Where There Is No Doctor 2010


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Where There Is No Doctor 2010

Where There Is No Doctor 2010

Library of Congress Cataloging-in-Publication Data

The Library of Congress has already cataloged the 10-digit ISBN as follows:

Werner, David, 1934-

Where there is no doctor: a village health care handbook / by 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-. III Title.

[DNLM: 1. Community Health Aides-handbooks.

2. Medicine-popular works. 3. Rural Health-handbooks.

WA 39 W492W]

RC81.W4813 1992 610-dc20

DNLM/DLC

92-1539

for Library of Congress CIP

Published by: Hesperian 1919 Addison St., #304 Berkeley, California 94704 • USA [email protected] • www.hesperian.org
Copyright © 1977, 1992, 2010 by the Hesperian Foundation First English edition: October 1977 Revised English edition: May 1992 Eleventh printing: July 2010 ISBN: 978-0-942364-15-6
The original English version of this book was produced in 1977 as a revised translation of the Spanish edition, Donde no hay doctor.
Hesperian 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 Hesperian.
Please contact Hesperian 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 book has been printed in the USA on 100% recycled paper by Worldcolor.

THIS REVISED EDITION CAN BE IMPROVED WITH YOUR HELP. If you are a community health worker, doctor, mother, or anyone with ideas or suggestions for ways this book could be changed to better meet the needs of your community, please write to Hesperian at the above address. Thank you for your help.

Where There Is No Doctor 2010
Thanks to the work and dedication of many groups and individuals around the world, Where There Is No Doctor has been translated into more than 80 languages. The following are some of the translations and the addresses
where you can obtain them.
Spanish and English editions are available from:
Hesperian 1919 Addison St., #304 • Berkeley, California 94704 • USA
www.hesperian.org • [email protected] tel: (510) 845-4507 •fax: (510) 845-0539

ARABIC: Arab Resource Collective P.O. Box 13-5916 Beirut, LEBANON www.mawared.org
CHICHEWA: Umoyo Trust P.O. Box 30514 Blantyre MALAWI www.umoyotrust.org
HAITIAN CREOLE: 4 The World Resource Distributors 1711-A.N. Barnes Springfield MO 65803 UNITED STATES www.4WRD.org
HINDI: VHAI 40 Institutional Area (South of IIT) Tong Swasthya Bhawan New Delhi, 110016 INDIA www.vhai.org

KHMER: Medicam Office #4 Street 522 Phnom Penh CAMBODIA http://wtind-khmer.blogspot.com
PORTUGUESE: Teaching Aids at Low Cost (TALC) P.O. Box 49 St. Albans, Herts. AL15TX UNITED KINGDOM www.talcuk.org
SWAHILI: Rotary Club of Dar es Salaam PO Box 1520 Dar es Salaam TANZANIA
URDU: Pakistan Medical Association PMA House,Garden Road Karachi 74400 Pakistan

Please write to Hesperian or look on our website at www.hesperian.org/publications_ translations.php for other editions including Albanian, Amharic, Aymara, Bengali, Burmese, Cebuano, Chinese, Dari, Farsi, French, Fulfide, German, Ilongo, Indonesian, Italian, Japanese, Jinghpaw, Kannada, Karakalpak, Kazakh, Korean, Lao, Malayalam, Marathi, Marshallese, Nepali, Oriya, Pashto, Quechua, Russian, Shan, Somali, Tamil, Telegu, Thai, Tibetan, Tigrinya, Uzbek, Vietnamese, and Zulu, as well as other English editions adapted for specific countries.
We are looking for ways to get this book to those it can serve best. If you are able to help or have suggestions, please contact Hesperian. We offer this book at a lower price to persons of low income living in poor countries.

Where There Is No Doctor 2010
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 other researchers of this revised edition: Suellen Miller, Susan Klein, Ronnie Lovich, Mary Ellen Guroy, Shelley Kahane, Paula Elster, and George Kent. For information 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 Hesperian 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, Martín 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, Elizabeth Babu, Marcos Burgos, Dan Eisenberg, Pam Fadem, Iñaki Fernández de Retana, Shu Ping Guan, Todd Jailer, Erika Leemann, Malcolm Lowe, Malini Mahendra, Jane Maxwell, Susan McCallister, Gail McSweeney, Elena Metcalf, Syema Muzaffar, Leana Rosetti, C. Sienkiewicz, Lora Santiago, Peter Small, Melissa Smith, Fred Strauss, Michael Terry, Fiona Thomson, Kathleen Vickery, Sarah Wallis, and Curt Wands. Dorothy Tegeler coordinated this 2010 reprint with help from Deborah Bickel, Kristen Cashmore, Kathy DeRemier, Jacob Goolkasian, Shu Ping Guan, Todd Jailer, Lisa Keller, Jane Maxwell, Susan McCallister, Maia Small, Kathleen Tandy, Fiona Thomson, Leah Uberseder, and Lily Walkover.
Artwork for this book was created by David Werner, Kyle Craven, Shu Ping Guan, Susan Klein, Regina Faul-Doyle, Sandy Frank, Fiona Thomson, and Lihua Wang. 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 417), 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 Buch, Lynne Coen, George Kent, Jack May, Oliver Bock, Bill Gonda, Ray Bleicher, and Jesús Manjárrez.
For this 1992 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. For this 2009 printing, thanks to Flora Family Foundation, Ford Foundation, Grousebeck Family Foundation, Moriah Fund, and West Foundation.
Finally, our warm thanks to the village health workers of Project Piaxtla in rural Mexico­— especially Martín Reyes, Miguel Angel Manjárrez, 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

INTRODUCTION

NOTE ABOUT THIS NEW EDITION

WORDS TO THE VILLAGE HEALTH WORKER (Brown Pages). . . . . . . . . . . . . .w1

Health Needs and Human Needs w2 Many Thing Relate to Health Care w7 Take a Good Look at Your Community w8 Using Local Resources to Meet Needs w12 Deciding What to Do and Where to
Begin w13 Trying a New Idea w15 A Balance Between People and Land w16

A Balance Between Prevention and Treatment w17
Sensible and Limited Use of Medicines w18 Finding Out What Progress Has Been
Made w20 Teaching and Learning Together w21 Tools for Teaching w22 Making the Best Use of This Book w28

Chapter 1 HOME CURES AND POPULAR BELIEFS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Home Cures That Help 1 Beliefs That Can Make People Well 2 Beliefs That Can Make People Sick 4 Witchcraft—Black Magic—and the Evil Eye 5 Questions and Answers 6 Sunken Fontanel or Soft Spot 9

Ways to Tell Whether a Home Remedy Works or Not 10
Medicinal Plants 12 Homemade Casts—for Broken Bones 14 Enemas, Laxatives, and Purges 15

Chapter 2 SICKNESSES THAT ARE OFTEN CONFUSED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

What Causes Sickness? 17 Different Kinds of Sicknesses and
Their Causes 18 Non-infectious Diseases 18 Infectious Diseases 19 Sicknesses That Are Hard to Tell Apart 20

Example of Local Names for Sicknesses 22 Misunderstanding Due to Confusion
of Names 25 Confusion between Different Illnesses
That Cause Fever 26

Chapter 3 HOW TO EXAMINE A SICK PERSON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Questions 29 General Condition of Health 30 Temperature 30 How to Use a Thermometer 31 Breathing (Respiration) 32 Pulse (Heartbeat) 32

Eyes 33 Ears 34 Skin 34 The Belly (Abdomen) 35 Muscles and Nerves 37

Chapter 4 HOW TO TAKE CARE OF A SICK PERSON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

The Comfort of the Sick Person 39 Special Care for a Person Who Is Very Ill 40 Liquids 40 Food 41 Cleanliness and Changing Position in Bed 41

Watching for Changes 41 Signs of Dangerous Illness 42 When and How to Look for Medical Help 43 What to Tell the Health Worker 43 Patient Report 44

Chapter 5 HEALING WITHOUT MEDICINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
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 The Most Dangerous Misuse of Medicine 50

When Should Medicine Not Be Taken? 54

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 How to Give Medicines to Small Children 62 How to Take Medicines 63

Dosage Instructions for Persons Who Cannot Read 63

Chapter 9 INSTRUCTIONS AND PRECAUTIONS FOR INJECTIONS. . . . . . . . . . . . . . . . . . . . . . . . 65

When to Inject and When Not To 65 Emergencies When It Is Important to Give
Injections 66 Medicines Not to Inject 67 Risks and Precautions 68 Dangerous Reactions From Injecting Certain
Medicines 70

Avoiding Serious Reactions to Penicillin 71 How to Prepare a Syringe for Injection 72 How to Inject 73 How Injections Can Disable Children 74 How to Sterilize Equipment 74

Chapter 10 FIRST AID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Basic Cleanliness and Protection 75 Fever 75 Shock 77 Loss of Consciousness 78 When Something Gets Stuck in the
Throat 79 Drowning 79 When Breathing Stops: Mouth-to-Mouth
Breathing 80 Emergencies Caused by Heat 81 How to Control Bleeding from a Wound 82 How to Stop Nosebleeds 83 Cuts, Scrapes, and Small Wounds 84 Large Cuts: How to Close Them 85 Bandages 87

Infected Wounds 88 Bullet, Knife, and Other Serious Wounds 90 Emergency Problems of the Gut
(Acute Abdomen) 93 Appendicitis, Peritonitis 94 Burns 96 Broken Bones (Fractures) 98 How to Move a Badly Injured Person 100 Dislocations
(Bones Out of Place at a Joint) 101 Strains and Sprains 102 Poisoning 103 Snakebite 104 Other Poisonous Bites and Stings 106

Chapter 11 NUTRITION: WHAT TO EAT TO BE HEALTHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Sicknesses Caused by Not Eating Well 107 Why It Is Important to Eat Right 109 Preventing Malnutrition 109 Main Foods and Helper Foods 110 Eating Right to Stay Healthy 111 How to Recognize Malnutrition 112 Eating Better When You Do Not Have Much
Money or Land 115 Where to Get Vitamins: In Pills or
in Foods? 118 Things to Avoid in Our Diet 119 The Best Diet for Small Children 120 Harmful Ideas about Diet 123

Special Diets for Specific Health Problems 124
Anemia 124 Rickets 125 High Blood Pressure 125 Fat People 126 Constipation 126 Diabetes 127 Acid Indigestion, Heartburn, and Stomach
Ulcers 128 Goiter
(A Swelling or Lump on the Throat) 130

Chapter 12 PREVENTION: HOW TO AVOID MANY SICKNESSES . . . . . . . . . . . . . . . . . . . . . . . . . . 131

Cleanliness—and Problems from Lack of Cleanliness 131
Basic Guidelines of Cleanliness 133 Sanitation and Latrines 137 Worms and Other Intestinal Parasites 140 Roundworm (Ascaris) 140 Pinworm (Threadworm, Enterobius) 141 Whipworm (Trichuris) 142 Hookworm 142 Tapeworm 143

Trichinosis 144 Amebas 144 Giardia 145 Blood Flukes
(Schistosomiasis, Bilharzia) 146 Vaccinations (lmmunizations)—Simple,
Sure Protection 147 Other Ways to Prevent Sickness and Injury 148 Habits That Affect Health 148

Chapter 13 SOME VERY COMMON SICKNESSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Dehydration 151 Diarrhea and Dysentery 153 The Care of a Person with Acute Diarrhea 160 Vomiting 161 Headaches and Migraines 162 Colds and the Flu 163 Stuffy and Runny Noses 164 Sinus Trouble (Sinusitis) 165 Hay Fever (Allergic Rhinitis) 165 Allergic Reactions 166 Asthma 167 Cough 168

Bronchitis 170 Pneumonia 171 Hepatitis 172 Arthritis (Painful, Inflamed Joints) 173 Back Pain 173 Varicose Veins 175 Piles (Hemorrhoids) 175 Swelling of the Feet and Other Parts
of the Body 176 Hernia (Rupture) 177 Seizures (Fits, Convulsions) 178

Chapter 14 SERIOUS ILLNESSES THAT NEED SPECIAL MEDICAL ATTENTION . . . . . . . . . . . .179

Tuberculosis (TB, Consumption) 179 Rabies 181 Tetanus (Lockjaw) 182 Meningitis 185 Malaria 186

Dengue (Breakbone Fever, Dandy Fever) 187
Brucellosis (Undulant Fever, Malta Fever) 188 Typhoid Fever 188 Typhus 190 Leprosy (Hansen’s Disease) 191

Chapter 15 SKIN PROBLEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193

General Rules for Treating Skin Problems 193 Instructions for Using Hot Compresses 195 Identifying Skin Problems 196 Scabies 199 Lice 200 Bedbugs 200 Ticks and Chiggers 201 Small Sores with Pus 201 Impetigo 202 Boils and Abscesses 202 Itching Rash, Welts, or Hives 203 Things That Cause Itching or Burning of the
Skin 204 Shingles (Herpes Zoster) 204 Ringworm, Tinea (Fungus Infections) 205 White Spots on the Face and Body 206 Mask of Pregnancy 207 Pellagra and Other Skin Problems Due
to Malnutrition 208

Warts (Verrucae) 210 Corns 210 Pimples and Blackheads (Acne) 211 Cancer of the Skin 211 Tuberculosis of the Skin or
Lymph Nodes 212 Erysipelas and Cellulitis 212 Gangrene (Gas Gangrene) 213 Ulcers of the Skin Caused by
Poor Circulation 213 Bed Sores 214 Skin Problems of Babies 215 Eczema
(Red Patches with Little Blisters) 216 Psoriasis 216

Chapter 16 THE EYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

Danger Signs 217 Injuries to the Eye 218
How to Remove a Speck of Dirt from
the Eye 218 Chemical Burns of the Eye 219 Red, Painful Eyes—Different Causes 219 ‘Pink Eye’ (Conjunctivitis) 219 Trachoma 220
Infected Eyes in Newborn Babies
(Neonatal Conjunctivitis) 221 Iritis (Inflammation of the Iris) 221 Glaucoma 222
Infection of the Tear Sac
(Dacryocystitis) 223

Trouble Seeing Clearly 223 Cross-Eyes and Wandering Eyes 223 Sty (Hordeolum) 224 Pterygium 224 A Scrape, Ulcer, or Scar on the Cornea 224 Bleeding in the White of the Eye 225 Bleeding behind the Cornea (Hyphema) 225 Pus behind the Cornea (Hypopyon) 225 Cataract 225 Night Blindness and Xerophthalmia 226 Spots or ‘Flies’ before the Eyes 227 Double Vision 227 River Blindness (Onchocerciasis) 227

Chapter 17 THE TEETH, GUMS, AND MOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

Care of Teeth and Gums 229 If You Do Not Have A Toothbrush 230 Toothaches and Abscesses 231 Pyorrhea, a Disease of the Gums 231

Sores or Cracks at the Corners of the
Mouth 232 White Patches or Spots in the Mouth 232 Cold Sores and Fever Blisters 232

Chapter 18 THE URINARY SYSTEM AND THE GENITALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

Urinary Tract Infections 234 Kidney or Bladder Stones 235 Enlarged Prostate Gland 235
Diseases Spread by Sexual Contact
(Sexually Transmitted Infections) 236
Gonorrhea (Clap, VD, the Drip) and
Chlamydia 236 Syphilis 237
Bubos: Bursting Lymph Nodes in
the Groin 238

Use of a Catheter to Drain Urine 239 Problems of Women 241 Vaginal Discharge 241
How a Woman Can Avoid Many
Infections 242 Pain or Discomfort in a Woman’s Belly 243
Men and Women Who Cannot Have Children
(Infertility) 244

Chapter 19 INFORMATION FOR MOTHERS AND MIDWIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

The Menstrual Period
(Monthly Bleeding in Women) 245
The Menopause
(When Women Stop Having Periods) 246 Pregnancy 247

How to Stay Healthy during Pregnancy 247 Minor Problems during Pregnancy 248 Danger Signs in Pregnancy 249
Check-ups during Pregnancy
(Prenatal Care) 250

Record of Prenatal Care 253 Things to Have Ready before the Birth 254 Preparing for Birth 256 Signs That Show Labor Is Near 258 The Stages of Labor 259 Care of the Baby at Birth 262 Care of the Cut Cord (Navel) 263 The Delivery of the Placenta (Afterbirth) 264 Hemorrhaging (Heavy Bleeding) 264 Medicines to Control Bleeding
After Birth or Miscarriage: Oxytocin, Ergonovine, Misoprostol 266

Difficult Births 267 Tearing of the Birth Opening 269 Care of the Newborn Baby 270 Illnesses of the Newborn 272 The Mothers Health after Childbirth 276 Childbirth Fever
(Infection after Giving Birth) 276 Care of the Breasts 277 Lumps or Growths in the Lower Part
of the Belly 280 Miscarriage (Spontaneous Abortion) 281 High Risk Mothers and Babies 282

Chapter 20 FAMILY PLANNING— HAVING THE NUMBER OF CHILDREN YOU WANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283

Choosing a Method of Family Planning 284 Oral Contraceptives
(Birth Control Pills) 286 Other Methods of Family Planning 290 Combined Methods 292

Methods for Those Who Never Want to Have More Children 293
Home Methods for Preventing Pregnancy 294

Chapter 21 HEALTH AND SICKNESSES OF CHILDREN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

What to Do to Protect Children’s Health 295
Children’s Growth— and the ‘Road to Health’ 297
Child Health Chart 298 Review of Children’s Health Problems
Discussed in Other Chapters 305 Health Problems of Children Not
Discussed in Other Chapters 309 Earache and Ear Infections 309 Sore Throat and Inflamed Tonsils 309 Rheumatic Fever 310 Infectious Diseases of Childhood 311 Chickenpox 311 Measles (Rubeola) 311 German Measles (Rubella) 312 Mumps 312

Whooping Cough 313 Diphtheria 313 Infantile Paralysis (Polio) 314 How to Make Simple Crutches 315 Problems Children Are Born With 316 Dislocated Hip 316 Umbilical Hernia
(Belly Button That Sticks Out) 317 A ‘Swollen Testicle’
(Hydrocele or Hernia) 317 Mentally Slow, Deaf, or Deformed
Children 318 The Spastic Child (Cerebral Palsy) 320 Slow Development in the
First Months of Life 321 Sickle Cell Disease 321 Helping Children Learn 322

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Where There Is No Doctor 2010