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[image, unknown] HEALTH[image, unknown]

Seed banks or stethoscopes?

‘Trying to promote health care through the medical profession is like trying to promote land reform through big landowners’ says David Werner, author of Where there is no doctor (reviewed in the June NI). It is important to crack the monopoly of the professionals and bring medical knowledge back to village homes and village classrooms where it is most needed, he argues.

But many villagers have had their self confidence drained away by long years of instruction by experts — in schools, at hospital, in their fields. What they need, says Werner, are ‘materials that help them regain that confidence in their own experience so they can question the expertise from outside.’

His new book Helping health workers learn aims to provide just that. Available in November, it is a wealth of suggestions for health education materials that people can make for themselves: a cardboard box painted and cut to look like a woman to show how babies are born; the amazing cardboard ‘flexi-baby’ to demonstrate difficulties in childbirth; a ‘gourd baby’ with strategically placed ‘leaks’ to teach about the dangers of dehydration and diarrhoea (see illustration).

Many of these ideas are the invention of Werner’s own helpers at Sierra Madre in Mexico. And the book was born out of his conviction that health workers are the best teachers — of each other and of their village neighbours. Almost ruefully, Werner now admits that ‘the most positive thing I can do is to keep out of the way. My presence in the village programme is no longer wanted or needed, so I have undertaken to phase myself out’.

His voluntary redundancy was made possible by his success in transferring teaching and learning skills rather than just information to the villagers. Now health workers welcome visiting experts on their own terms, insisting that they become auxiliaries of the health team — helping out with advice when asked — rather than awesome authority figures, downgrading health workers’ capabilities by their very presence.

The doctors are learning too. Health workers in Sierra Madre have developed an acute ear for mystifying language and demand an explanation for every unfamiliar word — and explanations for the explanations if these are also couched in unfamiliar language. Many a visiting lecturer has found himself unable to proceed past his first sentence!

A two-way learning process takes place between health-worker and villager too. Villagers have been encouraged to discover for themselves why they fall ill by playing what Werner calls the ‘but why?’ game: Mario has tetanus — but why? — because he stepped on a thorn — but why? — because he had no sandals — but why? — because his mother had no money to buy them for him — but why?... In this way people soon find out that no disease has a single cause. And there is no ‘correct’ cure either. It is up to them to decide how best to tackle the many causes of disease. And it is not always to the medicine bottle that they turn for the solution.

One group of villagers decided that one way to tackle diarrhoea would be to form a corn bank. They realised that a good diet is one of the best ways of preventing diarrhoea and that food shortage was often a result of debts incurred by those forced to borrow seed at crippling interest rates from local land barons. So, a village corn seed bank, lending at low interest rates with flexible repayments, could break that particular link in the poverty-sickness chain.

But it is this sort of chain-effect reasoning that alarms governments. ‘There are bound to be clashes with the government when a programme helps the poor to take action to solve their own problems’,warns Werner. ‘Few dare to train village health workers in Guatemala or El Salvador these days?

This is because an effective primary health care system can easily become what Werner calls ‘the health care of liberation’. When people understand the links between inequality and poor health — and gain experience in organising themselves to break those links — primary health care becomes a dangerous threat to any government that represents the privileged at the expense of the weak.

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[image, unknown] CHURCH AND DEVELOPMENT[image, unknown]

Salvation suspended

When the World Council of Churches’ (WCC) Central Committee met for its August session in Dresden it was able to announce a membership exceeding 300 churches in 100 countries: three new members — all Reformed Churches from Africa — had joined. ‘Plus three,’ proclaimed the news item. But in honesty it had to add ‘minus one’. The Salvation Army had resigned.

This is a serious loss. The Army, with branches in 86 countries, was among the 146 founding members in 1948. The cause of the rift is both political and theological. The Army suspended its WCC membership in 1978 in protest at the controversial $85,000 WCC grant to the Patriotic Front in Zimbabwe. Subsequently the Presbyterian Church in Ireland withdrew its membership too.

Between its decision to suspend membership and its final withdrawal in August, the Salvation Army has continued to work alongside the WCC and its letter of resignation pledges continued support for the Council ‘especially in world mission, evangelism and Third World development’.

The sting came at the tail-end of the resignation press release: ‘The Army will maintain its 116 years’ tradition as a part of the universal Church of Christ with a strong social conscience serving the spiritually needy without political bias and regardless of creed or culture’ (our italics).

The question is whether a ‘strong social conscience' can operate ‘without political bias’. Perhaps any effective support for a disadvantaged group is a threat to somebody’s political dominance. If staying in the WCC indicates one kind of political stance, does not the severance from it at least appear to be a commitment to the opposing political point of view.

Ironically the Salvation Army has itself been under fire recently for ‘evangelistic imperialism’. It has been accused of putting pressure on down-and-outs to sing hymns and pray with the Army organisers: shelter, food and bed are nothing more than a Trojan horse for religious evangelism, say critics.

The disagreement over politics is connected with a theological disagreement between the Army and the WCC. In 1975 the WCC Assembly decided to foster ‘full eucharistic fellowship’ among Council members. Each church would commit itself to using the symbols of water, bread and wine as a means of helping heal the split between the ideals of the Gospel and the day-to-day practicalities of life.

But the Salvation Army uses neither baptism (water) or communion (bread and wine). Perhaps this is one reason for its difficulty in acknowledging the inevitable links between any group of believers and the pressures and politics of the real world.

Michael Hare Duke

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[image, unknown] LAND REFORM[image, unknown]

Hard to swallow

All the United Nations family is at it. A decade for water, a year for the disabled and now World Food Day on 16 October. In Issue 81 of Ceres, the Food and Agriculture Organization’s magazine, Paul Harrison sets the scene for the Day.

Drawing on evidence from the World Bank, the Intemational Labour Organization and the FAO (hardly revolutionary bodies) Harrison concludes ‘the single most important reason why hunger exists where there is enough for everyone is inequality.’

In 1977 the world consumed ten per cent more food than necessary. Yet, according to World Bank estimates, over a fifth of the global family went hungry.

So hunger is not a question of food production — but of distribution and the means to buy it. Yet World Food Day will concentrate mainly on ways to grow more food to stock an already - overflowing pantry. Less than ten per cent of the world’s cereals could provide sufficient nourishment for all the hungry. Yet four times that was fed to cattle between 1975 and 1977. It is not hungry cows that are to blame, but the massive wealth-gap that means some countries pay more to feed their livestock than others can afford for their hungry citizens.

Inequalities within Third World countries add to the problems — how few own how much of the farming land is a reliable barometer of both inequality and hunger (see table). On such a reckoning Latin America is the most scarred of continents, with the wealthiest eight per cent controlling 80 per cent of the farmland.

The obvious injustice of warped ownership patterns is compounded by cheap govemment loans to the big farmers: they are less of a risk, they repay promptly, provide collateral, and can use their contacts to pull strings. And large loans are much less of a headache to the civil servant than all those little dribs and drabs to small-holders. In 1976, a World Bank report in Pakistan found 40 per cent of the farmers cornering 97 per cent of available credit.

Yet, large farms are usually the most inefficient. Another World Bank survey of 40 countries found that nations with small farms and a more equal land distribution had higher yields and more employment per hectare: Yields were higher in South Korea and Japan than India, Pakistan, the Philippines and Turkey. And a recent International Labour Organization study estimated that if land was more fairly distributed food output would rise by ten per cent in Pakistan, 28 per cent in Colombia and Malaysia and 80 per cent in the grossly unequal North-East of Brazil.

All the evidence points to it a fairer society means less hunger. And this is what the Food and Agriculture Organization should emphasise on World Food Day.

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[image, unknown] NATIVE PEOPLES[image, unknown]

The line of least resistance

This summer the World Bank released its first document about minority peoples in developing countries. There are more than 200 million such people living in various parts of the world. And almost everywhere discrimination and disregard for their rights pushes them down among the most under-privileged of the world’s poor.

The Bank has a reputation for ignoring human rights. The release of this report follows a period of severe criticism from anthropologists, activists and increasingly, from tribal people themselves.

Economic Development and Tribal People is full of bold phrases, calling for a ‘moral imperative’ to prevent entire tribes from being ‘sacrificed for a goal of economic development’. The report suggests:
• the Bank only fund projects in tribal lands after people living there are both consulted and agree
• research of the social and environmental impact of projects precede any decision-making
• projects should contain elementary safe-guards of human rights not currently taken into consideration in Bank funding.

But the rhetoric goes further— castigating the Bank for allowing so many projects to go ahead before the presence of tribal people was even suspected by Bank planners.

However, ignorance was no excuse at the Chico River project in the Philippines. Tribal people whose livelihood was threatened by the project loudly rejected the project at the earliest planning stages in the 1960s.

As a result the plans were quietly shelved — until the declaration of martial law in 1972. Without informing the people, surveys began again. And so did the opposition of native peoples. At one point women disrobed — a traditional way of showing their defencelessness to shame the enemy. They also dismantled the construction camps and dumped the equipment outside the local military headquarters.

The govemment retaliated with arrests, bribery attempts and intimidation. Meanwhile, the Bank withdrew part of their promised loan for the project. Now Bank representatives deny all responsibility for the Chico project. But their involvement continues: the irrigation part of the scheme still receives Bank money. And just 75 kilometres from Chico another $200 million World Bank loan helps build the Magat dam — which will flood the ancestral lands of another 150,000 tribal people.

Out of all this the Bank seems to have leamed one lesson. The report says it is ‘poor planning’ to ignore tribal groups if they actually have the muscle to threaten a project. So far tribal people near the Magat dam have been relatively quiet.

If even a handful of the report’s recommendations were taken seriously a sigh of relief would go up from everyone threatened by World Bank-funded dams, roads, irrigation and forestry projects.

But it will take more than one report to transform the Bank from one of the most unkissable frogs in the international lily pond into a shining prince to champion tribal rights.

Geoff Nettleton

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[image, unknown] SOUTH AFRICA[image, unknown]

Kiwi clashes

Hundreds of protesters rushed torn-down fences and onto a rugby field in New Zealand this August. Standing arms-linked, centre-field, surrounded by police, within an hour they brought about the cancellation of the South African Springboks’ second game in their New Zealand tour.

The anti-apartheid movement began in New Zealand 21 years ago with the ‘No Maoris, no tour’ controversy over whether the country should send an all-white rugby team to South Africa. To exclude Maoris (New Zealand’s aboriginal minority) would lend tacit support to the white regime in South Africa, argued the anti-apartheid group.

The team — all white — went. In 1965, the Springboks (all white) returned the compliment and toured New Zealand. In 1970 the first multi-racial New Zealand team toured South Africa — which bestowed ‘honorary white’ status on the visiting team’s Maori members. But in 1973 the anti-apartheid movement had its first success when Labour Prime Minister Norman Kirk cancelled another Springbok tour of New Zealand.

So the current tour — the first to New Zealand for 16 years — is not just a rugby tour. It is more a trial of strength between the anti-apartheid movement and the ‘rugby-at-all-costs, no-politics-in-sport, freedom-of-association and don’t-rock-the-boat’ attitudes of perhaps half the New Zealand population.

This conflict culminated in September with the unprecedented spectacle of anti-apartheid’s light aircraft attack on the final match of the tour. As smoke bombs rained through the air, the election-year theme of ‘law and order’ gained a new significance.

But more than law and order is being challenged, argues Rev. Brian Tumer of the National Council of Churches. The anti-apartheid movement has gathered a cross-section of all ages to walk under its banner. And the growing political awareness of that wide cross-section — not easily pigeon-holed into the usual ‘trendy-lefty’ compartments — poses a bigger, long-term threat. It threatens a government committed to selling New Zealand’s energy resources to the highest bidder.

‘The government is right if it thinks the opposition to it's growth strategy will come from those opposing the Springboks’ tour’, says Rev. Turner. ‘People are growing more aware of the similarity between separate (apartheid) development in South Africa and New Zealand’s energy-intensive growth model.’ Both systems exploit people and places, acquire land and natural resources by force, resettle those that get in the way and result in a widening gap between rich and poor.

But those who challenge Prime Minister Muldon’s conservative government soon feel the chill winds of its displeasure. CORSO, one of the country’s major aid agencies, was stripped of its tax-deductability status two years ago because it pointed out the parallels between the causes of poverty in the Third World and the causes of poverty in New Zealand. So CORSO and similar non-government agencies have been holding back on the rugby tour debate, leaving the midfield to the protests of church and civic leaders.

Tony Ford

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[image, unknown] LATIN AMERICA[image, unknown]

Ecuador's border sideshow

On 24th May, President Jaime Roldos Aguilera of Ecuador, his wife, the Defence Minister and six others died when their light aircraft crashed in the semi-jungle south of the country.

The news of the President’s death, coming less than 20 months after his inauguration, was seen as merely another disaster for a country already bedevilled by problems since the beginning of the year.

On the 22nd January war broke out between Ecuador and Peru in the remote Condor mountains where an ill-defined border has long been in dispute. At the foot of the mountains lie rich deposits of oil, estimated at between 5,000 and 15,000 million barrels. The Ecuadorian press immediately accused Peru of instigating the border clashes to divert attention from internal economic problems and political unrest. But such an accusation could equally well have been levelled at Ecuador.

After nine years of military and civilian dictatorship, Roldos was the youngest ever freely-elected leader in Latin America when he took office in August 1979. Sixteen months later, with inflation up 15 per cent. Roldos was coming under mounting pressure to rejuvenate the ailing economy, placate an impatient middle class, and reassure the population that they, too, would shortly share in the spoils from Ecuador’s oil exports.

What the war with Peru achieved — through a jingoistic media campaign that reached its zenith in a massive street rally in February — was a breathing space for the Government. It distracted public concern away from its inability to control inflation or dispel gloomy economic forecasts.

On 20th February it was announced that Peru had again attacked border posts in the Condor region. The announcement coincided neatly with a new package of economic measures, including petrol price increases of 200 per cent and bus fare rises of 40 per cent Concerted trade union anger soon came to a head with the one-day General Strike on 13th May.

During the same period, the President’s leftist sympathies for Castro’s Cuba, the insurgents in El Salvador and the Sandinista Government in Nicaragua suffered a serious set-back. Under pressure from within his own party (and probably also from the Reagan administration) he was forced to expel a group of fund-raising guerrillas from El Salvador. And, after Cuban commandos had stormed the Ecuadorian Embassy in Havana to arrest a group of dissidents occupying the building, he reduced relations with Cuba to the level of Commercial Attache.

So, after the news of the plane crash that killed him, it was not unreasonable to suspect sabotage — from the left or the right from Ml9 guerrillas as a repraisal for the capture and return to Colombia of other guerrillas discovered in Ecuador in March; or from restive army generals unconvinced of the feasibility of democracy in a country more familiar with dictatorships.

Vice President Osvaldo Hurtado has not inherited an enviable task. The current glut on world markets has led to a loss in revenue from oil, cocoa and coffee. And the Government’ s failure to stimulate agricultural and industrial production, or to halt the steady drift of campesinos into the already overcrowded cities, has led to an ever deepening depression in the country.

Phil Harris

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New Internationalist issue 104 magazine cover This article is from the October 1981 issue of New Internationalist.
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