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  • From: "Gaden@ziplip.com" <Gaden@ziplip.com>
  • To: permaculture@lists.ibiblio.org
  • Subject: [permaculture] Waving not Drowning
  • Date: Sun, 13 Jul 2003 21:16:59 -0700 (PDT)


Re: Bob Howard's - "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."

I quite agree with you Bob, you can't take the experienced professionals out
of the equation. They have a crucial role to play. Organisations like
Médecins Sans Frontières (Doctors Without Borders) do a wonderful job in this
regard. Just as there is sometimes a place for high tech solutions.

I think that one of the points of this thread has been that low
tech/minimalist training solutions are sometimes undervalued and
unrecognized, yet can make a significant difference to a community. There are
also the independence and empowerment that are generated by solutions which
come from within a community.

Provision of community support is always a balancing act which is in a
constant squiggle of feedback. Balancing the expressed needs of the community
with the externally perceived needs. Short term against long term. Balancing
the ideal situation with the practical, the doable. Available funds,
available personnel, suitable equipment, accommodation, transport,
accessibility, who pays what. The list goes on. And while bureaucrats
sometimes take years to decide, people go on dying for want of even the most
basic care.

Obviously, the situation is highly variable from one community to the next.
Some countries require that new graduates spend a period of time working in
an isolated or disadvantaged area. In other circumstances however, the
'authorities' place the community in the 'too hard' basket. Community
self-help projects often address needs overlooked by governments and the
larger aid organisations.

(Tony Vaux wrote the revealing book, "The Selfish Altruist" regarding the
nature and motivations of the international aid industry. Tony worked as a
senior emergency program coordinator with Oxfam for over 20years)

By way of example, I've been involved in programs delivering support services
into remote Indian (Asia) villages. I've seen how something as simple as
teaching village mothers how to make their own ORS (oral rehydration
solution) from locally available ingredients, saves many babies and young
children from dying of dehydration. (diarrhea, being by far, the greatest
single factor in infant mortality)

For several years, the Missionary Sisters of Charity in Calcutta have had a
youth-delivered maternity/infant care program. After school, trained 12yr old
schoolgirls would visit their regular caseload of mothers. Delivering basic
health care and nutritional information, performing health checks and
weighing of babies, checking growth rates etc. In the event of problems
becoming apparent, they would give the alert for more advanced medical
support to attend. In western society, the concept would be scoffed at for
all manner of legal and social reasons. In a disadvantaged community, it
saves lives.

It's not just a third world problem. Finding higly paid professionals willing
to live in remote areas and country towns is becoming a challenge for many
communities. Issues such as high insurance premiums are pushing the
availability of obstetrics out of reach of many communities. The role of the
community midwife is again becoming more socially valued.

I remember speaking with an Australian woman who worked for over 20 years as
a nurse in remote aboriginal communities of Northern Australia. Scheduled
visits from doctors were sometimes weeks apart and then only for a day or
two. The duties that community nurses performed daily were often far outside
those that a nurse in a city hospital would legally be allowed to do. But
such were the exigencies of living in a remote location.

I guess the point of all these list discussions (for me, anyway) is not to
offer definitive statements about what this or that community may need.
Rather to try to illustrate the range of possibilities which may be
available. A grab-bag of ideas, tools, and concepts which have been tried by
someone, somewhere. To aid the cross-fertilization of these throughout the
members of this international community. To share and support.

One of the ways we do that is by sharing our own thoughts and experiences.
Bob, it would be great to hear more about your experiences as a 'third world'
nurse. There are bound to be people here who could learn something from your
accounts. Thanks for your input, Bob.

Gaiden




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