Taking Sides -The Choices before the health worker

Throughout history, all human populations have lived with the threat of disease and sickness. Though every society evolved its own ways of dealing with this reality, it was only in the last two centuries that human beings could entertain visions of a disease free existence. The development and growth of modern medicine gave society potent tools to actively intervene in the disease process and it seemed just a matter of time before suf fering and pain could be banished from human con-sciousness forever.

The initial euphoria generated by modern medicine has however given way to concern for several reasons and a serious debate has arisen in the last 10 to 15 years about the effectiveness of modern medicine and the need to find alternatives.

In India, the discussions have centered around the high cost of a Western oriented hospital based health care system, the inequitable distribution of health ser-vices, and the inappropriateness of medical education in dealing with the health problems of the majority, Most of the alternatives being tried out are therefore. aimed at dealing with these problems. However, each of the alternatives tried out so far has not really suc-ceeded in substantially improving the health situation in India because they do not take into account the exploitative nature of our society.

Our book argues that disease is a product of the way of life of the people which is shaped by the social, political and economic forces of the society. It is these very forces that determine the extent to which health programmes, no matter how innovative, will succeed or fail.

It is true that at present there are no alternate models of health care which adequately address the issues in-

volved. Such a model would have to evolve aut of the day to day experience of both the health workers as well as the people for whom health services are intended.

The health services of our country rest on the work being done by middle level workers-nurses, auxilliary nurse midwives, and paramedicals. It is these workers who confront the social and economic reality of the people they work with, Yet it is these workers who are least involved in a critical examination of their work. Firstly, being in the lower rungs of the hierarchy of medical services, they are expected to follow orders and not really take part in decision making. Secondly even if they were to be included in the decision making process, their training does not prepare them to translate practical experiences into conceptual thought and vice versa.

It is because of these limitations that even sensitive and highly motivated middle level workers often feel frustrated. Scattered in terms of physical distance and often working in isolation these workers have nobody with whom they can clarify their thoughts or discuss their work in a meaningful way. We firmly believe that much could be achieved by these workers if they could be helped in developing a perspective regard-ing their work.

This book on rural health care intends to provide such a perspective. It has grown out of our experience of conducting several short-term and long-term training programmes with middle level health workers all over India. It looks at the day to day experiences of these workers, attempts to place these experiences within a perspective and offers some suggestions which need to be explored further.