Alfred K. Neumann

Role of the indigenous medicine practitioner in two areas of India—Report of a study☆

Interviews of 72 rural indigenous medicine practitioners in India in a southern district (Kerala State) and a northern district (Punjab State) are reported as well as the results of observations of their work while diagnosing and treating a total of 542 patients. The practitioners were located in the vicinity of 2 primary health care centers. The stereotype of the indigenous medicine practitioner as one using traditional herbs oils and incantations and having little or nothing to do with modern medicine is not supported by this enquiry. The training of the men was extremely varied and ranged from an apprenticeship of a few months duration to 6 years of formal training in a recognized school of indigenous medicine. The practitioners were present in a ratio of about 1:1500 of rural population and outnumbered modern (allopathic) physicians by 10:1. They treated all types of illnesses and appeared to be well regarded by the villagers. Many had stethoscopes and the majority used modern methods. About 1/3 of the patients seen in the north by the indigenous practitioners were given injections. Half of these were penicillin or streptomycin. It is suggested similar studies be carried out in India and elsewhere and the entire question of the role of indigenous medicine practitioners and their relationship to modern medicine especially in rural areas be subject to critical review. Included in this is the question of the role these men might play in disseminating family planning information and supplies.(AUTHOR ABSTRACT)

The Obsolescence of Distinct Domestic and International Health Sectors

yas HE traditional and historic bases for differentiating domestic and international health in Western nations have, as a result of profoundly changing epidemiology and demographics, lost meaning. International health F has been viewed as independent and unrelated to the >c X* domestic health sector as a legacy of colonialization, and as a result of distinctive economic development issues, cultural backgrounds, and regionalism of health problems. Four phenomena have contributed to an unprecedented internationalization of domestic health: i) the re-emergence of a deadly infectious disease pandemic with the human immunodeficiency virus (i); 2) health effects anticipated from environmental exploitation and decay (global warming, ozone depletion, toxic and radioactive waste disposal, deteriorating air and water quality, deforestation and desertification) (2, 3); 3) a shift in immigration patterns such that developing world peoples comprise a majority of immigrants to Western nations (84% of 64,3000 immigrants to the United States in 1988 were of Latin American or Asian origin) (4), and are often foci of endemic and epidemic diseases, both infectious and noninfectious; 4) an emerging global economic interdependence, independent of but heightened by the facts that the United States is now a debtor nation, and that Japan leads in international health funding. The consequences of these trends are that the infrastructures of developed nations face qualitatively new and intense pressures from developing world peoples. Furthermore, the global village concept has never more aptly described the status of world health. We suggest that there exists a mutuality and parallelism of domestic-international public health research, practice and interest which must be nurtured. Mutual areas of

Self-care in rural areas of India and Nepal.

Self-care during illness and pregnancies by individuals and their families is a ubiquitous and integral part of societies throughout the world. This paper reports findings about self-care practices identified during four studies carried out over a ten-year period involving about 14,000 interviews in 7,400 households comprising over 48,000 people in three Indian states and three districts of Nepal. The proportion of ill individuals using self-care over a two-week period in the different study areas ranged from 19 to 42 percent. This involved 5 to 9 percent of the total population in self-care activities during these two weeks. Much larger differences were found between India and Nepal in the use of self-care during pregnancies. Self-care or care by relatives and friends was the predominant source of maternity care in Nepal, including deliveries, while Indian maternal care was dominated by traditional birth attendants. Comparisons also were made between self-care and the use of professional healers or health care services during the same time period. Differences in the use of self-care by age, sex, caste, access to government or special project services, type of illness, and duration and severity of illness have also been shown. The need for similar, better standardized surveys in combination with intensive studies examining the details and rationale behind self-care practices in different societies has been stressed as an essential step in developing programs to expand or modify self-care practices of individuals and their families.

Factors associated with success among southern Cheyenne and Arapaho Indians

Researchers in applied social science are seeking ways of approaching the facilitation of community-based development at the grass-roots level. Much research to date has focused on negative social aspects in communities, such as substance abuse and high numbers of school drop-outs. An innovative approach was developed that involved looking instead at successful individuals in communities. Individuals identified as successful were interviewed about the factors they associated with their own success. The experience of supportive parenting during their childhoods and moderation in alcohol and other substance use as adults were strongly correlated with success in life. The interview process provided an effective springboard for discussions and the development of intervention strategies at the community level.

The Danfa family planning program in rural Ghana.

The objectives of the Danfa Family Planning Program in rural Ghana are to provide family planning services to the people in the region and to conduct research into ways of making these services as effective and accessible as possible within given resource limitations. The effort is made to describe the planning and operating experience of the program during its 1st 2 1/2 years. In order to test the hypotheses and satisfy service, research, and teaching objectives, the region in which the project operates was divided into 4 areas with each area receiving different service inputs. This division was related to the following arguments with the 4th area used as a control area to learn how much family planning occurs in the absence of special health, education, and family planning programs: 1) couples will want to limit the number of their children only if they perceive that they need no longer fear that several of them will die before reaching adulthood; 2) the most cost-effective approach is to provide family planning services in conjunction with an intensive educational program promoting good health practices and family planning but without comprehensive health services; and 3) by amking family planning services available without concern for comprehensive health services or a special education program, adequate acceptance of family planning and a favorable fertility change at minimum cost will be achieved. The 4 research areas covering about 200 square miles are located in a rural region 8-50 miles north of Accra, the capital of Ghana, and have a population of 60,000. It was learned that it is easier to operate a family planning program in this region of rural Ghana than had originally been anticipated and that education about the benefits of family planning and the methods available along with accessibility to services are 2 elements that are crucial to the success of a family planning program in this setting.

Attitudes towards family size and family planning in rural Ghana-Danfa Project: 1972 survey findings.

A KAP survey of 2000 households in the Danfa Project in Ghana was conducted April-October 1972. Follow-up surveys were taken in 1975 and 1977 to evaluate changes related to health education and family planning programs. 2745 females aged 15-44 and 1973 males aged 15-64 were interviewed. More older men were included because of their remarriage practices. 47.5% were under 15; average age 17. The population is primarily agricultural; 2/3 adults are uneducated. The birth rate is 47/1000; the death rate 17/1000. With a growth rate of 3% the population will double in twenty years. Five questionnaires were used to obtain information on fertility maternal and child health practices illness within the preceding 2 weeks and family planning KAP. 70% approved family planning but most preferred large families. Ideal family size for males was 9.8 children for females 6.6. Women with 10 children are honored in their villages. Ghanans marry early: men in mid-20s women 18-19 and start families immediately. The desire for large families eliminates motivation to use birth control. Improved health conditions increased size of reproductive age population and early marital age will increase the 3% growth rate. Women will be more important than men in deciding family planning practice. Most villagers hear about family planning by word of mouth. Village-based health educators work with birth attendants community leaders teachers and church groups to encourage family planning.

An approach to evaluating the quality of primary health care in rural clinics in Ghana

This study is a simple low cost assessment of the quality of care in a rural primary health care setting using the Danfa Health Center and 3 satellite clinics. The evaluation data are based on structured observations of the care provided by medical assistants (MAs) midwives and community health nurses (CHNs) providers serving the greatest proportion of the population. The clinical conditions (topics) selected for study were care of pediatric malaria prenatal midwifery care and postnatal health education. Attention was focused on the collection of process data relevant to health services research because although analyzing structural characteristics is easier presence of structural facilities does not guarantee access and use. Criteria were developed by 2 physician specialists and reviewed by peers in the University of Ghana Medical School and the Ministry of Health. The health center and 3 satellite clinics under study serve a population of about 12000 48% of which were under 15. MAs were found to rigorously follow only 2 test criteria: questioning regarding duration of fever and prescription of medicine. Other tests such as blood films were not performed often enough by expected performance level standards although noncompliance might have been justifiable in the case for example of the MAs not palpating spleens where most people have enlarged spleens. Midwives met standards for 6 of 12 performance protocols; still disquieting. Requesting inexpensive hemoglobin lab tests for example might be desirable. CHNs showed a considerable disparity with acceptable standards exceeding them in only 1 out of 12 procedures. More experience is needed to select criteria carefully and observe reasons for noncompliance. A greater involvement of personnel in the process of evaluation would facilitate constructive changes for improved quality of care and staff training.

Strategies for strengthening health services infrastructure: A case study in Ghana☆

Abstract The Danfa Comprehensive Rural Health and Family Planning Project is a long-term collaborative project between a Ghanaian medical school and an American school of public health with financial and technical support from Ghana and USAID. Project efforts have focused on training. service and research in a rural agricultural area 8–50 miles north of Accra. Staff have been particularly concerned with strengthening the health service infrastructure in the area in order thai project activities can be replicated elsewhere. Training, information transfer and cost control have been essential in this effort to institutionalize project findings.

Integration of family planning and maternal and child health in rural West Africa.

The Danfa Comprehensive Rural Health and Family Planning Project in Ghana is a service teaching research and demonstration project in the rural part of the country. Instituted in 1970 for an 8-year period the project was designed to investigate the feasibility and advantages of an integrated delivery system for family planning and maternal and child health services. The advantages of integrated health care are cited. It was postulated before the project started that integrated health care would be most effective in per acceptor costs and acceptance rates. Within the project area different areas provide different programs of health care. The various types of care are described. Functional and cost analysis show that for every family planning acceptor in the area providing only family planning services 2 acceptors are gained by the family planning plus health education program and 5 for the comprehensive health care/family planning program.

Family planning and indigenous medicine practitioners

Abstract The role—present and potential—of Indias indigenous medicine practitioners in the government family planning program is discussed. Results from interviews with 62 active traditional healers (six of the interviews in detail) in a North Indian development block are presented. Special emphasis is placed on the traditional healers opinions and knowledge of family planning and his opinion of and willingness to participate in the government family planning program.