One of the oldest and most interesting of U.S.-based self-care programs is the Hesperian Foundation in Palo Alto, California. For the past 17 years, Foundation Director David Werner and coworkers have supported a self sufficient villager-operated health program in Ajoya, a small, remote village high in the mountains of western Mexico.
After many years of on-site coordination by foundation staff, the villagers paid them the highest possible tribute—they explained that they were ready to run things on their own and asked the outsiders to leave. It is a measure of Werner and colleagues' approach to self-care that they were delighted. The villagers now run the program entirely, on their own.
In recent years the Hesperian folks have focused on providing written materials that support self-care education programs. In 1977 they published Werner's pioneering self-care text, Where There Is No Doctor, a Mexican villager's guide to basic medical skills—everything from rehydrating sick babies to inserting a urinary catheter. That book is currently used by a wide range of self-care education programs—especially those in Third World countries.
Now Werner and Bill Bower have produced a second, equally remarkable volume, Helping Health Workers Learn. The first book teaches basic medical skills. The second looks at how health skills and attitudes are learned and taught.
The "health workers" of the title are not doctors and nurses, but village health workers—laypeople with a special interest in and calling for working with health problems, laypeople who are natural helpers. But there is much in this volume for professional health workers to learn.
Helping Health Workers Learn is one of the few books on health education that face up to this major problem: Many health education programs increase layfolks' dependence on all-powerful professionals and undermine people's sense of their own abilities to take care of them selves. The authors clearly recognize that one of the biggest obstacles to self responsibility in health is the unwillingness of professionals to let go of control.
Werner and Bower offer guidelines as simple as they are antithetical to the assumptions behind most professional health education:
This may be the best available guide to putting together a self-care program.
-How you teach health to laypeople is just as important as what you teach them.
-Make it clear that you do not have all the answers.
- Share your knowledge openly, don't guard it and use it as a source of power.
-Teach people to use commonly available supplies and resources. Don't make them dependent on services, information, and supplies only you can provide.
-If certain community leaders are known to dominate group discussions, ask them, politely, to remain silent, so that those who seldom speak can make their suggestions first.
- Some of the best community health workers are those with serious physical handicaps.
-Persons with only a few years of schooling often make more community strengthening health workers than those with more formal education.
-Make yourself as unnecessary as possible, as soon as possible.
-Advise, don't boss.
Helping Health Workers Learn
David Werner and Bill Bower
1982/634 pages/$6.50 (plus $2 for shipping and handling) from:
The Hesperian Foundation
P.O. Box 1692
Palo Alto, CA 94302