WEBVTT

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[...]

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[Marciana walking down a road]

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[Birds chirping]

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[...]

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[Rural Health Workers]

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[...]

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[Birds chirping]

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[Highway traffic engine sounds]

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[Narrator:] Tall buildings, big highways, comfortable homes.

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A car for every family.

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For years, these have been the symbols of modern life.

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But only a small part of the world's population

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can afford such a life.

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The same is true of health care.

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There are very few hospitals in developing countries

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where treatment is given free.

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[...]

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These hospitals can't cope with the health needs of all

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the poor people in the cities.

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[Gentle music]

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[Murmuring doctor on hospital rounds]

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[Narrator:] So much money has been poured into big hospitals

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and sophisticated equipment by governments

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all around the world that it affects the training

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of medical students.

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They learn their job on expensive equipment.

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[Doctor:] [Non-English speech]

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[Narrator:] They are trained more in curative

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than preventive medicine.

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Many of them aim to become specialists.

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Few are taught to concern themselves

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with basic health care.

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[Doctor:] [Non-English speech]

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[...]

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[Narrator:] This kidney machine costs more than $10,000.

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One nurse has to be in attendance at all hours.

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This raises questions about the allocation of resources.

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So much technology.  So
many highly skilled people

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engaged in saving a few
lives.

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So little money.

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So few qualified people involved in tackling basic health needs

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around the world.

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[South Asian music]

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How can doctors and nurses use their skills

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for these wider needs?

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Small groups of doctors in several countries

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have begun seeking ways to do so.

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Bangladesh faces these problems as sharply

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as any country in the world.

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Health care is inadequate in its few big cities.

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It is even less adequate in rural areas.

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[Cultural music]

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In Noakhali District,
where 120,000 people live.

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There are three doctors at the health center.

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They do an important job in treating drastic cases.

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But they realize that a single district hospital will always

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be overcrowded.

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[Non-English speech]

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[Narrator:] They also realize that since health  care should consist more

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of preventive than curative work,

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it need not depend primarily on doctors and nurses.

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So, they set out to train paramedical workers

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and to create a network of five sub-centers

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where there are clinics.

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[Babies crying]

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There's a clinic within two miles of every home.

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These are run by an assistant nurse

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with clinic assistants who have only five weeks training

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before attacking work
like malaria cases.

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[Babies crying]

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They also run special
clinics for children

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under five.  Keeping a record
of each child's health

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and giving immunization.

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[Baby crying]

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[Indiscriminate chatter]

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[Narrator:] At these clinics, they also supply a daily food supplement.

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Wheat mixed with chickpea, to 4,000 young children.

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The assistants often visit
women in their homes.

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Giving advice on nutrition,
immunizations,

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and family planning.

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A doctor isn't needed
for any of these jobs,

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but he visits each sub-center
twice a week for serious cases.

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[Flute music]

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[Children playing]

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[Splashing]

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Health cannot be studied
as something separate

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in the community.

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It is linked to every
aspect of development.

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To sanitation and
clean water supplies.

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[Flute music continues]

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And to food production.

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[Man coaxing oxen]

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[Narrator:] Especially in countries
where there is heavy

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population pressure on the
land.  Health care

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depends very directly
upon the people

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being able to make the most
productive use

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of all the land
available.

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Only in that way
will large families

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be able to enjoy
enough nutritious food.

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[Land and agricultural management]

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[Man riding a cart in the city]

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[Indiscriminate chatter]

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So how broad should the
function of a health worker be?

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There is no single answer.

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It is different
between countries

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and within a single country.

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[Helicopter fly-over]

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Panama is a country with 9,000 small communities scattered

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in the mountains and
along jungle rivers.

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Each group of communities
has to work out its own needs

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and how to tackle them.

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[Festive music]

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Near Colón, a village began
with a household survey.

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Collecting facts on
people of all ages.

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[Festive music]

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They paid particular
concern to the growth

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and the state of health
of the younger children.

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[Singer, festive music]

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[Health care worker recording data]

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[Music continues]

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Members of the community health committee, a cross-section

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of the villagers, analyzed the statistics from the survey.

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[Villagers looking at chart]

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[Resultados sobre la hemoglobina]
[Results on hemoglobin chart]

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Then they held a meeting
for the whole community,

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putting the facts before them.

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[Speaker 1:] [Non-English speech]

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[Narrator:] They heard
people's concerns.

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And together, they planned a community program of action.

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[Non-English speech]

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One measure they decided
on with hospital officials

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and the medical officer who's in charge

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of public health in the province, was to choose and train

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a medical assistant.

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The people elected their own
medical assistant.

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Marciana [Inaudible].  Someone
they knew could do

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the job they had just defined.

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[...]

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She was trained at the
district health center.

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And goes back there once a
week for further training

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and to get medical supplies.

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[Baby crying]

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[Chickens clucking]

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She is also trained how to
move around the community,

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encouraging people in many
efforts of self-improvement.

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She is mostly on
her own and coping

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with a wide range
of jobs that go

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beyond the normal boundaries of
mother and child health care.

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For example, she advises on
improvements to sanitation.

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[Crickets chirping]

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[...]

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[Crickets chirping]

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[...]

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In three years, 40 other
assistants like Marciana,

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have been selected and given
basic training in Colón.

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And they are now working as part
of the provincial health team.

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In their villages, they are
the health team and

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something more important.
[Threshing sounds]

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They have shown
the community what

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it can do once it starts to
mobilize its own resources.

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[Threshing sounds]

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[Instrumental music]

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[Men at an altar]

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In a very different culture
in Northeast Thailand.

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The medical faculty of
Khon Kaen University

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asked officials in
16 provinces.

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What was most wanted in health care?

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Back came the answer
from the villages.

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Someone nearby to
consult when we are ill.

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[...]

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So Dr. [? Kawhi ?] and his staff
began simple training courses

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in 1975 for village
health volunteers.

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Unlike Bangladesh
and Panama, these

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are part-time health workers
who earn in their living

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by farming.

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Training courses are short.

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Two or three weeks at a time.

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But they attend several courses
over a period of two years.

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[Instructor talking in background]

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The university has found there is

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a need for more appropriate teaching materials

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for this new level of pupils.

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It makes do with some traditional equipment.

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But it does its utmost to give realistic training.

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[Instrumental music]

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The series of short courses should

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equip a village health worker with the skills

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to treat common illnesses.

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Mr. Mechai, farmer who lives 50 miles from

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Khon Kaen, treats malaria and diarrhea.

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Gives advice on nutrition
and family planning,

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and tells villagers how to protect themselves against parasites.

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He also knows when and how to refer difficult cases.

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[Music continues]

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The villagers appreciate Mr. Mechai's work.

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They built a small clinic for him.

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[...]

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[Native American music]
[Snowcapped mountain panorama]

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[Camera zooms into rural community]

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In Canada also, some
rural communities

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have shown they know best
what they need in health care.

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A group of Indian leaders
told health officials

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the best way was a broad
educational approach.

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Health, they said, wasn't just a segment of somebody's life.

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It covered everything, from how and where they placed a house

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and found clean water supplies to their daily food needs.

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[Water pouring, splashing]

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[...]

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In 1964, the government of Canada [Dog barking]

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began training community
health representatives

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at Fort Qu'Appelle, Saskatchewan.

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Eugenie LaValley was one of the first,

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working in her own Piapot Indian reserve.

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As she explains, her job led
her into teaching many things.

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[Eugenie LaValley:] The minute I graduated

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from the fort, that
was the first thing I did.

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I had to come and talk to
the chief and then the nurse,

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and I had a very good nurse.

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I can say that much because
she was always out there.

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If I had a meeting,
she was there.

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And that used to be a big
lift, because at that time,

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even I belonged here,
I was still afraid.

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You know, I needed somebody
there to give me courage.

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[Native American chanting in background]

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I used to go by seasons. Accidents in the winter,

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and you know, in the spring, it was X-rays for TB

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and stuff like that, and [?]

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And then in July, it used to
be more or less gardening.

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And in August, it was
judging of the gardens.

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But everything pertaining
to help is what, you know,

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what I worked on.

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On the long run, I think I made it.

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And I quit last year,
not rich at all, broke.

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But a lot, a lot of friends.

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[Native American chanting in background]

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[Narrator:] She
has retired now.

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But is still very much
involved in community affairs.

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As an Indian band counselor
and member of the school board.

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She has handed on her
job on the health team

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to Violet Piapot.

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[Women walking on snow covered road]

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Violet works closely with the nurse who visits her clinic.

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[Background chatter]

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The nurse gives immunizations.

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[Baby crying]
[Nurse gives baby an immunization shot]

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[Baby crying]

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[...]

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Violet keeps the health
records of each child.

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She also spends time with
the children in school.

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Teaching them about
a good balanced diet.

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[Violet:] [Inaudible]

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[Student responds]

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[...]

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[Students respond]

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[...]

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[Violet:] [Irma:] Do you
drink a lot of milk?

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[Irma:]: Yeah.

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[Students chatter]

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[Narrator:] Home visits,
talking to people at leisure

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and in their own free language, are a very important part

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of the community health representatives' work.

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[Violet:] Well, I was always interested in people.

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I think that was my main,

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maybe main reason.

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And towards the end,
this is one of my biggest

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thrills is visiting around.

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We used to talk about anything.

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I never, never put pressure on
anybody unless it was urgent.

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You know, like I used to just
more or less give them hello

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and talk about maybe
the stars or something.

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You know, just anything.
Just kind of break that ice.

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Go easy.

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And then advertising
the clinic dates,

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you know, mark their
calendar and little things

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like that so they won't forget.

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So you know, it's the trust and the confidence of the people

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that I think I always
worked on first.

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[Native American chanting in background]

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[Latin theme music]

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[Narrator:] In Saskatchewan, they were told

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not to take people to hospitals

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except in an emergency.

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In Venezuela, they don't
need to be told that.

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The distances for most people to
any big hospital are too great.

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In the upper reaches
of the Orinoco River,

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the rocks and rapids are
a barrier to movement.

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But the river is still the main
highway in southern Venezuela.

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[Latin music]

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[Aerial view along the river]

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[Latin music]

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[Motorboat engine]

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[Latin theme music]

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Omana Prato, a medical auxiliary,

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visits his group of villages by dugout canoe,

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powered these days by a 30-horsepower outboard motor.

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[Latin music]

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[Motorboat engine]

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[Latin music]

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[Narrator:] He has had six months training.

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And he needs all that training to be self-reliant.

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Because, although the system of simplified medicine

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calls for regular supervision, in practice,

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the size of the area is too large for a community nurse

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to cover thoroughly.

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He takes and checks malaria swabs in his clinic.

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[Baby crying]

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[Dispensario Pendare sign]

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[Music continues]

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He makes house-to-house
visits around the villages.

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[Indistinct noises]

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[Music and villagers speaking to one another]

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[Narrator:] Many children suffer from malnutrition

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in the Amazonese jungle area.

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He tries to treat such cases before the weakened child

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is infected with other diseases.

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[Indistinct conversation]

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[Narrator:] Back in his home village, he calls the people

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for a general talk on hygiene.

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[Omana:] [Medical auxiliary] [Non-English speech]

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[Rooster crows]

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[Omana:] [Non-English speech]

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[Latin music]

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[Aerial view along the river]

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[Narrator:] It is 60 miles
by river past many rapids

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to the regional hospital
at Puerto Ayacucho.

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[Aerial view along the river]

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[Health care worker with young child]

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Only the worst cases of
emergency are taken there.

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The child needing a blood
transfusion.

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[Child crying]

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The baby who has been born months premature.

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[Child crying]

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[Light instrumental music]

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[Narrator:] Iran is a final example of these trends in health care.

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It has 12,000 doctors, but half of them

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practice in the capital, Tehran.

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And most of the rest
work in other big towns.

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[Suspenseful music]

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Yet, 20 million people still live in rugged countryside.

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And there are some 20,000 villages

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of less than 100 population.

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[Music continues]

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How can a country provide an effective system of health care

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for these small, scattered communities?

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Dr. Hussein [?] of Pahlavi University had a plan in 1972

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for a new level of health worker.

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[Doctor:] We thought that we can do some

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of the primary health work by the villagers themselves.

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Train them in the village, and deploy them in the village.

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Working as a health worker.

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This was an experimental program.

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Something similar to barefoot doctors of China.

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[Health worker talking to children]

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But in different socioeconomic and political situation

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such as Iran.

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What are the health needs of Iran?

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What are the basic
health needs of Iran?

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And do we need really, a major center

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with all multi-specialty clinic and multi-specialty?

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Or can we expand our money and have our priority

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in the villages, which has the basic health problem of

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upper respiratory tract infection in the winter

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and diarrhea in the summer?

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These are two major
killers in two seasons.

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By only treating these two major problem

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and improving the nutritional status of the children,

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we have certainly contributed a lot

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to the health of our population.

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[Persian music]

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[Narrator:] Mrs. [?] is one of 46 literate villagers

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in the Fars Province who trained for six

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months in a health center.

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[Persian music]

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Back in her village, she makes home visits to give advice

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on hygiene and sanitation.

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[Music continues]

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[Well water drawn up, metal squeaking]

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She also inspects water supplies.

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[Music continues]

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[Chorus of children speaking]

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She believes in teaching good health habits to all ages,

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but especially to the young.

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So she often gives
talks in the school.

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[Doctor:] With 33 million population of Iran,

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we have only a pool
of 12,000 physician.

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Even if we would have
enough physicians.

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Even if we would have
60,000 physician,

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they would not probably
be suitable for that kind

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of situation of a
community of 100.

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So there would be no choice but
to create a kind of manpower

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socially, economically,
and mentally suitable

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for that kind of community.

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[Village health worker] [Non-English speech]

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[Light drum music]

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[Narrator:] The village health worker

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is the first level in the health care system.

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Second comes the badar.

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who has had four years training.

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Then the physician at the
health corps station,

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and finally, the hospital.

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Dr. [?] explains.

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[Doctor:] What we have done is to create a system,

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which is, start from the village which has VHW,

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Village Health Worker, taking care of preventive measures

21:24.000 --> 21:31.466
and doing some therapeutic work in major and most important disease.

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Then they would refer the complicated cases

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to upper level, which is called badar.

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Badar would do at least 90 percent of the problem

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and refer the 10 percent of the problem to the health center,

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which is equipped by a physician.

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This is a health corps system which has 400 different posts

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all over Iran.

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And these are our young physicians who are

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doing their military work for two years in the villages.

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Whenever there is a complicated case,

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which I would believe is less than one percent of the cases,

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we can refer them to
university hospital.

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And this is the idea of having the village health worker,

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badar, health corps physician, and university

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hospital as a comprehensive health

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care for the entire nation.

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[Music]

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[Narrator:] There are still only a few village health workers in Iran.

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But these few have
proved their worth.

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Village health workers are
only part of a total health

22:50.000 --> 22:53.100
system in Iran or elsewhere.

22:53.100 --> 22:55.333
But they can be the
foundation block upon which

22:55.333 --> 22:58.199
the whole pyramid is built.

22:58.200 --> 23:00.333
If it is to be a solid structure,

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there must be a good way for one level

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to supervise the work of the level below.

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And it must be easy for workers at any level

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to put forward ideas about changes that can help improve

23:11.000 --> 23:12.600
the whole structure.

23:12.600 --> 23:16.100
The village health workers,
being closest to the people,

23:16.100 --> 23:18.200
have a voice that
should be heard.

23:18.200 --> 23:22.866
[Music continues]

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These are only six examples of
trends in rural health care.

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Other countries will find their own ways,

23:30.200 --> 23:34.966
drawing on their own traditions, but seeking the same goal.

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A better life for all their people.

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[Music]

23:42.266 --> 23:45.132
[Script, Clyde Sanger]

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[Drumming]

23:47.300 --> 23:49.400
[Narration, Paul Harris]

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[Drumming]

23:51.833 --> 23:57.333
[Filmed and produced by Neill McKee]

23:57.333 --> 24:01.233
[Drumming]

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[A production of IDRC, The International Development Research Centre]

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[Drumming