Where There Is No Doctor

512 Pages·2013·24.85 MB·English

by  David Werner

- -
revised edition
Library of Congress Cataloging-in-Publication Data
Werner, David, 1934-
Where there is no doctor: a village health care
handbook Ib y David Werner; with Carol Thuman and
Jane Maxwell. - Rev. ed.
Includes Index.
ISBN 0-942364-15-5
1. Medicine, Popular. 2. Rural health. I. Thuman, Carol,
1959- . II. Maxwell, Jane, 1941- . Ill. Title.
[DNLM: 1. Community Health Aides-handbooks.
2. Medicine-popular works. 3. Rural Health-handbooks.
WA 39 W492wI
RC81 .W4813 1992 610-dc20
DNLMIDLC 92-15 39
for Library of Congress CIP
Published by:
The Hesperian Foundation
1919 Addison St., #304
Berkeley, California 94704
United States of America
0
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 he1 ing pregnant women stay
healthy; giving f ood care and dealing with comprcations during labor,
childbirth and a er 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, cerebral palsy,
iuvenile arthritis, blindness, and deafness. The author gives suggestions for
simplified rehabilitation at the village level and explains how to make a variety
of approP riate low-cost aids. Emphasis is placed on how to help disabled
children ind 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: assessin 9, how much a child can
see, preventing blindness, moving around safely, teac ing 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: [phone]
Fax: [phone]
e-mail: [email protected]
Visit our website. ww.hesperian.org
Is
Where There 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 I
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-bein
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 0-942364-15
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 41 7) 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 Jesus 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
NOTE ABOUT THIS NEW EDITION
WORDS TO THE VILLAGE HEALTH WORKER (Brown Pages) . . . . . . . wl
Health Needs and Human Needs w2 A Balance Between Prevention and
Many Things Relate to Health Care w7 Treatment w17
Take a Good Look at Your Community w8 Sensible and Limited Use of Medicines w18
Using Local Resources to Meet Needs w12 Finding Out What Progress Has Been
Deciding What to Do and Where to Made w20
Begin w13 Teaching and Learning Together w21
Trying a New Idea w15 Tools for Teaching w22
A Balance Between People and Land w16 Making the Best Use of This Book w28
Chapter 1
HOME CURES AND POPULAR BELIEFS. . . . . . . . . . . . . . . . . . . . . 1
Home Cures That Help 1 Ways to Tell Whether a Home Remedy
Beliefs That Can Make People Well 2 Works or Not 10
Beliefs That Can Make People Sick 4 Medicinal Plants 12
Witchcraft-Black Magic-and the Evil Eye 5 Homemade Casts-for Broken Bones 14
_Qu_esti~onsanAdn swers 6 Enemas, Laxatives, and Purges 15
Sunken Fontanel or Soft Spo-t 9- - - - - - - - - - - - - - - - - - - -
Chapter 2
SICKNESSES THAT ARE OFTEN CONFUSED . . . . . . . . . . . . . . . . 17
What Causes Sickness? 17 Examples of Local Names for Sicknesses 22
Different Kinds of Sicknesses and Their Misunderstandings Due to Confusion of
Causes 18 Names 25
Non-infectious Diseases 18 Confusion between Different Illnesses That
Infectious Diseases 19 Cause Fever 26
Sicknesses That Are Hard to Tell Apart 20
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
Chapter 4
HOW TO TAKE CARE OF A SICK PERSON . . . . . . . . . . . . . . . . . . 39
The Comfort of the Sick Person 39 Watching for Changes 41
Special Care for a Person Who Is Very 111 40 Signs of Dangerous Illness 42
Liquids 40 When and How to Look for Medical Help 43
Food 41 What to Tell the Health Worker 43
Cleanliness and Changing Position in Bed 41 Patient Report 44
Chapter 5
HEALING WITHOUT MEDICINES . .
Healing with Water 46
When Water Is Better than Medicines 47
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 . . . . . . . . . . . . . . . . . . 59
Medicine in Liquid Form 61 Dosage Instructions for Persons Who
How to Give Medicines to Small Children 62 Cannot Read 63
How to Take Medicines 63
Chapter 9
INSTRUCTIONS AND PRECAUTIONS FOR INJECTIONS . . . . . . . . . . 65
When to Inject and When Not To 65 Avoiding Serious Reactions to Penicillin 71
Emergencies When It Is Important to Give How to Prepare a Syringe for Injection 72
Injections 66 How to Inject 73
Medicines Not to Inject 67 How Injections Can Disable Children 74
Risks and Precautions 68 How to Sterilize Equipment 74
Dangerous Reactions From Injecting Certain
Medicines 70
Chapter 10
FIRST AID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Fever 75 Infected Wounds 88
Shock 77 Bullet, Knife, and Other Serious Wounds 90
Loss of Consciousness 78 Emergency Problems of the Gut
When Something Gets Stuck in the (Acute Abdomen) 93
Throat 79 Appendicitis, Peritonitis 94
Drowning 79 Burns 96
When Breathing Stops: Mouth-to-Mouth Broken Bones (Fractures) 98
Breathing 80 How to Move a Badly Injured Person 100
Emergencies Caused by Heat 81 Dislocations
How to Control Bleeding from a Wound 82 (Bones out of Place at a Joint) 101
How to Stop'Nosebleeds 83 Strains and Sprains 102
Cuts, Scrapes, and Small Wounds 84 Poisoning 103
Large Cuts: How to Close Them 85 Snakebite 104
Bandages 87 Other Poisonous Bites and Stings 106
Chapter 11
NUTRITION: WHAT TO EAT TO BE HEALTHY . . . . . . . . . . . . . . . . . 107
Sicknesses Caused by Not Eating Well 107 Special Diets for Specific Health
Why It Is Important to Eat Right 109 Problems 124
Preventing Malnutrition 109 Anemia 124
Main Foods and Helper Foods 110 Rickets 125
Eating Right to Stay Healthy 111 High Blood Pressure 125
Howto-Recognize Malnutrition f12 Eat People 1%-
- - - - - - - - - - - - - - - - - - - - - -
Eating Better When You Do Not Have Much Constipation 126
Money or Land 11 5 Diabetes 127
Where to Get Vitamins: In Pills or Acid Indigestion, Heartburn, and Stomach
in Foods? 118 Ulcers 128
Things to Avoid in Our Diet 119 Goiter
The Best Diet for Small Children 120 (A Swelling or Lump on the Throat) 130
Harmful Ideas about Diet 123
Chapter 12
PREVENTION: HOW TO AVOID MANY SICKNESSES . . . . . . . . . . . . 131
Cleanliness-and Problems from Lack of Trichinosis 144
Cleanliness 131 Amebas 144
Basic Guidelines of Cleanliness 133 Giardia 145
Sanitation and Latrines 137 Blood Flukes
Worms and Other Intestinal Parasites 140 (Schistosomiasis, Bilharzia) 146
Roundworm (Ascaris) 140 Vaccinations (Immunizations)-Simple, Sure
Pinworm (Threadworm, Enterobius) 141 Protection 147
Whipworm (Trichuris) 142 Other Ways to Prevent Sickness and Injury 148
Hookworm 142 Habits That Affect Health 148
Tapeworm 143
Chapter 13
SOME VERY COMMON SICKNESSES . . . . . . . . . . . . . . . . . . . . .I51
Dehydration 151 Bronchitis 170
Diarrhea and Dysentery 153 Pneumonia 171
The Care of a Person with Acute Diarrhea 160 Hepatitis 172
Vomiting 161 Arthritis (Painful, Inflamed Joints) 173
Headaches and Migraines 162 Back Pain 173
Colds and the Flu 163 Varicose Veins 175
Stuffy and Runny Noses 164 Piles (Hemorrhoids) 175
Sinus Trouble (Sinusitis) 165 Swelling of the Feet and Other Parts of the
Hay Fever (Allergic Rhinitis) 165 Body 176
Allergic Reactions 16 6 Hernia (Rupture) 177
Asthma 167 Fits (Convulsions) 178
Cough 168
Chapter 14
SERIOUS ILLNESSES THAT NEED SPECIAL MEDICAL ATTENTION . . . 179
Tuberculosis (TB, Consumption) 179 Dengue (Breakbone Fever, Dandy
Rabies 181 Fever) 187
Tetanus (Lockjaw) 182 Brucellosis (Undulant Fever, Malta Fever) 188
Meningitis 185 Typhoid Fever 188
Malaria 186 Typhus 190
Leprosy (Hansen's Disease) 191
Chapter 15
SKIN PROBLEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193
General Rules for Treating Skin Problems 193 Warts (Verrucae) 21 0
Instructions for Using Hot Compresses 195 Corns 210
Identifying Skin Problems 196 Pimples and Blackheads (Acne) 211
Scabies 199 Cancer of the Skin 21 1
Lice 200 Tuberculosis of the Skin or Lymph
Bedbugs 200 Nodes 212
I
Ticks and Chiggers 201 Erysipelas and Cellulitis 212
1
Small Sores with Pus 201 Gangrene (Gas Gangrene) 21 3
Impetigo 202 Ulcers of the Skin Caused by Poor
'
1 Boils and Abscesses 202 Circulation 213
Itching Rash, Welts, or Hives 203 Bed Sores 214
Things That Cause ltching or Burning of the Skin Problems of Babies 215
I
Skin 204 Eczema
i
Shingles (Herpes Zoster) 204 (Red Patches with Little Blisters) 216
, Ringworm, Tinea (Fungus Infections) 205 Psoriasis 21 6
1 White Spots on the Face and Body 206
Mask of Pregnancy 207
Pellagra and Other Skin Problems Due to
, Malnutrition 208