Stephen Frankel - Böcker

This book presents the current place and future role of the community health worker. The majority of the world's population continues to suffer levels of ill-health and death that are only a distant memory in prosperous countries. Approaches to alleviating this burden are well-known, and range from specific medical interventions to broader development policies.Since the Chinese experience of mobilising 'barefoot doctors' became known, the approach of training villagers to offer local services has received strong support from international agencies and governments. More recently reports of the quality of the services offered by these workers has indicated that a large gulf may have existed between the rhetoric and the reality. Some have questioned the basic premise that such workers can make a valuable contribution. However, the debate has been informed only by a limited number of often dated accounts.This book analyses programmes in a limited number of countries whose experience is particularly relevant to understanding the role of these workers. The picture that emerges demonstrates the potential value of community health workers as individuals, but highlights the widespread failure of the programmes required to support them. Through case studies and an analytical overview, this book sets out the preconditions for effective community health worker programmes.

Dr Frankel's study of the rapid transformation of traditional medical care among the Huli of New Guinea by Western treatments strikingly combines the methods of social anthropology and epidemiology. Until the 1950s the Huli used only their own form of therapy, including symptomatic treatments, specialist surgery and major ritual intended to enlist the support of spirits. Since then, superficially at least, there has been a rejection of many traditional measures and a corresponding enthusiasm for Western treatments underpinned by Christianity. The Huli Response to Illness analyses the rich network of traditional belief relating to the classification and causation of illness, patterns of disease, historical experience, and the organisation of society. The methodological approach presented is notable not only for the study of medical pluralism, but also for examining the conditions which may influence responses to programmes of health improvement. The study as a whole integrates material conventionally divided between anthropological and medical texts and powerfully demonstrates the limitations of this traditional separation.