This month we review a manual for village health-workers that has become a best-seller in the Third World; and we hear voices of Australia's forgotten poor. Editor: Anuradha Vittachi

Where there is no doctor

Where there is no doctor
by David Werner

UK: Macmillan (pbk) £2.95/ export £1.95
US: Hesperian Foundation


From time to time an outstanding book is produced which meets an immediately felt need. Such is David Werner's book Where there is no doctor, which to me is the most important book to have come out in the health field in the last ten years.

Its UK publishers say, 'The demand is so great we can hardly keep up with the orders' - despite five reprints since January 1980 totalling 65,000 copies. They reckon a further 200,000 or so copies have been printed and sold by other groups, sometimes adapted to local needs. The first Portuguese edition of 15,000 copies sold out in Brazil within the week. There are now seven versions already available and at least 30 translations being made: soon you'll be able to read the book in Swahili, Indonesian, Hindi, or French, or Indian-English...

The book originated from David Werner's experience of a health programme being developed for impoverished villagers in the Mexican Sierras. It came out at a time of real dissatisfaction with the health professionals' monopoly of health care and their emphasis on curative services. The book is written very much for the village health worker who is a liberator rather than a lackey of other health professionals: the spearhead, David Werner feels, of change in the village.

So Werner leads his readers through the common problems they are likely to meet; helps them understand home cures and popular beliefs; offers simple remedies where possible - for example, he includes three pages on conditions that can be managed with water only. Wherever possibie the instructions are illustrated with clear, simple drawings.

David Werner has the immense advantage that he is not a doctor: he is an artist and, above all, a deeply feeling human being. To increase the accessibility of the book, he has disclaimed all copyright except in the case of commercial firms - and then only to ensure that the price is kept low. Oxfam has subsidised the Macmillan edition to the tune of UKP1 per export copy, since the book is almost invariably used in developing countries. Paradoxically, its low price means it is not stocked by many commercial outlets: booksellers prefer expensive, glossy medical books that boost their income.

Such an outstanding and widely read book will of course attract criticisms. Some people suggest that too much emphasis is placed on curative care or that the book is too didactic. But David Werner emphasises the importance of prevention throughout; the curative information is provided because he knows most people will at first turn to the book in order to get immediate help. He poignantly and repeatedly reminds us that the roots of so much illness lie in socioeconomic conditions, and in customs and habits like smoking and consuming alcohol. These factors will be emphasised even more in his new book due out this year called Helping Health Workers Learn.

David C Morley
Professor David C Morley is the head of the Tropical Child Health unit in the Insitiute of Child Health, University of London.

Down under, down under

On the Bread Line
edited by Graeme F Brewer for the Brotherhood of St. Laurence

Hyland House, Melbourne, AUS. $9.95

Australia - land of plenty, egalitarian society, lucky country. No beggars in the streets here. Yet the 1970s Australian Government Commission of Inquiry into Poverty concluded that 18 per cent of Australians subsist 'below, or perilously close to, its austere poverty line'.

Twenty-one accounts of poverty from taped interviews by a team from the Brotherhood of St Laurence, Melbourne, have been edited with the main aims of 'giving the material a more logical flow through the reorganisation of passages scattered over two or more interviews'. Thus 21 people, coping in their own ways with poverty, tell their stories with their own emphases and attitudes.

They are a motley collection. Two are women in their eighties, who somehow have managed to keep their cheerful mettle. There are five immigrants (from Uruguay, Turkey, Italy, Lebanon and Greece) and three country people who came to the city to try to find work. Two are Aborigines, one of whom is pale in colour, consequently finding it less difficult to obtain accommodation than his darker friends. A dark friend making application for a room, he says, might be told there are 'No vacancies', yet he, following almost immediately, would find rooms available.

Poverty means powerlessness, we know. Every one of these people has tried to be independent. 'I just felt I had to make it by myself,' says Isobel, who grew up in a 'home'. Nobody noticed she suffered from acute arthritis, a condition she had endured from childhood. She accepted it as just part of living and kept on with her hard physical work.

Attitudes range from almost unbelievable courage to despair. Linda became so weighed down by 'money problems' that she attempted suicide and then tried to smother her baby.

Mustafa's father was a veterinary doctor in Istanbul. He brought his family to Australia because 'there was fighting everywhere' at home. Here he took any odd job he could get and was eventually duped into going tomato picking by being told he would get plenty of veterinary work in the country. But the veterinary work has not eventuated and tomato picking is for only three months of the year at most. And 'We are stuck here because we sold up to come here.'

Maybe there are dole bludgers. The Brotherhood of St Laurence team of interviewers did not encounter them. Graeme Brewer hopes 'these accounts may go some way towards informing our notions of poverty and showing just cause why farreaching social change needs to be implemented so that "egalitarianism" in Australia may be other than mythical'.

Ann Jennison

Letter to a Teacher
...being the book that proved bright children are failed by dim educators

DON'T BE put off by the title of the book. It's not one of those twee compilations of children's letters, full of cute misunderstandings, togged up with wobbly drawings for moist-eyed parents to buy at Christmas. Anything but. It's dead straight, serious, and hits home.

Eight schoolchildren from the mountains near Florence wrote this book. They were all 'failures', written off by the Italian educational authorities. Yet their book won the Italian Physical Society's prize, usually reserved for promising physicists. It became a best-seller in Italy, was translated into several languages, and has been called 'a masterpiece of protest'.

The children wrote the book for their parents, peasant farmers and workers. Often uneducated themselves and busy working an 18-hour day, they had little option but to accept the teachers' assessments of their children as ineducable. But when Don Lorenzo Milani, a young priest, founded a school for the farming community of Barbiana in 1954, they had enough faith in their boys to give them another chance. No girls were sent to Barbiana - perhaps, as the boys scathingly explained, parents 'believe that a woman can live her life with the brains of a hen'.

The boys' dedication to learning is inspiring. One child describes his lonely journey to school - up to two hours long: 'At times I would start running because of a viper or because a crazy man, who lived alone at the Rock, would scream at me from a distance. . . I was eleven years old. You would have been scared to death.'

'You' refers to their ex-teachers - the sort who believe that poor children fail because they aren't interested in learning. 'You tell us that you fail only the stupid and lazy. Then you claim that God causes the stupid and the lazy to be born in the houses of the poor.'

Letter to a Teacher is a brilliant vindication of those who believed in the true potential of those children. Their fresh, abrupt prose reaches the ideal proposed by Orwell: it is like a pane of glass. Arguments to satisfy the intellect are energised by anger, and supported by a devastating collection of statistics. They show how, in the educational system, everything from blatant class prejudice to subject matter, language and timetabling militate against the poor's chances of success.

Italian schools, for instance, normally shut up shop at lunchtime. Teachers who moaned at working an 18 hour week then spent their afternoons tutoring the well-to do. 'In the morning,' write the boys, 'we pay them to give the same schooling to all. Later on in the day they get money from richer people to school their young gentlemen differently. Then, in June, at our expense, they preside at the trial and judge the differences.' Lengthy holidays and frequent pauses for exams added to their frustration. The rich used their leisure time to absorb more culture, to travel with their families. For the poor, the hours out of school were 'hours of loneliness and silence, good only for deepening their shyness'.

The school at Barbiana provided a brimming 8-hour day, 6 or 7 days a week. Many hours were spent understanding problems especially relevant to their own lives. The boys came to realise, that seeing their situation clearly and being able to communicate effectively had to be their first goal: 'We must become amateurs in everything and specialists only in the ability to speak.' The classical education pushed by the Right and the scientific education pushed by the Communists were equally irrelevant while the poor remained inarticulate victims, squeezed out by a classist exam system before they reached their teens.

In Barbiana, it was the school that stretched to meet the needs of its children. The least able was the neediest and therefore the favourite, not the first to be rejected. If any child did drop out, the whole school felt it had failed in its caring, and never forgot the pain of that loss. Not so the ordinary teacher: 'You fail us right out into the fields and factories and there you forget us'.

In an afterword, Lord Boyle, a former Minister of Education in Britain, assures the boys that they would be 'pleasantly surprised' at the number of schools in Britain sympathetic to their ideas. Twenty-seven years after the school at Barbiana was founded, Lord Boyle might be unpleasantly surprised at the number of teachers, in Britain and elsewhere, who do not yet appreciate how double-edged their condemnation is, when they say of their pupils: 'I failed them.'

Anuradha Vittachi

Letter to a Teacher
by the school of Barbiana (1970)

UK: Penguin Books (out of print)