Doing Grassroots Health Care

by Susan Stranaham

What the missionary does for herself she should do for others.

The concept of primary health care predates by many years the World Health Organization’s Declaration of Alma-Ata in 1978. Providing basic and essential care to families and individuals in their communities has always been a function of missionaries. By definition, primary health care includes promotion of proper nutrition and adequate supply of safe water, basic sanitation, health education, maternal and child health, immunizations and other preventive measures against local diseases. These primary health care activities are not, nor have they ever been, restricted to the health care professionals. In fact, doctors and nurses, often caught up in the struggle of maintaining the organized health care institutions at the hub of the health care delivery system, are unable to reach the populations at the periphery. The missionary working among the people on the fringe of the health care structure is often the only one available to provide even the minimum in health care needs.

The typical missionary brings with him a wealth of knowledge about primary health care. The measures he takes to protect himself and his family from disease may seem to be just good common sense, yet they form the basis of what the community needs. In establishing his home in the rural or semi-rural area, the missionary first of all will assure a safe supply of water. He knows that to prevent enteric diseases he must boil, filter and/or chemically disinfect his drinking water. To protect his source of water, he has to provide for proper disposal of human waste material. There are a variety of low-cost excreta disposal systems appropriate for rural environments. Information can be obtained from The World Bank ("Appropriate Technology for Water Supply and Sanitation") and from The World Health Organization ("Guide to Simple Sanitary Measures for the Control of Enteric Diseases"). It is estimated that as many as 20 percent of all deaths of children in Africa are caused by diarrhea contracted from contaminated food and water.

This death rate would drop considerably if missionaries would conscientiously teach and encourage their neighbors to practice the same protective and preventive measures they observe. Where this is being done, diarrheal diseases are being controlled. During an epidemic of severe diarrhea in Africa, local missionaries encouraged the population to boil their drinking water and use pit latrines for waste disposal. The epidemic was arrested.

Malnutrition continues to be a major health problem. Some missionaries, particularly women, are attacking the problem by teaching nutrition lessons during regularly scheduled women’s meetings. The emphasis is on a woman’s role of caring for her husband and children, which includes their physical wellbeing. Women are taught to use locally available foods providing the richest sources of vitamins and proteins. (Food Composition Tables for every area of the world can be obtained from the U.S. Department of Health, Education and Welfare, Public Health Service.) In some situations missionaries have encouraged cultivation of various species of beans and peanuts to provide necessary sources of protein. Other projects include raising rabbits, chickens and cattle. Fish farming is a promising source of protein.

Women’s meetings have also been used as an occasion to address the issue of local cultural food taboos that interfere with health. Some missionaries have used these meetings to approach the question of family planning, since multiple pregnancies have a deleterious effect on the health of both mothers and children. This subject, however, requires much tact and cultural sensitivity. One missionary who thought she was providing helpful information about birth control to the ladies of her church, offended them by approaching them directly instead of going through their husbands. Another project failed because the subject was broached at a meeting of women and men together, whereas local mores required separation of the sexes for such a delicate subject.

Pastors often assume a leadership role in their communities as well as in their churches. These are key men to train in the area of primary health care and community development. For this reason, many Bible schools have incorporated into their curriculum a course in community health. Basic, simple notions of health, hygiene, sanitation and nutrition are included in the classes. An informed pastor in Zaire was concerned about the health of the people in his community, which was located about 25 kilometers from the nearest health care facility. He interested a nurse from the nearest hospital in organizing a monthly under-five clinic in his village for the sake of the children. It met with such success that the village leaders, inspired by the pastor, are making plans to expand the clinic in prevention to a full-service health center.

Missionaries can play a major role in preventing infectious diseases by organizing and participating in mass vaccination programs against endemic and pernicious diseases. In her book, The People Time Forgot (Moody Press, Chicago 1981, p. 336), Alice Gibbons relates how an epidemic of whooping cough was prevented among the Damal tribal people of Irian Jaya. Missionaries, alarmed by the high mortality of whooping cough in children, organized a vaccination campaign that not only prevented an epidemic but also succeeded in eradicating the disease from the valley. In the same book, Mrs. Gibbons gives an account of missionaries attacking the serious problem of goiters and cretinism among the Damal, due to an inadequate quantity of iodine in their diet. After a campaign of iodine injections, goiters and new incidences of cretinism disappeared.

Some missionaries have attempted to improve the health of their local communities by obtaining verifuge and anti-malarial drugs and making them available to the people they serve. Others have been moved to dispense a few choice medicines from the back door of their own homes to relieve the suffering and symptoms of the most common ailments.

The missionary who is genuinely concerned about improving the quality of health of the people among whom he is attempting to establish the church will not have great difficulty in discovering ways to do it. His greatest contribution may be by his example and by teaching others to follow it, so that they might have better health by their own efforts. Contact with local and government health officials is imperative. Missionaries can and should cooperate with the health department and its plan to achieve "Health for All by the Year 2000." (The absence of evidence of a plan does not mean that there is not one.) The missionary’s participation may or may not be significant, but the good-will generated could have far-reaching ramifications.

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