My Experience: Community Approaches

Wed., Jul. 5, 2006

Sarah Shannon

Having worked in community health for 24 years, I have come to the conclusion that there really are no �magic bullets� or �quick wins� in public health. While teaching a mother how to rehydrate a sick child will certainly save lives, it won�t change the conditions that condemn children to suffer dehydration and chronic diarrhea. These problems are caused by a lack of access to safe drinking water, which, in turn, is caused by the violence of poverty.

Ultimately, scenarios like this can change when people are allowed to plan their own strategies for development and have the resources to implement them. That�s what the book Where There Is No Doctor does for health. It�s a village healthcare handbook written to be accessible to people with limited access to formal education. It helps people solve their immediate problems and then puts forward a vision of community control of healthcare�of community solutions to the root causes of ill health.

My experience with this resource began when I was only 22 and had arrived to volunteer in refugee camps in rural Honduras. Salvadoran refugees were streaming over the border, running for their lives from the Salvadoran military (funded by the U.S. government) in the midst of a civil war. They were malnourished, terrified, wounded, and carried nothing but the clothes on their backs. For my part, I had a suitcase full of clothes and a copy of Where There Is No Doctor. Shortly after I arrived, I was awakened in the middle of the night by a girl who said I had to come help deliver a baby. Although I knew nothing about delivering babies, I stumbled across camp where I was relieved to find the mother-to-be well attended by an experienced community midwife. As she let me stay and watch, and as I followed along in the book, I recognized that �untrained� people have a lot of skills and knowledge and that �trained� health workers�like me�have a lot to learn.

In the weeks and months that followed, I found that Where There Is No Doctor was very useful in helping me�and a crew of refugees�set up nutrition programs and water and sanitation systems, and provide extra training to people who had always taken care of their own health. Despite the alien environment of the refugee camps, everyone was learning the basic skills and knowledge to become effective health workers. The accessible presentation of information and self-reliant focus made the book an incredibly useful tool for all of us.

Yaqui Indians in Mexico used Hesperian�s environmental health materials at a recent workshop on pesticide poisoning. © Hesperian

Another thing I learned from Where There Is No Doctor is that compassion can be a powerful medicine. Although surrounded by the Honduran military for a week, I was asked to help Ricardo, only 18 months old, who was extremely dehydrated and malnourished. He was the kind of kid you look at and are sure he isn�t going to make it. His mother Marcela was barely able to walk. Her husband, a school teacher, had been murdered. Her daughter had died as they were trying to get to the border. We desperately wanted to help save Ricardo, but there didn�t seem much we could do for him. Marcela was told to feed him every hour, but she was disheartened that he couldn�t keep anything down. She was convinced he was going to die. What this exhausted, traumatized woman really needed from me was food, rest, help washing diapers and caring for her son, and emotional support. When we finally escaped from the army�s clutches, Marcela had access to more organized support in the camp and Ricardo survived.

Months later, Marcela approached me and asked if she could become a health promoter in the camps. She eventually became one of the best health workers I ever trained. Marcela would sit and talk for hours about her plans to return to her village and start a health promotion program there. She planned to set up a communal garden so there would be vegetables for the children; she would stock basic medicines and she would engage people to build latrines and teach them about safe drinking water and sanitation. Marcela joined the first group of refugees to return to El Salvador in 1986 while the war was still raging. Despite the risk of being singled out as a community organizer�a sure death sentence if she was captured by the military or death squads�Marcela did exactly what she planned.

When I finally left Central America many years later, I went to work for the Hesperian Foundation, the non-profit that developed this book. My first task was to help women and women�s

Visit Hesperian's get involved page for information on everything from hosting an awareness- and fund-raising house party to collaborating on books currently in progress.

organizations in more than 40 countries address their special health concerns for a new book, Where Women Have No Doctor. This large international network participated in every aspect of the book�s development�from determining the content, critiquing drafts, contributing stories of successes and challenges, and even providing some of the illustrations. The voices and collective wisdom of these women helped craft a book that has been widely used in different cultures and translated into 34 languages. I was thrilled to work with a group of Chinese colleagues in 2001 to produce a major Chinese edition of the manual, of which more than 100,000 copies were distributed to rural communities.

All of this work has confirmed that people suffering from inequality know what the problems are that keep them sick. And, the most forward-looking of them have come up with their own solutions. We are currently working with sweatshop workers as well as organizations fighting environmental devastation to develop books on workers� health and environmental health. Disability is also a central concern for community health. A family in Mexico, for example, just sent us plans of how they improved our latrine designed to be accessible to those in wheelchairs. In short, groups from all over the world are sharing experiences with us about how they are challenging the forces that keep them sick.

Information provided by Hesperian�s books and by health development programs is critical to helping people treat and solve their own health problems. But, in the long run, efforts to redress the inequality and poverty that keep people sick are what will really bring about lasting health in their communities. Resources like ours are designed to accompany people beyond that first curative step towards a healthier future.

Sarah Shannon
Executive Director
Hesperian Foundation

NEXT �FRONTLINES� ARTICLE: Interview with the Global Health Council�s Maurice Middleberg

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