[...] [Marciana walking down a road] [Birds chirping] [...] [Rural Health Workers] [...] [Birds chirping] [Highway traffic engine sounds] [Narrator:] Tall buildings, big highways, comfortable homes. A car for every family. For years, these have been the symbols of modern life. But only a small part of the world's population can afford such a life. The same is true of health care. There are very few hospitals in developing countries where treatment is given free. [...] These hospitals can't cope with the health needs of all the poor people in the cities. [Gentle music] [Murmuring doctor on hospital rounds] [Narrator:] So much money has been poured into big hospitals and sophisticated equipment by governments all around the world that it affects the training of medical students. They learn their job on expensive equipment. [Doctor:] [Non-English speech] [Narrator:] They are trained more in curative than preventive medicine. Many of them aim to become specialists. Few are taught to concern themselves with basic health care. [Doctor:] [Non-English speech] [...] [Narrator:] This kidney machine costs more than $10,000. One nurse has to be in attendance at all hours. This raises questions about the allocation of resources. So much technology. Somany highly skilled people engaged in saving a fewlives. So little money. So few qualified people involved in tackling basic health needs around the world. [South Asian music] How can doctors and nurses use their skills for these wider needs? Small groups of doctors in several countries have begun seeking ways to do so. Bangladesh faces these problems as sharply as any country in the world. Health care is inadequate in its few big cities. It is even less adequate in rural areas. [Cultural music] In Noakhali District,where 120,000 people live. There are three doctors at the health center. They do an important job in treating drastic cases. But they realize that a single district hospital will always be overcrowded. [Non-English speech] [Narrator:] They also realize that since health care should consist more of preventive than curative work, it need not depend primarily on doctors and nurses. So, they set out to train paramedical workers and to create a network of five sub-centers where there are clinics. [Babies crying] There's a clinic within two miles of every home. These are run by an assistant nurse with clinic assistants who have only five weeks training before attacking worklike malaria cases. [Babies crying] They also run specialclinics for children under five. Keeping a recordof each child's health and giving immunization. [Baby crying] [Indiscriminate chatter] [Narrator:] At these clinics, they also supply a daily food supplement. Wheat mixed with chickpea, to 4,000 young children. The assistants often visitwomen in their homes. Giving advice on nutrition,immunizations, and family planning. A doctor isn't neededfor any of these jobs, but he visits each sub-centertwice a week for serious cases. [Flute music] [Children playing] [Splashing] Health cannot be studiedas something separate in the community. It is linked to everyaspect of development. To sanitation andclean water supplies. [Flute music continues] And to food production. [Man coaxing oxen] [Narrator:] Especially in countrieswhere there is heavy population pressure on theland. Health care depends very directlyupon the people being able to make the mostproductive use of all the landavailable. Only in that waywill large families be able to enjoyenough nutritious food. [Land and agricultural management] [Man riding a cart in the city] [Indiscriminate chatter] So how broad should thefunction of a health worker be? There is no single answer. It is differentbetween countries and within a single country. [Helicopter fly-over] Panama is a country with 9,000 small communities scattered in the mountains andalong jungle rivers. Each group of communitieshas to work out its own needs and how to tackle them. [Festive music] Near Colón, a village beganwith a household survey. Collecting facts onpeople of all ages. [Festive music] They paid particularconcern to the growth and the state of healthof the younger children. [Singer, festive music] [Health care worker recording data] [Music continues] Members of the community health committee, a cross-section of the villagers, analyzed the statistics from the survey. [Villagers looking at chart] [Resultados sobre la hemoglobina][Results on hemoglobin chart] Then they held a meetingfor the whole community, putting the facts before them. [Speaker 1:] [Non-English speech] [Narrator:] They heardpeople's concerns. And together, they planned a community program of action. [Non-English speech] One measure they decidedon with hospital officials and the medical officer who's in charge of public health in the province, was to choose and train a medical assistant. The people elected their ownmedical assistant. Marciana [Inaudible]. Someonethey knew could do the job they had just defined. [...] She was trained at thedistrict health center. And goes back there once aweek for further training and to get medical supplies. [Baby crying] [Chickens clucking] She is also trained how tomove around the community, encouraging people in manyefforts of self-improvement. She is mostly onher own and coping with a wide rangeof jobs that go beyond the normal boundaries ofmother and child health care. For example, she advises onimprovements to sanitation. [Crickets chirping] [...] [Crickets chirping] [...] In three years, 40 otherassistants like Marciana, have been selected and givenbasic training in Colón. And they are now working as partof the provincial health team. In their villages, they arethe health team and something more important.[Threshing sounds] They have shownthe community what it can do once it starts tomobilize its own resources. [Threshing sounds] [Instrumental music] [Men at an altar] In a very different culturein Northeast Thailand. The medical faculty ofKhon Kaen University asked officials in16 provinces. What was most wanted in health care? Back came the answerfrom the villages. Someone nearby toconsult when we are ill. [...] So Dr. [? Kawhi ?] and his staffbegan simple training courses in 1975 for villagehealth volunteers. Unlike Bangladeshand Panama, these are part-time health workerswho earn in their living by farming. Training courses are short. Two or three weeks at a time. But they attend several coursesover a period of two years. [Instructor talking in background] The university has found there is a need for more appropriate teaching materials for this new level of pupils. It makes do with some traditional equipment. But it does its utmost to give realistic training. [Instrumental music] The series of short courses should equip a village health worker with the skills to treat common illnesses. Mr. Mechai, farmer who lives 50 miles from Khon Kaen, treats malaria and diarrhea. Gives advice on nutritionand family planning, and tells villagers how to protect themselves against parasites. He also knows when and how to refer difficult cases. [Music continues] The villagers appreciate Mr. Mechai's work. They built a small clinic for him. [...] [Native American music][Snowcapped mountain panorama] [Camera zooms into rural community] In Canada also, somerural communities have shown they know bestwhat they need in health care. A group of Indian leaderstold health officials the best way was a broadeducational approach. Health, they said, wasn't just a segment of somebody's life. It covered everything, from how and where they placed a house and found clean water supplies to their daily food needs. [Water pouring, splashing] [...] In 1964, the government of Canada [Dog barking] began training communityhealth representatives at Fort Qu'Appelle, Saskatchewan. Eugenie LaValley was one of the first, working in her own Piapot Indian reserve. As she explains, her job ledher into teaching many things. [Eugenie LaValley:] The minute I graduated from the fort, thatwas the first thing I did. I had to come and talk tothe chief and then the nurse, and I had a very good nurse. I can say that much becauseshe was always out there. If I had a meeting,she was there. And that used to be a biglift, because at that time, even I belonged here,I was still afraid. You know, I needed somebodythere to give me courage. [Native American chanting in background] I used to go by seasons. Accidents in the winter, and you know, in the spring, it was X-rays for TB and stuff like that, and [?] And then in July, it used tobe more or less gardening. And in August, it wasjudging of the gardens. But everything pertainingto help is what, you know, what I worked on. On the long run, I think I made it. And I quit last year,not rich at all, broke. But a lot, a lot of friends. [Native American chanting in background] [Narrator:] Shehas retired now. But is still very muchinvolved in community affairs. As an Indian band counselorand member of the school board. She has handed on herjob on the health team to Violet Piapot. [Women walking on snow covered road] Violet works closely with the nurse who visits her clinic. [Background chatter] The nurse gives immunizations. [Baby crying][Nurse gives baby an immunization shot] [Baby crying] [...] Violet keeps the healthrecords of each child. She also spends time withthe children in school. Teaching them abouta good balanced diet. [Violet:] [Inaudible] [Student responds] [...] [Students respond] [...] [Violet:] [Irma:] Do youdrink a lot of milk? [Irma:]: Yeah. [Students chatter] [Narrator:] Home visits,talking to people at leisure and in their own free language, are a very important part of the community health representatives' work. [Violet:] Well, I was always interested in people. I think that was my main, maybe main reason. And towards the end,this is one of my biggest thrills is visiting around. We used to talk about anything. I never, never put pressure onanybody unless it was urgent. You know, like I used to justmore or less give them hello and talk about maybethe stars or something. You know, just anything.Just kind of break that ice. Go easy. And then advertisingthe clinic dates, you know, mark theircalendar and little things like that so they won't forget. So you know, it's the trust and the confidence of the people that I think I alwaysworked on first. [Native American chanting in background] [Latin theme music] [Narrator:] In Saskatchewan, they were told not to take people to hospitals except in an emergency. In Venezuela, they don'tneed to be told that. The distances for most people toany big hospital are too great. In the upper reachesof the Orinoco River, the rocks and rapids area barrier to movement. But the river is still the mainhighway in southern Venezuela. [Latin music] [Aerial view along the river] [Latin music] [Motorboat engine] [Latin theme music] Omana Prato, a medical auxiliary, visits his group of villages by dugout canoe, powered these days by a 30-horsepower outboard motor. [Latin music] [Motorboat engine] [Latin music] [Narrator:] He has had six months training. And he needs all that training to be self-reliant. Because, although the system of simplified medicine calls for regular supervision, in practice, the size of the area is too large for a community nurse to cover thoroughly. He takes and checks malaria swabs in his clinic. [Baby crying] [Dispensario Pendare sign] [Music continues] He makes house-to-housevisits around the villages. [Indistinct noises] [Music and villagers speaking to one another] [Narrator:] Many children suffer from malnutrition in the Amazonese jungle area. He tries to treat such cases before the weakened child is infected with other diseases. [Indistinct conversation] [Narrator:] Back in his home village, he calls the people for a general talk on hygiene. [Omana:] [Medical auxiliary] [Non-English speech] [Rooster crows] [Omana:] [Non-English speech] [Latin music] [Aerial view along the river] [Narrator:] It is 60 milesby river past many rapids to the regional hospitalat Puerto Ayacucho. [Aerial view along the river] [Health care worker with young child] Only the worst cases ofemergency are taken there. The child needing a bloodtransfusion. [Child crying] The baby who has been born months premature. [Child crying] [Light instrumental music] [Narrator:] Iran is a final example of these trends in health care. It has 12,000 doctors, but half of them practice in the capital, Tehran. And most of the restwork in other big towns. [Suspenseful music] Yet, 20 million people still live in rugged countryside. And there are some 20,000 villages of less than 100 population. [Music continues] How can a country provide an effective system of health care for these small, scattered communities? Dr. Hussein [?] of Pahlavi University had a plan in 1972 for a new level of health worker. [Doctor:] We thought that we can do some of the primary health work by the villagers themselves. Train them in the village, and deploy them in the village. Working as a health worker. This was an experimental program. Something similar to barefoot doctors of China. [Health worker talking to children] But in different socioeconomic and political situation such as Iran. What are the health needs of Iran? What are the basichealth needs of Iran? And do we need really, a major center with all multi-specialty clinic and multi-specialty? Or can we expand our money and have our priority in the villages, which has the basic health problem of upper respiratory tract infection in the winter and diarrhea in the summer? These are two majorkillers in two seasons. By only treating these two major problem and improving the nutritional status of the children, we have certainly contributed a lot to the health of our population. [Persian music] [Narrator:] Mrs. [?] is one of 46 literate villagers in the Fars Province who trained for six months in a health center. [Persian music] Back in her village, she makes home visits to give advice on hygiene and sanitation. [Music continues] [Well water drawn up, metal squeaking] She also inspects water supplies. [Music continues] [Chorus of children speaking] She believes in teaching good health habits to all ages, but especially to the young. So she often givestalks in the school. [Doctor:] With 33 million population of Iran, we have only a poolof 12,000 physician. Even if we would haveenough physicians. Even if we would have60,000 physician, they would not probablybe suitable for that kind of situation of acommunity of 100. So there would be no choice butto create a kind of manpower socially, economically,and mentally suitable for that kind of community. [Village health worker] [Non-English speech] [Light drum music] [Narrator:] The village health worker is the first level in the health care system. Second comes the badar. who has had four years training. Then the physician at thehealth corps station, and finally, the hospital. Dr. [?] explains. [Doctor:] What we have done is to create a system, which is, start from the village which has VHW, Village Health Worker, taking care of preventive measures and doing some therapeutic work in major and most important disease. Then they would refer the complicated cases to upper level, which is called badar. Badar would do at least 90 percent of the problem and refer the 10 percent of the problem to the health center, which is equipped by a physician. This is a health corps system which has 400 different posts all over Iran. And these are our young physicians who are doing their military work for two years in the villages. Whenever there is a complicated case, which I would believe is less than one percent of the cases, we can refer them touniversity hospital. And this is the idea of having the village health worker, badar, health corps physician, and university hospital as a comprehensive health care for the entire nation. [Music] [Narrator:] There are still only a few village health workers in Iran. But these few haveproved their worth. Village health workers areonly part of a total health system in Iran or elsewhere. But they can be thefoundation block upon which the whole pyramid is built. If it is to be a solid structure, there must be a good way for one level to supervise the work of the level below. And it must be easy for workers at any level to put forward ideas about changes that can help improve the whole structure. The village health workers,being closest to the people, have a voice thatshould be heard. [Music continues] These are only six examples oftrends in rural health care. Other countries will find their own ways, drawing on their own traditions, but seeking the same goal. A better life for all their people. [Music] [Script, Clyde Sanger] [Drumming] [Narration, Paul Harris] [Drumming] [Filmed and produced by Neill McKee] [Drumming] [A production of IDRC, The International Development Research Centre] [Drumming