This month we review a manual for village health-workers that has become a best-seller in the Third World; and we hear voices of Australia's forgotten poor.
Editor: Anuradha Vittachi
Where there is no doctor
Where there is no doctor
by David Werner
UK: Macmillan (pbk) £2.95/ export £1.95
US: Hesperian Foundation
From time to time an outstanding book is produced which meets an immediately felt need. Such is David Werner's book Where there is no doctor, which to me is the most important book to have come out in the health field in the last ten years.
Its UK publishers say, 'The demand is so great we can hardly keep up with the orders' - despite five reprints since January 1980 totalling 65,000 copies. They reckon a further 200,000 or so copies have been printed and sold by other groups, sometimes adapted to local needs. The first Portuguese edition of 15,000 copies sold out in Brazil within the week. There are now seven versions already available and at least 30 translations being made: soon you'll be able to read the book in Swahili, Indonesian, Hindi, or French, or Indian-English...
The book originated from David Werner's experience of a health programme being developed for impoverished villagers in the Mexican Sierras. It came out at a time of real dissatisfaction with the health professionals' monopoly of health care and their emphasis on curative services. The book is written very much for the village health worker who is a liberator rather than a lackey of other health professionals: the spearhead, David Werner feels, of change in the village.
So Werner leads his readers through the common problems they are likely to meet; helps them understand home cures and popular beliefs; offers simple remedies where possible - for example, he includes three pages on conditions that can be managed with water only. Wherever possibie the instructions are illustrated with clear, simple drawings.
David Werner has the immense advantage that he is not a doctor: he is an artist and, above all, a deeply feeling human being. To increase the accessibility of the book, he has disclaimed all copyright except in the case of commercial firms - and then only to ensure that the price is kept low. Oxfam has subsidised the Macmillan edition to the tune of UKP1 per export copy, since the book is almost invariably used in developing countries. Paradoxically, its low price means it is not stocked by many commercial outlets: booksellers prefer expensive, glossy medical books that boost their income.
Such an outstanding and widely read book will of course attract criticisms. Some people suggest that too much emphasis is placed on curative care or that the book is too didactic. But David Werner emphasises the importance of prevention throughout; the curative information is provided because he knows most people will at first turn to the book in order to get immediate help. He poignantly and repeatedly reminds us that the roots of so much illness lie in socioeconomic conditions, and in customs and habits like smoking and consuming alcohol. These factors will be emphasised even more in his new book due out this year called Helping Health Workers Learn.
David C Morley
Professor David C Morley is the head of the Tropical Child Health unit in the Insitiute of Child Health, University of London.
Down under, down under
On the Bread Line
edited by Graeme F Brewer for the Brotherhood of St. Laurence
Hyland House, Melbourne, AUS. $9.95
Australia - land of plenty, egalitarian society, lucky country. No beggars in the streets here. Yet the 1970s Australian Government Commission of Inquiry into Poverty concluded that 18 per cent of Australians subsist 'below, or perilously close to, its austere poverty line'.
Twenty-one accounts of poverty from taped interviews by a team from the Brotherhood of St Laurence, Melbourne, have been edited with the main aims of 'giving the material a more logical flow through the reorganisation of passages scattered over two or more interviews'. Thus 21 people, coping in their own ways with poverty, tell their stories with their own emphases and attitudes.
They are a motley collection. Two are women in their eighties, who somehow have managed to keep their cheerful mettle. There are five immigrants (from Uruguay, Turkey, Italy, Lebanon and Greece) and three country people who came to the city to try to find work. Two are Aborigines, one of whom is pale in colour, consequently finding it less difficult to obtain accommodation than his darker friends. A dark friend making application for a room, he says, might be told there are 'No vacancies', yet he, following almost immediately, would find rooms available.
Poverty means powerlessness, we know. Every one of these people has tried to be independent. 'I just felt I had to make it by myself,' says Isobel, who grew up in a 'home'. Nobody noticed she suffered from acute arthritis, a condition she had endured from childhood. She accepted it as just part of living and kept on with her hard physical work.
Attitudes range from almost unbelievable courage to despair. Linda became so weighed down by 'money problems' that she attempted suicide and then tried to smother her baby.
Mustafa's father was a veterinary doctor in Istanbul. He brought his family to Australia because 'there was fighting everywhere' at home. Here he took any odd job he could get and was eventually duped into going tomato picking by being told he would get plenty of veterinary work in the country. But the veterinary work has not eventuated and tomato picking is for only three months of the year at most. And 'We are stuck here because we sold up to come here.'
Maybe there are dole bludgers. The Brotherhood of St Laurence team of interviewers did not encounter them. Graeme Brewer hopes 'these accounts may go some way towards informing our notions of poverty and showing just cause why farreaching social change needs to be implemented so that "egalitarianism" in Australia may be other than mythical'.