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permaculture - Re: [permaculture] Waving not Drowning

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  • From: Bob Howard <rmhoward@omninet.net.au>
  • To: john@eco-living.net, permaculture <permaculture@lists.ibiblio.org>
  • Cc:
  • Subject: Re: [permaculture] Waving not Drowning
  • Date: Mon, 14 Jul 2003 09:13:19 +0800



John Schinnerer wrote:

> Aloha,
>
> Thanks for this - "waving, not drowning" is what I'm getting at as well.
> Ask what they want, don't tell them what they need...pay attention to
> their context instead of assuming one's own applies.
>
> > Appropriate levels of support. They didn't need doctors when
> > 95% of their health needs could be provided by experienced (paramedic
> > style) nurses and midwives.
>
> A friend of mine in college really really wanted to go work offering basic
> health services in '3rd world' countries. As she looked more and more
> into what NGOs and agencies and so on she might work with, she discovered
> that in order to 'qualify' for actual hands-on work with almost all of
> them, she had to be an M.D.!!! When in fact what the clients needed was
> more like the above - basic trauma care, basic preventative and outpatient
> health services, nothing the average paramedic or nurse couldn't quite
> easily provide (and train them to provide).
>

Having worked as a nurse in a "third world" situation I can actually
appreciate why NGO'S would want an M.D. as opposed to a paramedic. The main
reason is that there are often local people on the ground with para medic
skills even in the most destitute of communities. Moreover these people have
essential local knowledge and even with minimal training are an essential part
of a health service. A doctor is needed in most cases not for the primary care
aspect but for the epidemiology and diagnostic skills that are part of
medical but not para medical training. These are essential requirements in the
field when it comes to identifying incipient epidemics of infectious disese
and difficult diagnosis - many conditions present quite differently in
extremely poor environments.

IN this case I would suggest a MD may be what they need as well as what they
want? This question (wants vs needs) is a commonplace in social worker
parlance but is often, I find, used with colonialist effect to define peoples
'real' i.e. acceptable needs.

Bob Howard


> John Schinnerer, MA
> -------------------------
> - Eco-Living -
> Cultural & Ecological Designing
> People - Place - Learning - Integration
> john@eco-living.net
> http://eco-living.net
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