Background[edit | edit source]

"Each month a civil servant dies in the capital because there is no penicillin. Each day a child in the country recovers from a fatal disease because of a plant growing in the forest." -Benjamin Owuor, quoted by Aggrey Nyong'o

"We are dedicated to completely eradicating all anti-scientific attitudes and ideas." -Cuban doctor

These contrasting views are common among people who are dedicated to improving the level of health among the world's poor. There is the romantic who unquestioningly believes in the general effectiveness of traditional remedies, and there is the crusading doctor who sees only superstition in native cures. Both perspectives are partly valid; traditional remedies range from the dramatically effective to the dangerous. The main weakness of traditional medicines has been the failure of its practitioners to question the validity of cures; due to coincidence and the power of suggestion, good and bad remedies are added uncritically to the medical kit of the indigenous healer. Nor has there been sufficient dispassionate review of what is effective, harmless, and dangerous within the drug arsenal of modern medicine. A major challenge in developing appropriate health practices and remedies is to draw together the effective, cheap, and safe treatments in both traditional and modern healing systems.

Equally important is the question of the kind of people and roles that are to be supported in a strategy for the development of a health care system or systems. Much has been written about why modern facilities cannot be extended to reach the entire population of most of the South. Among the many reasons for this, the great expense of elaborate facilities, the chronic shortage of professionals to work in rural areas, and the high cost of physician training programs are the most frequently cited. Because of these problems, health programs are increasingly involving lesser trained health workers from the communities in which they work. These people have in many ways a more demanding role than the doctor, requiring a broader range of skills and knowledge to successfully offer basic curative care, lead preventive and health education programs, and take part in community organizing. A unique and significant advantage Is that as members of their community they know it intimately. Schemes involving community level health workers are now operating all over the world.

The need for more "medical auxiliaries" is also acutely felt in the United States, a country which "imports" many thousands of graduates from the poor countries that can least afford it. This is no less than a national disgrace. We too need larger numbers of lesser trained health workers to become self-sufficient in health care. Such people are quite capable of treating most common health problems. Doctors are probably universally over-worked, whether in the halls of "Mass. General " or in the rural areas of Central America. Even selfless service in a needy area, however, does not begin to meet the longer-term health care needs of the people unless it involves training members of the community so that they can begin to tackle their own health care problems. In developing countries the vast majority of problems are relatively simple ones, often avoidable through the application of basic principles of preventative medicine, and usually compounded by a poor level of nutrition and a lack of access to prompt treatment.

A villager whose main qualifications are the ability to read and write (3 to 6 years of primary education) and a sense of responsibility and compassion for his or her fellow human beings can be trained in two months to diagnose, treat, and prevent 95% of the health problems commonly found in developing countries. Often these local health workers have proven themselves to be more effective in diagnosing and treating common local problems than a small overburdened professional staff. They live among the people they treat and charge what people can afford. Because they have grown up in the community, they know the socioeconomic and family history of their patients, and they are sensitive to local concepts of health, disease, and treatment. For these reasons they frequently have insights into the causes of local health problems and their advice is more likely to be understood and followed.

Unfortunately, those who endorse the use of village health workers frequently pay only lip service to the depth and breadth of indigenous knowledge and skills. In health care, as in other related aspects of community development, outside agencies have often been quick to assert the absolute superiority of their (usually Western-based) methods. And people who have been long oppressed and belittled are sometimes also quick to accept what outside agencies offer, abandoning their own traditions. Making matters worse, the chief medical personnel in programs working with village health workers often have little faith in these people and allow them few responsibilities; too often the result has been the creation of little more than referral systems that continue to swamp understaffed clinics in towns and cities.

This page includes content from David Bartecchi of Village Earth.