10-17
VILLAGE HEALTH WORKERS WHO FORM THEIR OWN
SUPPORT SYSTEM
In most large health programs, the direction of control is from the city or
government center to the communities. But in a people-centered approach, the
direction of control is ideally just the reverse: control and decision making are based
mainly in the community.
In many programs today, communities select their own health workers
and health committees. But seldom do community health workers have the
opportunity to select their own support systems for follow-up training and
referral.
In Ajoya, Mexico, however, the village health team has succeeded in building its
own support system. The village workers invite outside professionals, and have
worked out an effective referral system on their own terms. These are the team’s
guidelines for visiting professionals:
1. Outside professionals come only by invitation, and only for short visits. This
way it remains clear that the health team is self-run and not dependent on the
continued presence of outsiders.
2. Visiting professionals must speak the local language and are asked not to
dress in white.
3. Doctors are asked to teach, not to practice their skills. They serve as the
auxiliaries to the primary health workers.
4. Outside instructors and advisers come to learn as well as to teach. They are
expected to relate to the health workers as friends and equals.
5. To strengthen the sense of equality, visiting professionals and advisers
are expected to help with the daily agricultural work, and to clean up after
themselves.
The health team is very careful in deciding which professionals and advisers to
invite to their village. They recognize the tendency of doctors, especially, to think of
themselves as superior to others, and to set themselves up as authorities, even in
areas of health care they know little about.
The village workers have found that getting visiting doctors to clean up after
themselves is especially difficult. But they gently insist on it. One time a visiting
doctor demonstrated how to draw pus from an abscess, but afterward neglected
to wash the dirty instruments. The health workers
kept reminding the doctor
to clean them, but he kept
putting it off. One night
when he went to bed, the
doctor felt a lump under
his pillow cover. It was the
unwashed instruments!
Fortunately, the doctor was
good natured and look the lesson well. From then
on he was careful to clean up after himself.