. Save this information for the
health worker or doctor.
It is very important to look for signs that warn you that the person’s sickness
is serious or dangerous. A list of Signs of Dangerous Illness is on the next
page. If the person shows any of these signs, seek medical help immediately.
42
y
SIGNS OF DANGEROUS ILLNESS
A person who has one or more of the following
signs is probably too sick to be treated at home
without skilled medical help. His life may be in
danger. Seek medical help as soon as possible.
Until help comes, follow the instructions on the
pages indicated.
page
1 . Loss of large amounts of blood from anywhere in the body . .82, 264, 281
2. Coughing up blood 179
3. Marked blueness of lips and nails (if it is new) 30
4. Great difficulty in breathing; does not improve with rest 167, 325
5. The person cannot be wakened (coma) 78
6. The person is so weak he faints when he stands up 325
7. A day or more without being able to urinate 234
8. A day or more without being able to drink any liquids 151
9. Heavy vomiting or severe diarrhea that lasts for more than one day or
more than a few hours in babies 151
10. Black stools like tar, or vomit with blood or feces 128
1 1. Strong, continuous stomach pains with vomiting in a person
who does not have diarrhea or cannot have a bowel movement 93
12. Any strong continuous pain that lasts for more than 3 days 29 to 38
13. Stiff neck with arched back, with or without a stiff jaw 182, 185
14. More than one fit (convulsions)
in someone with fever or serious illness 76, 185
15. High fever (above 39°C) that cannot be
brought down or that lasts more than 4 or 5 days 75
16. Weight loss over an extended time 20, 400
17. Blood in the urine 146, 234
1 8. Sores that keep growing and do not go away with treatment ... 191, 196,
211, 212
19. A lump in any part of the body that keeps getting bigger 196, 280
20. Problems with pregnancy and childbirth:
any bleeding during pregnancy 249, 281
swollen face and trouble seeing in the last months 249
long delay once the waters have broken and labor has begun . . . . 267
severe bleeding 264
WHEN AND HOW TO LOOK FOR MEDICAL HELP
Seek medical help at the first sign of a dangerous illness. Do not wait until
the person is so sick that it becomes difficult or impossible to take him to a
health center or hospital.
If a sick or injured person’s condition could be made worse
by the difficulties in moving him to a health center, try to
bring a health worker to the person. But in an
emergency when very special attention or an
operation may be needed (for example,
appendicitis), do not wait for the health
worker. Take the person to the health
center or the hospital at once.
When you need to carry a
person on a stretcher, make sure
he is as comfortable as possible
and cannot fall out. If he has any
broken bones, splint them before
moving him (see p. 99). If the
sun is very strong, rig a sheet
over the stretcher to give shade
yet allow fresh air to pass under-
neath
WHAT TO TELL THE HEALTH WORKER
For a health worker or doctor to recommend treatment or prescribe medicine
wisely, she should see the sick person. If the sick person cannot be moved,
have the health worker come to him. If this is not possible, send a responsible
person who knows the details of the illness. Never send a small child or a
fool.
Before sending for medical help, examine the sick person carefully and
completely. Then write down the details of his disease and general condition
(see Chapter J3).
On the next page is a form on which you can make a PATIENT REPORT.
Several copies of this form are at the end of this book. Tear out one of these
forms and carefully complete the report, giving all the details you can.
When you send someone for medical help,
always send a completed information form with him.
PATIENT REPORT
TO USE WHEN SENDING FOR MEDICAL HELP
Name of the sick person: Age:
Male Female Where is he (she)?
What is the main sickness or problem right now?
When did it begin?
Flow did it begin?
Plas the person had the same problem before? When?
Is there fever? Flow high? ° When and for how long?
Pain? Where? What kind?
What is wrong or different from normal in any of the following?
Skin: Ears:
Eyes: Mouth and throat:
Genitals:
Urine: Much or little? Color? Trouble urinating?
Describe: Times in 24 hours: Times at night:
Stools: Color? Blood or mucus? Diarrhea?
Number of times a day: Cramps? Dehydration? Mild or
severe? Worms? What kind?
Breathing: Breaths per minute: Deep, shallow, or normal?
Difficulty breathing (describe): Cough (describe):
Wheezing? Mucus? With blood?
Does the person have any of the SIGNS OF DANGEROUS ILLNESS listed on
page 42? Which? (give details)
Other signs:
Is the person taking medicine? What?
Has the person ever used medicine that has caused a rash, hives (or bumps)
with itching, or other allergic reactions? What?
The state of the sick person is: Not very serious: Serious:
Very serious:
45
Healing Without
Medicines
CHAPTER
5
For most sicknesses no medicines are needed. Our bodies have their own
defenses, or ways to resist and fight disease. In most cases, these natural
defenses are far more important to our health than are medicines.
People will get well from most sicknesses
—including the common cold and ‘flu’ —
by themselves, without need for medicines.
To help the body fight off or overcome a sickness, often
keep clean get plenty of rest
all that is needed is to:
eat well and drink
a lot of liquid
Even in a case of more serious illness, when a medicine may be needed,
it is the body that must overcome the disease; the medicine only helps.
Cleanliness, rest, nutritious food, and lots of water are still very important.
Much of the art of health care does not — and should not — depend on use of
medications. Even if you live in an area where there are no modern medicines,
there is a great deal you can do to prevent and treat most common
sicknesses — if you learn how.
Many sicknesses can be prevented or treated without medicines.
If people simply learned how to use water correctly, this alone might do
more to prevent and cure illnesses than all the medicines they now use . . . and
misuse.
46
HEALING WITH WATER
Most of us could live without medicines. But no one can live without water. In
fact, over half (57%) of the human body is water. If everyone living in farms and
villages made the best use of water, the amount of sickness and death
— especially of children — could be reduced.
For example, correct use of water is basic both in the prevention and
treatment of diarrhea. In many areas diarrhea is the most common cause of
sickness and death in small children. Contaminated (unclean) water is often
part of the cause.
An important part of the prevention of diarrhea and many other illnesses is to
make sure that drinking water is safe. Protect wells and springs from dirt and
animals by putting fences or walls around them. Use cement or rock to provide
good drainage around the well or spring, so that rain or spilled water runs
away from it.
Where water may be contaminated,
an important part of the prevention of
diarrhea is to boil or filter the water used
for drinking or for preparing foods. This is
especially important for babies. Babies'
bottles and eating utensils should also
be boiled. If regular boiling of bottles is
not possible, it is safer to use a cup and
spoon. Washing hands with soap and
water after a bowel movement (shitting)
and before eating or handling foods is
also important.
A common cause of death in children
with diarrhea is severe dehydration,
or loss of too much water from the body
(see p. 151). By giving a child with
diarrhea plenty of water (best with
sugar or cereal and salt), dehydration
can often be prevented or corrected
(see Rehydration Drink, p. 152).
Giving lots of liquids to a child with diarrhea is more important than any
medicine. In fact, if enough liquid is given, no medicine is usually needed in
the treatment of diarrhea.
On the next 2 pages are a number of other situations in which it is often
more important to use water correctly than to use medicines.
2 0 1 2 m < m CD T)
Times When the Right Use of Water
May Do More Good than Medicines
47
to help prevent
1 . diarrhea, worms,
gut infections
2. skin infections
3. wounds becoming
infected; tetanus
to treat
1 . diarrhea,
dehydration
2. illnesses with fever
3. high fever
4. minor urinary
infections (common
in women)
5. cough, asthma,
bronchitis,
pneumonia,
whooping cough
PREVENTION
use water see page
boil or filter drinking 135
water, wash hands,
etc.
bathe often 133
wash wounds well 84, 89
with soap and clean
water
TREATMENT
use water
drink plenty of
liquids
drink plenty of
liquids
remove clothing
and soak body
with cool water
75
76
drink plenty of 235
water
drink a lot of 168
water and breathe
hot water vapors
(to loosen mucus)
48
to treat
use water
see page
6. sores, impetigo,
ringworm of skin
or scalp, cradle
cap, pimples
scrub with soap
and clean water
201, 202,
205, 211,
215
7. infected wounds,
abscesses, boils
hot soaks or
compresses
88, 202
8. stiff, sore muscles
and joints
hot compresses
102, 173,
174
9. strains and sprains
the first day: soak
joint in cold water;
then use hot soaks
102
&%\
10. itching, burning, or
weeping irritations
of the skin
cold compresses
193, 194
1 1 . minor burns
hold in cold water
at once
96
12. sore throat or
tonsillitis
gargle with warm
salt water
309
13. acid, lye, dirt, or
irritating
substance in eye
flood eye with cool
water at once, and
continue for 30
minutes
219
14. stuffed up nose
sniff salt water
164
15. constipation,
hard stools
drink lots of water
(also, enemas are
safer than laxatives,
but do not overuse)
15, 126
16. cold sores or
fever blisters
hold ice on blister
for 1 hr. at first sign
232
In each of the above cases (except pneumonia) when water is used
correctly, often medicines are not needed. In this book you will find many
suggestions for ways of healing without need for medicine. Use medicines
only when absolutely necessary.
Right and Wrong Uses
of Modern Medicines
CHAPTER
49
6
Some medicines sold in pharmacies or village stores can be very useful. But
many are of no value. Of the 60,000 medicines sold in most countries, the
World Health Organization says that only about 200 are necessary.
Also, people sometimes use the best medicines in the wrong way, so that
they do more harm than good. To be helpful, medicine must be used
correctly.
Many people, including most doctors and health workers, prescribe far more
medicines than are needed — and by so doing cause much needless sickness
and death.
There is some danger in the use of any medicine.
Some medicines are much more dangerous than others. Unfortunately,
people sometimes use very dangerous medicines for mild sicknesses. (I have
seen a baby die because his mother gave him a dangerous medicine,
chloramphenicol, for a cold.) Never use a dangerous medicine for a mild
illness.
REMEMBER: MEDICINES CAN KILL
Guidelines for the use of medicine:
1 . Use medicines only when necessary.
2. Know the correct use and precautions for any medicine you use (see the
GREEN PAGES).
3. Be sure to use the right dose.
4. If the medicine does not help, or causes problems, stop using it.
5. When in doubt, seek the advice of a health worker.
Note: Some health workers and many doctors give medicines when none is
needed, often because they think patients expect medicine and will not be
satisfied until they get some. Tell your doctor or health worker you only want
medicine if it is definitely needed. This will save you money and be safer for
your health.
Only use a medicine when you are sure it is needed
and when you are sure how to use it.
50
THE MOST DANGEROUS MISUSE OF MEDICINE
Here is a list of the most common and dangerous errors people make in
using modern medicines. The improper use of the following medicines causes
many deaths each year. BE CAREFUL!
1. Chloramphenicol (Chloromycetin) (p. 357)
The popular use of this medicine for simple diarrhea and
other mild sicknesses is extremely unfortunate, because it is
so risky. Use chloramphenicol only for very severe illnesses,
like typhoid (see p. 188). Never give it to newborn babies.
2. Oxytocin (Pitocin), Pituitrin, and Ergonovine (Ergotrate) (p. 391)
Unfortunately, some midwives use these medicines to speed
up childbirth or ‘give strength’ to the mother in labor. This
practice is very dangerous. It can kill the mother or the child.
Use these medicines only to control bleeding after the child
is born (see p. 266).
3. Injections of any medicine
The common belief that injections are usually better
than medicine taken by mouth is not true. Many times
medicines taken by mouth work as well as or better
than injections. Also, most medicine is more
dangerous injected than when taken by mouth. Injections given to a child
who has a mild polio infection (with only signs of a cold) can lead to paralysis
(see p. 74). Use of injections should be very limited (read Chapter 9 carefully).
4. Penicillin (p. 351)
Penicillin works only against certain types of infections. Use of penicillin for
sprains, bruises, or any pain or fever is a great mistake. As a general rule,
injuries that do not break the skin, even if they make large bruises, have no
danger of infection; they do not need to be treated with penicillin or any other
antibiotic. Neither penicillin nor other antibiotics helps colds (see p. 163).
Penicillin is dangerous for some people. Before using it, know its risks and
the precautions you must take — see pages 70 and 351 .
5. Kanamycin and Gentamicin (Garamycin) (p. 359)
Too much use of these antibiotics for babies has caused permanent hearing
loss (deafness) in millions of babies. Give to babies only for life-threatening
infections. For many infections of the newborn, ampicillin works as well and is
much less dangerous.
51
6. Anti-diarrhea medicines with hydroxyquinolines (Clioquinol,
di-iodohydroxyquinoline, halquinol, broxyquinoline: Diodoquin,
EnteroquinoJ, Amicline, Quogyl, and many other brand names) (p. 370)
In the past clioquinols were widely used to treat diarrhea. These dangerous
medicines are now prohibited in many countries — but in others are still sold.
They can cause permanent paralysis, blindness, and even death. For treatment
of diarrhea, see Chapter 13.
7. Cortisone and cortico-steroids (Prednisolone, dexamethasone, and others)
These are powerful anti-inflammatory drugs that are occasionally needed for
severe attacks of asthma, arthritis, or severe allergic reactions. But in many
countries, steroids are prescribed for minor aches and pains because they
often give quick results. This is a big mistake. Steroids cause serious or
dangerous side effects — especially if used in high doses or for more than a few
days. They lower a person’s defenses against infection. They can make
tuberculosis much worse, cause bleeding of stomach ulcers, and make bones
so weak that they break easily.
8. Anabolic steroids (Nandrolone decanoate, Durabolin, Deca-Durabolin,
Orabolin; stanozolol, Cetabon; oxymetholone, Anapolon; ethylestrenol,
Organaborat. There are many other brand names.)
Anabolic steroids are made from male hormones and are mistakenly used in
tonics to help children gain weight and grow. At first the child may grow faster,
but he will stop growing sooner and end up shorter than he would have if he
had not taken the medicine. Anabolic steroids cause very dangerous side
effects. Girls grow hair on their faces like boys, which does not go away, even
when the child stops taking the medicine. Do not give growth tonics to
children. Instead, to help your child grow, use the money to buy food.
9. Arthritis medicines (Butazones: oxyphenbutazone, Amidozone; and
phenylbutazone, Butazolidin)
These medicines for joint pain (arthritis) can cause a dangerous, sometimes
deadly, blood disease (agranulocytosis). They can also damage the stomach,
liver, and kidneys. Do not use these dangerous medicines. For arthritis,
aspirin (p. 379) or ibuprofen (p. 380) is much safer and cheaper. For pain and
fever only, acetaminophen (p. 380) can be used.
10. Vitamin B12, liver extract, and iron injections (p. 393)
Vitamin B12 and liver extract do not help anemia or ‘weakness’
except in rare cases. Also, they have certain risks when injected.
They should only be used when a specialist has prescribed them
after testing the blood. Also, avoid injectable iron, such as Inferon.
To combat anemia, iron pills are safer and work as well (see p. 124).
52
11. Other vitamins (p. 392)
As a general rule, DO NOT INJECT VITAMINS. Injections are more
dangerous, more expensive, and usually no more effective than pills.
Unfortunately, many people waste their money on syrups, tonics, and 'elixirs’
that contain vitamins. Many lack the most important vitamins (see p. 118). But
even when they contain them, it is wiser to buy more and better food.
Body-building and protective foods like beans, eggs, meat, fruit, vegetables,
and whole grains are rich in vitamins and other nutrients (see p. 111). Giving a
thin, weak person good food more often will usually help him far more than
giving him vitamin and mineral supplements.
A person who eats well does not need extra vitamins.
THE BEST WAY TO GET VITAMINS:
For more information about vitamins, when they are necessary, and the foods
that have them, read Chapter 1_[, especially pages 1 1 1 and 118.
12. Combination medicines
Sometimes, 2 or more medicines are combined in the same pill or tonic.
Usually they are less effective, and more expensive, when prepared this way.
Sometimes they do more harm than good. If someone wants to prescribe
combination medicines, ask him or her to prescribe only the medicine that is
really necessary. Do not waste your money on these medicines.
Some common combination medicines that should be avoided are:
• cough medicines which contain medicines both to suppress a cough and
also to get rid of mucus. (Cough medicines are almost always useless and
a waste of money, whether or not they combine medicines.)
* antibiotics combined with anti-diarrhea medicine
• antacids to treat stomach ulcers together with medicine to prevent
stomach cramps
* 2 or more pain medicines (aspirin with acetaminophen — sometimes also
with caffeine)
53
13. Calcium
Injecting calcium into a vein can be extremely dangerous. It
can quickly kill someone if not injected very slowly. Injecting
calcium into the buttocks sometimes causes very serious
abscesses or infections.
Never inject calcium without first seeking medical advice!
Note: In Mexico and other countries where people eat a lot of corn tortillas or
other foods prepared with lime, it is foolish to use calcium injections or tonics
(as is often done to ‘give strength’ or ‘help children grow’). The body gets all
the ca
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