15-3
RE-EXAMINING SOME COMMON ASSUMPTIONS
All aspects of a health worker training program-methods, materials, and content—
should be continually re-examined. Questions like those on the previous page need
to be asked again and again. It is important that health workers take an active
part in this questioning process.
Much of the standard advice taught to health workers and villagers comes from
faraway lands where conditions are very different. Some of it may apply to your
own situation. Some may not. And some may even do more harm than good. Often
recommendations from outside need to be adapted or completely changed. When
planning a course or class, or providing any sort of information to student health
workers, it is important to ask yourself:
• How is this information or advice likely to be accepted and used in the
particular situation where the health workers will work?
• How is it likely to affect people’s well-being-in terms not only of their
immediate health needs, but of their long-range environmental, economic, and
social needs?
Before giving people standard health advice,
consider the reality of their lives.
To follow are 5 examples of standard health recommendations that need to
be re-examined: (1) boiling of drinking water, (2) use of hybrid grains, (3) use of
‘flowcharts’, (4) official inspection of food and marketplace, and (5) use of packaged
rehydration salts.
Example 1: Drinking water—to boil or not to boil?
Boil all drinking water is standard
advice in many health programs. But is it
good advice?
Often it is not! In fact, advising
families to boil drinking water may do
more harm than good.
Boiling does kill germs. But there are
many other ways that the same germs
can reach a child’s mouth.
Water piped into homes, even if it is
not ‘pure’, usually proves to be far more
helpful in preventing infection. This
is because it allows families to keep
their homes and their children cleaner.
For keeping a family healthy, quantity
and availability of water are usually more
important than its purity.
IS THIS APPROPRIATE ADVICE?
Perhaps we should think again about
this recommendation in Where There Is
No Doctor. Health advice needs to be
adapted to local conditions.