When There is No Doctor - Contents
This handbook has been written primarily for those who live far from medical
centers, in places where there is no doctor. But even where there are doctors, people
can and should take the lead in their own health care. So this book is for everyone
who cares. It has been written in the belief that:
1. Health care is not only everyone’s right, but everyone’s responsibility.
2. Informed self-care should be the main goal of any health program or
activity.
3. Ordinary people provided with clear, simple information can prevent and
treat most common health problems in their own homes—earlier, cheaper,
and often better than can doctors.
4. Medical knowledge should not be the guarded secret of a select few, but
should be freely shared by everyone.
5. People with little formal education can be trusted as much as those with a
lot. And they are just as smart.
6. Basic health care should not be delivered, but encouraged.
Clearly, a part of informed self-care is knowing one’s own limits. Therefore
guidelines are included not only for what to do, but for when to seek help. The book
points out those cases when it is important to see or get advice from a health worker
or doctor. But because doctors or health workers are not always nearby, the book also
suggests what to do in the meantime—even for very serious problems.
This book has been written in fairly basic English, so that persons without much
formal education (or whose first language is not English) can understand it. The
language used is simple but, I hope, not childish. A few more difficult words have
been used where they are appropriate or fit well. Usually they are used in ways that
their meanings can be easily guessed. This way, those who read this book have a
chance to increase their language skills as well as their medical skills.
Important words the reader may not understand are explained in a word list or
vocabulary at the end of the book. The first time a word listed in the vocabulary is
mentioned in a chapter it is usually written in italics.
Where There Is No Doctor was first written in Spanish for farm people in the
mountains of Mexico where, 27 years ago, the author helped form a health care
network now run by the villagers themselves. Where There Is No Doctor has been
translated into more than 50 languages and is used by village health workers in over
100 countries.
Introduction
The first English edition was the result of many requests to adapt it for use in Africa
and Asia. I received help and suggestions from persons with experience in many
parts of the world. But the English edition seems to have lost much of the flavor and
usefulness of the original Spanish edition, which was written for a specific area, and
for people who have for years been my neighbors and friends. In rewriting the book to
serve people in many parts of the world, it has in some ways become too general.
To be fully useful, this book should be adapted by persons familiar with the
health needs, customs, special ways of healing, and local language of specific
areas.
Persons or programs who wish to use this book, or portions of it, in preparing their
own manuals for villagers or health workers are encouraged to do so. Permission
from the author or publisher is not needed—provided the parts reproduced are
distributed free or at cost—not for profit. It would be appreciated if you would (1)
include a note of credit and (2) send a copy of your production to Hesperian, 1919
Addison St., #304, Berkeley, California 94704, U.S.A.
For local or regional health programs that do not have the resources for revising this
book or preparing their own manuals, it is strongly suggested that if the present edition
is used, leaflets or inserts be supplied with the book to provide additional information
as needed.
In the Green Pages (the Uses, Dosage, and Precautions for Medicines) blank
spaces have been left to write in common brand names and prices of medicines.
Once again, local programs or organizations distributing the book would do well to
make up a list of generic or low-cost brand names and prices, to be included with
each copy of the book.
This book was written for anyone who wants to do something about his or her own
and other people’s health. However, it has been widely used as a training and work
manual for community health workers. For this reason, an introductory section has
been added for the health worker, making clear that the health worker’s first job is to
share her knowledge and help educate people.
Today in over-developed as well as under-developed countries, existing health care
systems are in a state of crisis. Often, human needs are not being well met. There is
too little fairness. Too much is in the hands of too few.
Let us hope that through a more generous sharing of knowledge, and through
learning to use what is best in both traditional and modern ways of healing, people
everywhere will develop a kinder, more sensible approach to caring—for their own
health, and for each other.
—D.W.
INTRODUCTION
NOTE ABOUT THIS NEW EDITION
WORDS TO THE VILLAGE HEALTH WORKER (Brown Pages). . . . . . . . . . . . . .w1
Health Needs and Human Needs w2 A Balance Between Prevention and
Many Thing Relate to Health Care w7 Treatment w17
Take a Good Look at Your Community w8 Sensible and Limited Use of Medicines w18
Using Local Resources to Meet Needs w12 Finding Out What Progress Has Been
Deciding What to Do and Where to Made w20
Begin w13 Teaching and Learning Together w21
Trying a New Idea w15 Tools for Teaching w22
A Balance Between People and Land w16 Making the Best Use of This Book w28
Chapter 1
HOME CURES AND POPULAR BELIEFS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Home Cures That Help 1 Ways to Tell Whether a Home Remedy
Beliefs That Can Make People Well 2 Works or Not 10
Beliefs That Can Make People Sick 4 Medicinal Plants 12
Witchcraft—Black Magic—and the Evil Eye 5 Homemade Casts—for Broken Bones 14
Questions and Answers 6 Enemas, Laxatives, and Purges 15
Sunken Fontanel or Soft Spot 9
Chapter 2
SICKNESSES THAT ARE OFTEN CONFUSED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
What Causes Sickness? 17 Example of Local Names for Sicknesses 22
Different Kinds of Sicknesses and Their Misunderstanding Due to Confusion of
Causes 18 Names 25
Non-infectious Diseases 18 Confusion between Different illnesses That
Infectious Diseases 19 Cause Fever 26
Sicknesses That Are Hard to Tell Apart 20
Chapter 3
HOW TO EXAMINE A SICK PERSON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Questions 29 Eyes 33
General Condition of Health 30 Ears 34
Temperature 30 Skin 34
How to Use a Thermometer 31 The Belly (Abdomen) 35
Breathing (Respiration) 32 Muscles and Nerves 37
Pulse (Heartbeat) 32
Chapter 4
HOW TO TAKE CARE OF A SICK PERSON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
The Comfort of the Sick Person 39 Watching for Changes 41
Special Care for a Person Who Is Very Ill 40 Signs of Dangerous Illness 42
Liquids 40 When and How to Look for Medical Help 43
Food 41 What to Tell the Health Worker 43
Cleanliness and Changing Position in Bed 41 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 When Should Medicine Not Be Taken? 54
The Most Dangerous Misuse of Medicine 50
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 Dosage Instructions for Persons Who
How to Give Medicines to Small Children 62 Cannot Read 63
How to Take Medicines 63
Chapter 9
INSTRUCTIONS AND PRECAUTIONS FOR INJECTIONS. . . . . . . . . . . . . . . . . . . . . . . . 65
When to Inject and When Not To 65 Avoiding Serious Reactions to Penicillin 71
Emergencies When It Is Important to Give How to Prepare a Syringe for Injection 72
Injections 66 How to Inject 73
Medicines Not to Inject 67 How Injections Can Disable Children 74
Risks and Precautions 68 How to Sterilize Equipment 74
Dangerous Reactions From Injecting Certain
Medicines 70
Chapter 10
FIRST AID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
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
CPoisoning 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 Special Diets for Specific Health
Why It Is Important to Eat Right 109 Problems 124
Preventing Malnutrition 109 Anemia 124
Main Foods and Helper Foods 110 Rickets 125
Eating Right to Stay Healthy 111 High Blood Pressure 125
How to Recognize Malnutrition 112 Fat People 126
Eating Better When You Do Not Have Much Constipation 126
Money or Land 115 Diabetes 127
Where to Get Vitamins: In Pills or Acid Indigestion, Heartburn, and Stomach
in Foods? 118 Ulcers 128
Things to Avoid in Our Diet 119 Goiter
The Best Diet for Small Children 120 (A Swelling or Lump on the Throat) 130
Harmful Ideas about Diet 123
Chapter 12
PREVENTION: HOW TO AVOID MANY SICKNESSES . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Cleanliness—and Problems from Lack of Trichinosis 144
Cleanliness 131 Amebas 144
Basic Guidelines of Cleanliness 133 Giardia 145
Sanitation and Latrines 137 Blood Flukes
Worms and Other Intestinal Parasites 140 (Schistosomiasis, Bilharzia) 146
Roundworm (Ascaris) 140 Vaccinations (lmmunizations)—Simple, Sure
Pinworm (Threadworm, Enterobius) 141 Protection 147
Whipworm (Trichuris) 142 Other Ways to Prevent Sickness and Injury 148
Hookworm 142 Habits That Affect Health 148
Tapeworm 143
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 Special Diets for Specific Health
Why It Is Important to Eat Right 109 Problems 124
Preventing Malnutrition 109 Anemia 124
Main Foods and Helper Foods 110 Rickets 125
Eating Right to Stay Healthy 111 High Blood Pressure 125
How to Recognize Malnutrition 112 Fat People 126
Eating Better When You Do Not Have Much Constipation 126
Money or Land 115 Diabetes 127
Where to Get Vitamins: In Pills or Acid Indigestion, Heartburn, and Stomach
in Foods? 118 Ulcers 128
Things to Avoid in Our Diet 119 Goiter
The Best Diet for Small Children 120 (A Swelling or Lump on the Throat) 130
Harmful Ideas about Diet 123
Chapter 12
PREVENTION: HOW TO AVOID MANY SICKNESSES . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Cleanliness—and Problems from Lack of Trichinosis 144
Cleanliness 131 Amebas 144
Basic Guidelines of Cleanliness 133 Giardia 145
Sanitation and Latrines 137 Blood Flukes
Worms and Other Intestinal Parasites 140 (Schistosomiasis, Bilharzia) 146
Roundworm (Ascaris) 140 Vaccinations (lmmunizations)—Simple, Sure
Pinworm (Threadworm, Enterobius) 141 Protection 147
Whipworm (Trichuris) 142 Other Ways to Prevent Sickness and Injury 148
Hookworm 142 Habits That Affect Health 148
Tapeworm 143
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 13
SOME VERY COMMON SICKNESSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Dehydration 151 Bronchitis 170
Diarrhea and Dysentery 153 Pneumonia 171
The Care of a Person with Acute Diarrhea 160 Hepatitis 172
Vomiting 161 Arthritis (Painful, Inflamed Joints) 173
Headaches and Migraines 162 Back Pain 173
Colds and the Flu 163 Varicose Veins 175
Stuffy and Runny Noses 164 Piles (Hemorrhoids) 175
Sinus Trouble (Sinusitis) 165 Swelling of the Feet and Other Parts of the
Hay Fever (Allergic Rhinitis) 165 Body 176
Allergic Reactions 166 Hernia (Rupture) 177
Asthma 167 Fits (Convulsions) 178
Cough 168
Chapter 14
SERIOUS ILLNESSES THAT NEED SPECIAL MEDICAL ATTENTION . . . . . . . . . . . .179
Tuberculosis (TB, Consumption) 179 Dengue (Breakbone Fever, Dandy
Rabies 181 Fever) 187
Tetanus (Lockjaw) 182 Brucellosis (Undulant Fever, Malta Fever) 188
Meningitis 185 Typhoid Fever 188
Malaria 186 Typhus 190
Leprosy (Hansen’s Disease) 191
Chapter 15
SKIN PROBLEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193
General Rules for Treating Skin Problems 193 Warts (Verrucae) 210
Instructions for Using Hot Compresses 195 Corns 210
Identifying Skin Problems 196 Pimples and Blackheads (Acne) 211
Scabies 199 Cancer of the Skin 211
Lice 200 Tuberculosis of the Skin or Lymph
Bedbugs 200 Nodes 212
Ticks and Chiggers 201 Erysipelas and Cellulitis 212
Small Sores with Pus 201 Gangrene (Gas Gangrene) 213
Impetigo 202 Ulcers of the Skin Caused by Poor
Boils and Abscesses 202 Circulation 213
Itching Rash, Welts, or Hives 203 Bed Sores 214
Things That Cause Itching or Burning of the Skin Problems of Babies 215
Skin 204 Eczema
Shingles (Herpes Zoster) 204 (Red Patches with Little Blisters) 216
Ringworm, Tinea (Fungus Infections) 205 Psoriasis 216
White Spots on the Face and Body 206
Mask of Pregnancy 207
Pellagra and Other Skin Problems Due to
Malnutrition 208
Chapter 16
THE EYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Danger Signs 217 Trouble Seeing Clearly 223
Injuries to the Eye 218 Cross-Eyes and Wandering Eyes 223
How to Remove a Speck of Dirt from the Sty (Hordeolum) 224
Eye 218 Pterygium 224
Chemical Burns of the Eye 219 A Scrape, Ulcer, or Scar on the Cornea 224
Red, Painful Eyes—Different Causes 219 Bleeding in the White of the Eye 225
‘Pink Eye’ (Conjunctivitis) 219 Bleeding behind the Cornea (Hyphema) 225
Trachoma 220 Pus behind the Cornea (Hypopyon) 225
Infected Eyes in Newborn Babies Cataract 225
(Neonatal Conjunctivitis) 221 Night Blindness and Xerophthalmia 226
Iritis (Inflammation of the Iris) 221 Spots or ‘Flies’ before the Eyes 227
Glaucoma 222 Double Vision 227
Infection of the Tear Sac River Blindness (Onchocerciasis) 227
(Dacryocystitis) 223
Chapter 17
THE TEETH, GUMS, AND MOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Care of Teeth and Gums 229 Sores or Cracks at the Corners of the
If You Do Not Have A Toothbrush 230 Mouth 232
Toothaches and Abscesses 231 White Patches or Spots in the Mouth 232
Pyorrhea, a Disease of the Gums 231 Cold Sores and Fever Blisters 232
Chapter 18
THE URINARY SYSTEM AND THE GENITALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Urinary Tract Infections 234 Use of a Catheter to Drain Urine 239
Kidney or Bladder Stones 235 Problems of Women 241
Enlarged Prostate Gland 235 Vaginal Discharge 241
Diseases Spread by Sexual Contact How a Woman Can Avoid Many
(Sexually Transmitted Infections) 236 Infections 242
Gonorrhea (Clap, VD, the Drip) and Pain or Discomfort in a Woman’s Belly 243
Chlamydia 236 Men and Women Who Cannot Have Children
Syphilis 237 (Infertility) 244
Bubos: Bursting Lymph Nodes in the
Groin 238
Chapter 19
INFORMATION FOR MOTHERS AND MIDWIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
The Menstrual Period How to Stay Healthy during Pregnancy 247
(Monthly Bleeding in Women) 245 Minor Problems during Pregnancy 248
The Menopause Danger Signs in Pregnancy 249
(When Women Stop Having Periods) 246 Check-ups during Pregnancy
Pregnancy 247 (Prenatal Care) 250
Record of Prenatal Care 253 Tearing of the Birth Opening 269
Things to Have Ready before the Birth 254 Care of the Newborn Baby 270
Preparing for Birth 256 Illnesses of the Newborn 272
Signs That Show Labor Is Near 258 The Mothers Health after Childbirth 276
The Stages of Labor 259 Childbirth Fever
Care of the Baby at Birth 262 (Infection after Giving Birth) 276
Care of the Cut Cord (Navel) 263 Care of the Breasts 277
The Delivery of the Placenta (Afterbirth) 264 Lumps or Growths in the Lower Part of the
Hemorrhaging (Heavy Bleeding) 264 Belly 280
The Correct Use of Oxytocics: Miscarriage (Spontaneous Abortion) 281
Ergonovine, Oxytocin, Pitocin, etc. 266 High Risk Mothers and Babies 282
Difficult Births 267
Chapter 20
FAMILY PLANNING—
HAVING THE NUMBER OF CHILDREN YOU WANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Choosing a method of Family Planning 284 Methods for Those Who Never Want to Have
Oral Contraceptives More Children 293
(Birth Control Pills) 286 Home Methods for Preventing
Other Methods of Family Planning 290 Pregnancy 294
Combined Methods 292
Chapter 21
HEALTH AND SICKNESSES OF CHILDREN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
What to Do to Protect Children’s Mumps 312
Health 295 Whooping Cough 313
Children’s Growth— Diphtheria 313
and the ‘Road to Health’ 297 Infantile Paralysis (Polio) 314
Child Health Chart 298 How to Make Simple Crutches 315
Review of Children’s Health Problems Problems Children Are Born With 316
Discussed in Other Chapters 305 Dislocated Hip 316
Health Problems of Children Not Umbilical Hernia
Discussed in Other Chapters 309 (Belly Button That Sticks Out) 317
Earache and Ear Infections 309 A ‘Swollen Testicle’
Sore Throat and Inflamed Tonsils 309 (Hydrocele or Hernia) 317
Rheumatic Fever 310 Mentally Slow, Deaf, or Deformed
Infectious Diseases of Childhood 311 Children 318
Chickenpox 311 The Spastic Child (Cerebral Palsy) 320
Measles (Rubeola) 311 Retardation in the First Months of Life 321
German Measles (Rubella) 312 Sickle Cell Disease 321
Helping Children Learn 322
Chapter 22
HEALTH AND SICKNESSES OF OLDER PEOPLE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Summary of Health Problems Discussed in Deafness 327
Other Chapters 323 Loss of Sleep (Insomnia) 328
Other Important Illnesses of Old Age 325 Diseases Found More Often in People over
Heart Trouble 325 Forty 328
Words to Younger Persons Who Want to Cirrhosis of the Liver 328
Stay Healthy When Older 326 Gallbladder Problems 329
Stroke (Apoplexy, Cerebro-Vascular Accepting Death 330
Accident, CVA) 327
Chapter 23
THE MEDICINE KIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
How to Care for Your Medicine Kit 332 The Village Medicine Kit 336
Buying Supplies for the Medicine Kit 333 Words to the Village Storekeeper
The Home Medicine Kit 334 (or Pharmacist) 338
THE GREEN PAGES—The Uses, Dosage, and Precautions for Medicines . . . . . . . 339
List of Medicines in the Green Pages. 341
Index of Medicines in the Green Pages . 345
Information on Medicines . 351
THE BLUE PAGES-New information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
VOCABULARY—Explaining Difficult Words. . . . . . . . . . . . . . . . . . . . . 419
ADDRESSES FOR TEACHING MATERIALS. . . . . . . . . . . . . . . . . . . . . 429
INDEX (Yellow Pages). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Dosage Instructions for Persons Who Cannot Read
Making Medical Reports
Information About Vital Signs
HIV/AIDS 399
Sores on the Genitals 402
Circumcision and Excision 404
Special Care for Small, Early,
and Underweight Babies 405
Ear Wax 405
Leishmaniasis 406
Guinea Worm 406
Emergencies Caused by Cold 408
How to Measure Blood Pressure 410
Poisoning from Pesticides 412
Complications from Abortion 414
Drug Abuse and Addiction 416
VOCABULARY—Explaining Difficult Words. . . . . . . . . . . . . . . . . . . . . 419
ADDRESSES FOR TEACHING MATERIALS. . . . . . . . . . . . . . . . . . . . . 429
INDEX (Yellow Pages). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Dosage Instructions for Persons Who Cannot Read
Making Medical Reports
Information About Vital Signs
This handbook has been written primarily for those who live far from medical
centers, in places where there is no doctor. But even where there are doctors, people
can and should take the lead in their own health care. So this book is for everyone
who cares. It has been written in the belief that:
1. Health care is not only everyone’s right, but everyone’s responsibility.
2. Informed self-care should be the main goal of any health program or
activity.
3. Ordinary people provided with clear, simple information can prevent and
treat most common health problems in their own homes—earlier, cheaper,
and often better than can doctors.
4. Medical knowledge should not be the guarded secret of a select few, but
should be freely shared by everyone.
5. People with little formal education can be trusted as much as those with a
lot. And they are just as smart.
6. Basic health care should not be delivered, but encouraged.
Clearly, a part of informed self-care is knowing one’s own limits. Therefore
guidelines are included not only for what to do, but for when to seek help. The book
points out those cases when it is important to see or get advice from a health worker
or doctor. But because doctors or health workers are not always nearby, the book also
suggests what to do in the meantime—even for very serious problems.
This book has been written in fairly basic English, so that persons without much
formal education (or whose first language is not English) can understand it. The
language used is simple but, I hope, not childish. A few more difficult words have
been used where they are appropriate or fit well. Usually they are used in ways that
their meanings can be easily guessed. This way, those who read this book have a
chance to increase their language skills as well as their medical skills.
Important words the reader may not understand are explained in a word list or
vocabulary at the end of the book. The first time a word listed in the vocabulary is
mentioned in a chapter it is usually written in italics.
Where There Is No Doctor was first written in Spanish for farm people in the
mountains of Mexico where, 27 years ago, the author helped form a health care
network now run by the villagers themselves. Where There Is No Doctor has been
translated into more than 50 languages and is used by village health workers in over
100 countries.
Introduction
The first English edition was the result of many requests to adapt it for use in Africa
and Asia. I received help and suggestions from persons with experience in many
parts of the world. But the English edition seems to have lost much of the flavor and
usefulness of the original Spanish edition, which was written for a specific area, and
for people who have for years been my neighbors and friends. In rewriting the book to
serve people in many parts of the world, it has in some ways become too general.
To be fully useful, this book should be adapted by persons familiar with the
health needs, customs, special ways of healing, and local language of specific
areas.
Persons or programs who wish to use this book, or portions of it, in preparing their
own manuals for villagers or health workers are encouraged to do so. Permission
from the author or publisher is not needed—provided the parts reproduced are
distributed free or at cost—not for profit. It would be appreciated if you would (1)
include a note of credit and (2) send a copy of your production to Hesperian, 1919
Addison St., #304, Berkeley, California 94704, U.S.A.
For local or regional health programs that do not have the resources for revising this
book or preparing their own manuals, it is strongly suggested that if the present edition
is used, leaflets or inserts be supplied with the book to provide additional information
as needed.
In the Green Pages (the Uses, Dosage, and Precautions for Medicines) blank
spaces have been left to write in common brand names and prices of medicines.
Once again, local programs or organizations distributing the book would do well to
make up a list of generic or low-cost brand names and prices, to be included with
each copy of the book.
This book was written for anyone who wants to do something about his or her own
and other people’s health. However, it has been widely used as a training and work
manual for community health workers. For this reason, an introductory section has
been added for the health worker, making clear that the health worker’s first job is to
share her knowledge and help educate people.
Today in over-developed as well as under-developed countries, existing health care
systems are in a state of crisis. Often, human needs are not being well met. There is
too little fairness. Too much is in the hands of too few.
Let us hope that through a more generous sharing of knowledge, and through
learning to use what is best in both traditional and modern ways of healing, people
everywhere will develop a kinder, more sensible approach to caring—for their own
health, and for each other.
—D.W.
INTRODUCTION
NOTE ABOUT THIS NEW EDITION
WORDS TO THE VILLAGE HEALTH WORKER (Brown Pages). . . . . . . . . . . . . .w1
Health Needs and Human Needs w2 A Balance Between Prevention and
Many Thing Relate to Health Care w7 Treatment w17
Take a Good Look at Your Community w8 Sensible and Limited Use of Medicines w18
Using Local Resources to Meet Needs w12 Finding Out What Progress Has Been
Deciding What to Do and Where to Made w20
Begin w13 Teaching and Learning Together w21
Trying a New Idea w15 Tools for Teaching w22
A Balance Between People and Land w16 Making the Best Use of This Book w28
Chapter 1
HOME CURES AND POPULAR BELIEFS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Home Cures That Help 1 Ways to Tell Whether a Home Remedy
Beliefs That Can Make People Well 2 Works or Not 10
Beliefs That Can Make People Sick 4 Medicinal Plants 12
Witchcraft—Black Magic—and the Evil Eye 5 Homemade Casts—for Broken Bones 14
Questions and Answers 6 Enemas, Laxatives, and Purges 15
Sunken Fontanel or Soft Spot 9
Chapter 2
SICKNESSES THAT ARE OFTEN CONFUSED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
What Causes Sickness? 17 Example of Local Names for Sicknesses 22
Different Kinds of Sicknesses and Their Misunderstanding Due to Confusion of
Causes 18 Names 25
Non-infectious Diseases 18 Confusion between Different illnesses That
Infectious Diseases 19 Cause Fever 26
Sicknesses That Are Hard to Tell Apart 20
Chapter 3
HOW TO EXAMINE A SICK PERSON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Questions 29 Eyes 33
General Condition of Health 30 Ears 34
Temperature 30 Skin 34
How to Use a Thermometer 31 The Belly (Abdomen) 35
Breathing (Respiration) 32 Muscles and Nerves 37
Pulse (Heartbeat) 32
Chapter 4
HOW TO TAKE CARE OF A SICK PERSON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
The Comfort of the Sick Person 39 Watching for Changes 41
Special Care for a Person Who Is Very Ill 40 Signs of Dangerous Illness 42
Liquids 40 When and How to Look for Medical Help 43
Food 41 What to Tell the Health Worker 43
Cleanliness and Changing Position in Bed 41 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 When Should Medicine Not Be Taken? 54
The Most Dangerous Misuse of Medicine 50
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 Dosage Instructions for Persons Who
How to Give Medicines to Small Children 62 Cannot Read 63
How to Take Medicines 63
Chapter 9
INSTRUCTIONS AND PRECAUTIONS FOR INJECTIONS. . . . . . . . . . . . . . . . . . . . . . . . 65
When to Inject and When Not To 65 Avoiding Serious Reactions to Penicillin 71
Emergencies When It Is Important to Give How to Prepare a Syringe for Injection 72
Injections 66 How to Inject 73
Medicines Not to Inject 67 How Injections Can Disable Children 74
Risks and Precautions 68 How to Sterilize Equipment 74
Dangerous Reactions From Injecting Certain
Medicines 70
Chapter 10
FIRST AID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
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
CPoisoning 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 Special Diets for Specific Health
Why It Is Important to Eat Right 109 Problems 124
Preventing Malnutrition 109 Anemia 124
Main Foods and Helper Foods 110 Rickets 125
Eating Right to Stay Healthy 111 High Blood Pressure 125
How to Recognize Malnutrition 112 Fat People 126
Eating Better When You Do Not Have Much Constipation 126
Money or Land 115 Diabetes 127
Where to Get Vitamins: In Pills or Acid Indigestion, Heartburn, and Stomach
in Foods? 118 Ulcers 128
Things to Avoid in Our Diet 119 Goiter
The Best Diet for Small Children 120 (A Swelling or Lump on the Throat) 130
Harmful Ideas about Diet 123
Chapter 12
PREVENTION: HOW TO AVOID MANY SICKNESSES . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Cleanliness—and Problems from Lack of Trichinosis 144
Cleanliness 131 Amebas 144
Basic Guidelines of Cleanliness 133 Giardia 145
Sanitation and Latrines 137 Blood Flukes
Worms and Other Intestinal Parasites 140 (Schistosomiasis, Bilharzia) 146
Roundworm (Ascaris) 140 Vaccinations (lmmunizations)—Simple, Sure
Pinworm (Threadworm, Enterobius) 141 Protection 147
Whipworm (Trichuris) 142 Other Ways to Prevent Sickness and Injury 148
Hookworm 142 Habits That Affect Health 148
Tapeworm 143
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 Special Diets for Specific Health
Why It Is Important to Eat Right 109 Problems 124
Preventing Malnutrition 109 Anemia 124
Main Foods and Helper Foods 110 Rickets 125
Eating Right to Stay Healthy 111 High Blood Pressure 125
How to Recognize Malnutrition 112 Fat People 126
Eating Better When You Do Not Have Much Constipation 126
Money or Land 115 Diabetes 127
Where to Get Vitamins: In Pills or Acid Indigestion, Heartburn, and Stomach
in Foods? 118 Ulcers 128
Things to Avoid in Our Diet 119 Goiter
The Best Diet for Small Children 120 (A Swelling or Lump on the Throat) 130
Harmful Ideas about Diet 123
Chapter 12
PREVENTION: HOW TO AVOID MANY SICKNESSES . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Cleanliness—and Problems from Lack of Trichinosis 144
Cleanliness 131 Amebas 144
Basic Guidelines of Cleanliness 133 Giardia 145
Sanitation and Latrines 137 Blood Flukes
Worms and Other Intestinal Parasites 140 (Schistosomiasis, Bilharzia) 146
Roundworm (Ascaris) 140 Vaccinations (lmmunizations)—Simple, Sure
Pinworm (Threadworm, Enterobius) 141 Protection 147
Whipworm (Trichuris) 142 Other Ways to Prevent Sickness and Injury 148
Hookworm 142 Habits That Affect Health 148
Tapeworm 143
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 13
SOME VERY COMMON SICKNESSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Dehydration 151 Bronchitis 170
Diarrhea and Dysentery 153 Pneumonia 171
The Care of a Person with Acute Diarrhea 160 Hepatitis 172
Vomiting 161 Arthritis (Painful, Inflamed Joints) 173
Headaches and Migraines 162 Back Pain 173
Colds and the Flu 163 Varicose Veins 175
Stuffy and Runny Noses 164 Piles (Hemorrhoids) 175
Sinus Trouble (Sinusitis) 165 Swelling of the Feet and Other Parts of the
Hay Fever (Allergic Rhinitis) 165 Body 176
Allergic Reactions 166 Hernia (Rupture) 177
Asthma 167 Fits (Convulsions) 178
Cough 168
Chapter 14
SERIOUS ILLNESSES THAT NEED SPECIAL MEDICAL ATTENTION . . . . . . . . . . . .179
Tuberculosis (TB, Consumption) 179 Dengue (Breakbone Fever, Dandy
Rabies 181 Fever) 187
Tetanus (Lockjaw) 182 Brucellosis (Undulant Fever, Malta Fever) 188
Meningitis 185 Typhoid Fever 188
Malaria 186 Typhus 190
Leprosy (Hansen’s Disease) 191
Chapter 15
SKIN PROBLEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193
General Rules for Treating Skin Problems 193 Warts (Verrucae) 210
Instructions for Using Hot Compresses 195 Corns 210
Identifying Skin Problems 196 Pimples and Blackheads (Acne) 211
Scabies 199 Cancer of the Skin 211
Lice 200 Tuberculosis of the Skin or Lymph
Bedbugs 200 Nodes 212
Ticks and Chiggers 201 Erysipelas and Cellulitis 212
Small Sores with Pus 201 Gangrene (Gas Gangrene) 213
Impetigo 202 Ulcers of the Skin Caused by Poor
Boils and Abscesses 202 Circulation 213
Itching Rash, Welts, or Hives 203 Bed Sores 214
Things That Cause Itching or Burning of the Skin Problems of Babies 215
Skin 204 Eczema
Shingles (Herpes Zoster) 204 (Red Patches with Little Blisters) 216
Ringworm, Tinea (Fungus Infections) 205 Psoriasis 216
White Spots on the Face and Body 206
Mask of Pregnancy 207
Pellagra and Other Skin Problems Due to
Malnutrition 208
Chapter 16
THE EYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Danger Signs 217 Trouble Seeing Clearly 223
Injuries to the Eye 218 Cross-Eyes and Wandering Eyes 223
How to Remove a Speck of Dirt from the Sty (Hordeolum) 224
Eye 218 Pterygium 224
Chemical Burns of the Eye 219 A Scrape, Ulcer, or Scar on the Cornea 224
Red, Painful Eyes—Different Causes 219 Bleeding in the White of the Eye 225
‘Pink Eye’ (Conjunctivitis) 219 Bleeding behind the Cornea (Hyphema) 225
Trachoma 220 Pus behind the Cornea (Hypopyon) 225
Infected Eyes in Newborn Babies Cataract 225
(Neonatal Conjunctivitis) 221 Night Blindness and Xerophthalmia 226
Iritis (Inflammation of the Iris) 221 Spots or ‘Flies’ before the Eyes 227
Glaucoma 222 Double Vision 227
Infection of the Tear Sac River Blindness (Onchocerciasis) 227
(Dacryocystitis) 223
Chapter 17
THE TEETH, GUMS, AND MOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Care of Teeth and Gums 229 Sores or Cracks at the Corners of the
If You Do Not Have A Toothbrush 230 Mouth 232
Toothaches and Abscesses 231 White Patches or Spots in the Mouth 232
Pyorrhea, a Disease of the Gums 231 Cold Sores and Fever Blisters 232
Chapter 18
THE URINARY SYSTEM AND THE GENITALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Urinary Tract Infections 234 Use of a Catheter to Drain Urine 239
Kidney or Bladder Stones 235 Problems of Women 241
Enlarged Prostate Gland 235 Vaginal Discharge 241
Diseases Spread by Sexual Contact How a Woman Can Avoid Many
(Sexually Transmitted Infections) 236 Infections 242
Gonorrhea (Clap, VD, the Drip) and Pain or Discomfort in a Woman’s Belly 243
Chlamydia 236 Men and Women Who Cannot Have Children
Syphilis 237 (Infertility) 244
Bubos: Bursting Lymph Nodes in the
Groin 238
Chapter 19
INFORMATION FOR MOTHERS AND MIDWIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
The Menstrual Period How to Stay Healthy during Pregnancy 247
(Monthly Bleeding in Women) 245 Minor Problems during Pregnancy 248
The Menopause Danger Signs in Pregnancy 249
(When Women Stop Having Periods) 246 Check-ups during Pregnancy
Pregnancy 247 (Prenatal Care) 250
Record of Prenatal Care 253 Tearing of the Birth Opening 269
Things to Have Ready before the Birth 254 Care of the Newborn Baby 270
Preparing for Birth 256 Illnesses of the Newborn 272
Signs That Show Labor Is Near 258 The Mothers Health after Childbirth 276
The Stages of Labor 259 Childbirth Fever
Care of the Baby at Birth 262 (Infection after Giving Birth) 276
Care of the Cut Cord (Navel) 263 Care of the Breasts 277
The Delivery of the Placenta (Afterbirth) 264 Lumps or Growths in the Lower Part of the
Hemorrhaging (Heavy Bleeding) 264 Belly 280
The Correct Use of Oxytocics: Miscarriage (Spontaneous Abortion) 281
Ergonovine, Oxytocin, Pitocin, etc. 266 High Risk Mothers and Babies 282
Difficult Births 267
Chapter 20
FAMILY PLANNING—
HAVING THE NUMBER OF CHILDREN YOU WANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Choosing a method of Family Planning 284 Methods for Those Who Never Want to Have
Oral Contraceptives More Children 293
(Birth Control Pills) 286 Home Methods for Preventing
Other Methods of Family Planning 290 Pregnancy 294
Combined Methods 292
Chapter 21
HEALTH AND SICKNESSES OF CHILDREN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
What to Do to Protect Children’s Mumps 312
Health 295 Whooping Cough 313
Children’s Growth— Diphtheria 313
and the ‘Road to Health’ 297 Infantile Paralysis (Polio) 314
Child Health Chart 298 How to Make Simple Crutches 315
Review of Children’s Health Problems Problems Children Are Born With 316
Discussed in Other Chapters 305 Dislocated Hip 316
Health Problems of Children Not Umbilical Hernia
Discussed in Other Chapters 309 (Belly Button That Sticks Out) 317
Earache and Ear Infections 309 A ‘Swollen Testicle’
Sore Throat and Inflamed Tonsils 309 (Hydrocele or Hernia) 317
Rheumatic Fever 310 Mentally Slow, Deaf, or Deformed
Infectious Diseases of Childhood 311 Children 318
Chickenpox 311 The Spastic Child (Cerebral Palsy) 320
Measles (Rubeola) 311 Retardation in the First Months of Life 321
German Measles (Rubella) 312 Sickle Cell Disease 321
Helping Children Learn 322
Chapter 22
HEALTH AND SICKNESSES OF OLDER PEOPLE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Summary of Health Problems Discussed in Deafness 327
Other Chapters 323 Loss of Sleep (Insomnia) 328
Other Important Illnesses of Old Age 325 Diseases Found More Often in People over
Heart Trouble 325 Forty 328
Words to Younger Persons Who Want to Cirrhosis of the Liver 328
Stay Healthy When Older 326 Gallbladder Problems 329
Stroke (Apoplexy, Cerebro-Vascular Accepting Death 330
Accident, CVA) 327
Chapter 23
THE MEDICINE KIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
How to Care for Your Medicine Kit 332 The Village Medicine Kit 336
Buying Supplies for the Medicine Kit 333 Words to the Village Storekeeper
The Home Medicine Kit 334 (or Pharmacist) 338
THE GREEN PAGES—The Uses, Dosage, and Precautions for Medicines . . . . . . . 339
List of Medicines in the Green Pages. 341
Index of Medicines in the Green Pages . 345
Information on Medicines . 351
THE BLUE PAGES-New information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
VOCABULARY—Explaining Difficult Words. . . . . . . . . . . . . . . . . . . . . 419
ADDRESSES FOR TEACHING MATERIALS. . . . . . . . . . . . . . . . . . . . . 429
INDEX (Yellow Pages). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Dosage Instructions for Persons Who Cannot Read
Making Medical Reports
Information About Vital Signs
HIV/AIDS 399
Sores on the Genitals 402
Circumcision and Excision 404
Special Care for Small, Early,
and Underweight Babies 405
Ear Wax 405
Leishmaniasis 406
Guinea Worm 406
Emergencies Caused by Cold 408
How to Measure Blood Pressure 410
Poisoning from Pesticides 412
Complications from Abortion 414
Drug Abuse and Addiction 416
VOCABULARY—Explaining Difficult Words. . . . . . . . . . . . . . . . . . . . . 419
ADDRESSES FOR TEACHING MATERIALS. . . . . . . . . . . . . . . . . . . . . 429
INDEX (Yellow Pages). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Dosage Instructions for Persons Who Cannot Read
Making Medical Reports
Information About Vital Signs
Comment