[REGGAE MUSIC] MAVIS GILMOUR: This isJamaica, our Jamaica. We have got cool mountainsand hot music, green fields, blue waters, pretty beaches,beautiful views everywhere you look. There's really no other placethat seems to have so much of what everybodywants and needs. We have got new industries,making new jobs. No wonder so many peoplecome to Jamaica as strangers and go away as friends. And no wonder so many of ourrelatives who have gone abroad are so happy to come back home. Everywhere in theisland, you can see a friendlywave, a happy smile, and see our folks walking good. But things are not quite asrosy as we want them to be. Think about the children yousee who walk around half hungry all the time. They never get agood start in life because there are toomany of them in the family and not enough foodor money to go around. Or how about the cultivator whocuts his leg with his machete or mother who cutsherself on the wash pan, and there is no one aboutwho knows how to take care of the wound, all the oldfolks who just cannot make it to the nearestclinic by themselves, and they havenobody to help them? And every day, there are morebabies being born, more mouths to feed, more bodies to carefor, more schools to build, more jobs to find. In the countryparts, especially, it is awful hard to get medicalhelp when you need it. Clinics are far awayand difficult to get to over bad roads. The clinics are often crowded. Well, the plaintruth is we're still terribly short ofdoctors and nurses, and it takes manyyears to train them. Good health iseverybody's concern. Jamaica's future dependson having a healthy people. Our greatest healthneed in Jamaica today is the lack ofmedical help and knowledge at the village level, in ourhomes, and in our families. To help provide thehealth care that is so badly needed, especiallyin the country parts, the government has starteda new program, a program of community health aides. KENNETH STANDARD:Well, our department of social andpreventive medicine has been working for sometime in the nearby village of Hermitage. And in recent years, weextended our services to the neighboringcommunity of August Town. This we did withlimited resources. But in doing this, we involvedthe community from the outset in helping to plan the program. And from the community,we had volunteers who assisted us with the clinic. Then it occurred tous that at some stage, it would be nice ifthese volunteers who were helping invarious ways could be given someorganized training so that they would be able tofunction more effectively. Our concept wasthat this training should be valuable tothe aides in helping them to be the arms of thehealth nurse working in the community, ourown public health nurse. The responsibilities ofthe aides, we often stress, was that they wouldwork not alone but under the direct supervisionof some professional worker-- in our case, thepublic health nurse. But we saw them asworking as the arms, also, of community developmentworkers and, in fact, bridging the effortsin the community. In fact, they could beconsidered the first port of call for activitiesrelated not only to health but community development. [MUSIC PLAYING] KENNETH MCNEILL:We have recently introduced a newsystem of health care delivery in Jamaica, whichinvolves the use of community health aides. We have, therefore, takenthe decision in government to implement it substantiallyin the first place to cover the parishesof Hanover and St. James and also to cover a substantialportion of the city of Kingston in the areas of greatest need. And this is the manualof the training program. You'll see it's quite acomprehensive manual that covers a number ofwhat we describe as modular skills with whichthese people will be equipped. And here is Nurse [INAUDIBLE],,who is our senior public health nurse-- in fact, the principalnursing officer in charge of thepublic health program, and who is, in fact, incharge of this program. Now, I want you to understandthat this program falls under the professionals. It will fall under thepublic health nurses so that the communityhealth aides will be trained by the public health nurses. They will be responsibleto the public health nurses so that we are not fragmentingthe general responsibilities. SPEAKER 1: I'm goingto do it for you today, but you must takeher to the clinic. tomorrow, must takeher up to the doctor. SPEAKER 2: Yes, all right. MAVIS GILMOUR: Community healthaides will work in the village where they live. They will bringhealth care and advice to the families intheir own areas. SPEAKER 1: This thingthat I'm putting on here is acriflavine-- acriflavine. Can you remember what you giveAngela for lunch yesterday? SPEAKER 2: Well, forlunch, [INAUDIBLE] get the [INAUDIBLE] porridge. SPEAKER 1: Porridge? SPEAKER 2: Yes. SPEAKER 1: Whatkind of porridge? SPEAKER 2: Cornmeal. SPEAKER 1: Cornmeal? SPEAKER 2: Yes. SPEAKER 1: Fine. What kind of milk didyou put in the porridge? SPEAKER 2: Dry milk. SPEAKER 1: Dried skim milk? SPEAKER 2: Yes, yes. SPEAKER 1: Oh, fine. Anything else that you canremember for lunch yesterday that [INAUDIBLE]? SPEAKER 2: And some biscuit. SPEAKER 1: Biscuit? SPEAKER 2: Yes. SPEAKER 1: Fine. How many children haveyou got, Mrs. Thompson? SPEAKER 2: I havehere eight children. SPEAKER 1: Eight children? SPEAKER 2: Yes. SPEAKER 1: Mrs. Thompson,what are you doing about it? You want to go to Eldersley? SPEAKER 2: Yes, next month. I want to start it. SPEAKER 1: You didn't go theresince you have the last child? SPEAKER 2: No. SPEAKER 1: Why you didn't? Don't you know thatdelay is dangerous? SPEAKER 2: Yes, that is true. SPEAKER 1: Well, Mrs. Thompson. SPEAKER 2: But youhave a sick baby. You know, that's why I[INAUDIBLE] doing all the time. SPEAKER 1: Well, withall the sick baby, Mrs. Thompson,delay is dangerous. And what I'm advisingyou, Mrs. Thompson, is that you go to the familyplanning clinic in Eldersley. SPEAKER 2: Yes. SPEAKER 1: You willmeet with the officers there, the familyplanning officers. And they will be able totell you much about it. SPEAKER 2: Yes. SPEAKER 1: Even more than whatI would be able to tell you. And you'll get all theinformation that you need. Then Mrs. Thompson? SPEAKER 2: Yes? SPEAKER 1: What aboutthe baby's father? Is the baby's fathersupporting the child? SPEAKER 2: No. SPEAKER 1: Oh. Imagine, the baby's fatheris not supporting the child. And how you believethat you will get along with so many children? SPEAKER 2: I don't know. I have to go and look work. SPEAKER 1: And ifyou have a baby, you cannot lookwork with a baby. SPEAKER 2: No, can't go. SPEAKER 1: Well,you see the sense in what I am saying to you. You see the sense inwhat I'm saying to you? SPEAKER 2: Yes, yes. SPEAKER 1: And you aregoing to promise me? You are promising me that I'llsee you at the family planning clinic in Eldersley? SPEAKER 2: Yes, I hopeto go there next month. SPEAKER 1: Promise methat I will see you there. SPEAKER 2: Yes. And leave somethingup there good for me. SPEAKER 1: Oh, that's funny. SPEAKER 2: Very nice. [LAUGHS] SPEAKER 1: That you will get. That you will get. That you will get. MAVIS GILMOUR: The communityhealth aides will work closely with the public healthnurse and leading citizens who take an interest incommunity health matters. SPEAKER 3: [INAUDIBLE] todayMrs. [INAUDIBLE] Gordon. And she's a newcommunity health aide. You know, she will beworking in this area. She has undergone a periodof eight weeks' training, and she is expected to dothose duties that do not need the skill of a trained nurse. I know that you are aperson who is always very interested in thehealth of the community and the whole well-beingof the community and that, especially, likeI've always come to talk to youabout these people, I have brought Mrs. Gordon. During her period ofeight weeks' training, she has covered a number ofsubjects, important subjects, subjects that willhelp her to really help the people in our community. And she's very interestedin this sort of thing. You know, she hascovered subjects like first aid andbandaging, home nursing, knowing the common signsand symptoms of disease, knowing about thecirculatory system and the digestive system. She has also covered thingsabout her community health and knowing hercommunity, knowing the people who livein her community, and knowing the servicesthat are available. SPEAKER 4: That's nice. SPEAKER 3: I'msure you will find her a very interested personin the community at large. And I am sure youwill always find work for her because you'realways having your sick list, and you're always wantingus to come in and see to these people. SPEAKER 4: Let me hope so. SPEAKER 3: I'm sure shewill be a great help. SPEAKER 4: Well, I'mdelighted, Mrs. Gordon. MAVIS GILMOUR: Many oldpeople need special help. This old man is deaf and livesfar away from the clinic. He has a sore on his leg. The community health aide isdoing a dressing at his home until he can getback to the clinic. SPEAKER 5: Mr. [INAUDIBLE]? SPEAKER 6: Mm-hmm? SPEAKER 5: When isyour appointment to go to the clinic? SPEAKER 6: Your what? SPEAKER 5: Your appointmentto go back to the hospital? SPEAKER 6: When am I[INAUDIBLE] to go back there? SPEAKER 5: Mm-hmm. SPEAKER 6: [INAUDIBLE]three weeks' time. SPEAKER 5: Three weeks' time. Please make sure that youremember that three weeks' time, you are to go backto see the doctor, OK? MAVIS GILMOUR: Goodhealth starts early. That is why we havewell baby clinics, to provide care formothers and babies to make sure they stay healthy. The community health aideswill help at these clinics. SPEAKER 7: Soyou're breastfeeding Angela at the moment, yeah? Well, we don't have anysubstitute for breastfeeding, and at the moment, Angelacan't take anything else now beside the breast. You don't give her anythingelse beside breast? SPEAKER 8: No. Just leave [INAUDIBLE] she drinkthe breast milk on [INAUDIBLE].. I give her some breastmilk [INAUDIBLE].. SPEAKER 7: [INAUDIBLE],,yes, that's right. Vanessa, you have to takeall the balanced diet now. That's so your babycan be properly fed. And you must get some rest. You must drink alot of milk that you can have plenty of breastmilk to feed your baby. You must eat a lot ofvegetables and a lot of meat. And you must get a lot of rest,even half an hour rest each day that your baby can behealthy and strong. MAVIS GILMOUR: Thereal hope of Jamaica lies in the healthof our children. Even with a good startin life, children need a lot to grow uphealthy and strong. Sometimes, though, peopledon't know the right foods to feed their children. They need help in planningthe children's diet. The community health aide istrained to give such help. SPEAKER 9: All thesethings are sterilized now with boiled water,the cold boiled water, and straining themilk and everything. MAVIS GILMOUR: Ofcourse, healthy children are happy children. Too many children tooclose together in a family can cause health problemsfor mothers and for children and hardships for grandmothers. SPEAKER 9: OK, youcan just look at it-- 8 ounces. See the measuring cup? 8 ounces. MAVIS GILMOUR: Withfewer children, there will be more foodand clothes, more love and attention, moreeducation, more of everything for every member of the family. SPEAKER 9: So givethis to Carla, OK? You're thegrandmother for Carla? You're thegrandmother for Carla? SPEAKER 10: Yes, yes,the grandmother, yes. SPEAKER 9: Andwhere's the mother? SPEAKER 10: Mother [INAUDIBLE]. SPEAKER 9: Is she married? SPEAKER 10: No, she notmarried, not [INAUDIBLE].. MAVIS GILMOUR: Whencommunity health aides come on theirregular visits, they will also give you adviceabout family planning to help you better your life. SPEAKER 9: Adviseher, the mother. SPEAKER 10: Oh, yes, yes. SPEAKER 9: You know, because-- you can tell her thatif you are living-- if you are having children innow, you wouldn't have so many and your children are here,and your children are there and you ask somebodyto take care of them. And you'll put them at thestreetside, abandoned there. You know, it's not looking good. MAVIS GILMOUR: Lifedoesn't always go smoothly. When you're old orsick or can't work, sometimes you need a helpinghand to get back on your feet. Community health aides aretrained to help old folks like this old man. He recently came homefrom the hospital. He had a stroke. And the communityhealth aide is helping him to exercise his armsand legs every day so he may get back his strength. SPEAKER 11: Open the fingers. Open them. Open them. Open them. SPEAKER 12: [INAUDIBLE] MAVIS GILMOUR:Community health aides know where and when to gofor the right medical help. SPEAKER 13: You see,I was looking for you to come to theclinic with Jerrell. And I don't see him come. And you've been complaining thatJerrell has a cold in his head. So I come this morning. I'm not leaving you. You are going to the clinic tosee the doctor this morning. Yes, you see, inyour condition, I was wondering if hewasn't feeling well that I could take him up for you. But since you are coming, wewill go along to the clinic. So you must remember togive Jerrell his medicine. And it's important now for youto have all the rest you can. With this babycoming, you probably will have to neglect Jerrell. So you must see to it that heget his feeding, properly, see him like the new-coming baby. Give him hugs when you can. Give him things from thefamily pot, as usual. Give him his milk, cheese,even sole fish if him want. You have a lot ofprotein in sole fish. OWEN MINOTT: Even thoughour training out here is so good inmedical school, we're quite incapable of communicatingadequately with the patient. As an example of how the aidecan be an extension of the work that a doctor or nursecan do, let us just focus for a minute on a problemlike I had this morning right here in the clinic. We have a malnourishedchild, somebody who is vomiting, having diarrhea. And the mother is doing thebest she can to feed the child. But her best consistsof giving the child glucose water, which,when a child is vomiting, is a good thing to do. But the stage isnow reached where the mother has had thischild on glucose water for about two weeks. The thing is that she was toldto put the child on glucose water when it wasvomiting, but she didn't understand to take it offwhen the vomiting had stopped. So we now have amother with a problem of a child who isno longer vomiting but who is heading forprotein malnutrition. And this is wherethe aide comes in. Because she could have explainedto the mother what is going on. In the follow-up withregard to the patient, she would have gone unseen. [REGGAE MUSIC] MAVIS GILMOUR: Thiscommunity health aid program, which has started inSt. Elizabeth, Hanover, and St. James, will bring basichealth care to your homes. It will make it possible tobring to the local village level on a regular basis modernmedical care and knowledge, not only about the growth anddevelopment of the child but also the everydaycare of minor ailments for both young and old. As we have seen, thecommunity health aid has been well trainedin such health areas as first aid, familyplanning, counseling, the feeding and care ofinfants and old people, and maternal and child care. They will work directlyunder the supervision of the public health nurse. They are accepted by thewhole medical profession and are recognized as a valuableaddition to the health team. Your communityhealth aid will be your neighbor and yourfriend, someone near at hand you can turn towhen you need help. She will be your first portof call for health problems and health information. Look out for her. She will be wearing this badge. She will be your helper. [MUSIC PLAYING]