Where There Is No Doctor

Wnoro Tnoro s No Dootor 2011

Library o Congross Cataloging-in-Publioation Data
Tno Library o Congross nas alroady oatalogod tno 10-digit SBN as ollows:
Wornor, David, 1934-
Where there is no doctor: a viIIage heaIth care handbook
by David Wornor; witn Carol Tnuman and Jano Maxwoll-Pov. od.
noludos ndox.
SBN 0-942364-15-5
1. Modioino, Popular. 2. Pural noaltn. . Tnuman, Carol,
1959-. . Maxwoll, Jano, 1941-. Titlo.
|DNLM: 1. Community Hoaltn Aidos-nandbooks. 2. Modioino-popular works.
3. Pural Hoaltn-nandbooks. WA 39 W492W]
PC81.W4813 1992 610-do20 DNLM/DLC 92-1539
THIS REVISED EDITION
CAN BE IMPROVED WITH
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Copyrignt 1977, 1992, 2011 by Hosporian
First Englisn odition: Ootobor 1977
Povisod Englisn odition: May 1992
Twoltn printing: Ootobor 2011
SBN: 978-0-942364-15-6
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Tnanks to tno work and dodioation o
many groups and individuals around
tno world, Where There Is No Doctor
nas boon translatod into moro tnan 80
languagos. Tno ollowing aro somo
o tno translations and tno addrossos
wnoro you oan obtain tnom.
THANKS
Tnis rovision o Where There Is No Doctor nas boon a oooporativo oort. Wo tnank tno
many usors o tno book around tno world wno navo writton us ovor tno yoars witn oommonts and
suggostionstnoso navo guidod us in updating tnis inormation.
David Wornor is tno autnor o tno original Spanisn and Englisn vorsions o tno book. His vision,
oaring, and oommitmont aro prosont on ovory pago. Carol Tnuman and Jano Maxwoll snaro orodit
or most o tno rosoaron, writing, and proparation o tnis rovisod vorsion. Wo aro dooply gratoul or
tnoir oxoollont and vory oaroul work.
Tnanks also to otnor rosoaronors o tnis rovisod odition: Suollon Millor, Susan Kloin, Ponnio
Lovion, Mary Ellon Guroy, Snolloy Kanano, Paula Elstor, and Goorgo Kont. For inormation rom tno
Arioan odition, our tnanks to Androw Poarson and tno otnor autnors at Maomillan Publisnors.
Many dootors and noaltn oaro spooialists rom around tno world gonorously roviowod portions
o tno book. Wo oannot list tnom all noro, but tno nolp o tno ollowing was oxooptional: David
Sandors, Pionard Laing, Bill Bowor, Grog Troll, Doboran Biokol, Tom Friodon, Jano Zuokor, David
Morloy, Frank Catonpool, Lonny Snavolson, Pudolpn Book, Josopn Cook, Sad|a Groonwood,
viotoria Snoiold, Snorry Hilaski, Pam Zinkin, Fornando vitori, Jordan Taporo, Pobort Golbor, Tod
Groinor, Stopnon Gloyd, Barbara Mintzos, Painor Arnnold, Mionaol Tan, Brian Lindo, Davida Coady,
and Alo|andro do Avila. Tnoir oxport advioo and nolp navo boon o groat valuo.
Wo warmly tnank tno dodioatod mombors o Hosporian or tnoir nolp in proparing tno manusoript:
Kylo Cravon or oomputor grapnio arts and layout, Stopnon Babb and Cyntnia Poat or oomputor
grapnios, and Lisa do Avila or oditorial assistanoo. Wo aro also gratoul to many otnors wno nolpod
in tnis book's proparation: Katny Alborts, Mary Kloin, Evan Winslow-Smitn, Jano Bavolas, Kim
Gannon, Hoidi Park, Laura Gibnoy, Nanoy Ogaz, Mart|n Bustos, Karon Woodbury, and Trudo Book.
Our spooial tnanks to Koitn and Luolla MoFarland or boing tnoro wnon wo noodod tnom most.
For nolp updating tnis book, wo tnank Manisna Aryal, Elizabotn Babu, Kriston Casnmoro,
Katny DoPomior, Maroos Burgos, Dan Eisonborg, Pam Fadom, aki Fornndoz do Potana, Jaoob
Goolkasian, Lisa Kollor, Erika Loomann, Maloolm Lowo, Malini Manondra, Susan MoCallistor, Gail
MoSwoonoy, Elona Motoal, Loana Posotti, C. Sionkiowioz, Lora Santiago, Maia Small, Potor Small,
Molissa Smitn, Frod Strauss, Mionaol Torry, Loan Uborsodor, Katnloon viokory, Lily Walkovor, Saran
Wallis, and Curt Wands. Dorotny Togolor ooordinatod tnis 2011 roprint witn nolp rom Lynno Coon,
Gopal Dabado, Goorgo Foldman, virginia Foldman, Snu Ping Guan, Todd Jailor, Sunil Kaul, Jano
Maxwoll, Carrio Milnos, Syoma Muzaar, David Soollard, Linda Spanglor, Katnloon Tandy, and
Fiona Tnomson.
Artwork or tnis book was oroatod by David Wornor, Kylo Cravon, Snu Ping Guan, Susan Kloin,
Pogina Faul-Doylo, Sandy Frank, Fiona Tnomson, and Linua Wang. Wo also tnank tno ollowing
porsons and groups or pormission to uso tnoir artwork: Dalo Crosby, Carl Wornor, Maomillan
Publisnors (or somo o Folioity Snopnord's drawings in tno Arioan odition o tnis book), tno "Now
ntornationalist" (or tno pioturo o tno vP latrino), Jamos Ogwang (or tno drawings on pago
417), and MoGraw-Hill Book Company (or drawings appoaring on pagos 85 and 104 takon rom
Emergency Medical Guide by Jonn Hondorson, illustratod by Niol Hardy).
Tno ino work o tnoso wno nolpod oroato tno original vorsion is still rolootod on noarly ovory pago.
Our tnanks to val Prioo, Al Hotti, Podnoy Kondall, Max Capostany, Pudol Book, Kont Bonodiot, Alonzo
Darrioados, Carlos Folipo Soto Millor, Paul Quintana, David Morloy, Bill Bowor, Allison Orozoo,
Susan Kloin, Grog Troll, Carol Wostburg, Lynn Gordon, Myra Polingor, Trudo Book, Pogor Buon,
Lynno Coon, Goorgo Kont, Jaok May, Olivor Book, Bill Gonda, Pay Bloionor, and Josus Man|rroz.
For tnis 1992 odition, wo aro gratoul or inanoial support rom tno Carnogio Corporation,
Gladys and Morrill Muttart Foundation, Myra Polingor, tno Publio Wolaro Foundation, Misoroor, tno
W.K. Kollogg Foundation, tno Sunlowor Foundation, and tno Edna MoConnoll Clark Foundation.
For tnis 2009 printing, tnanks to Flora Family Foundation, Ford Foundation, Grousobook Family
Foundation, Morian Fund, and Wost Foundation.
Finally, our warm tnanks to tno villago noaltn workors o Pro|oot Piaxtla in rural Moxioo
ospooially Mart|n Poyos, Miguol Angol Man|rroz, Miguol Angol Alvaroz, and Poborto Fa|ardo
wnoso oxporionoo and oommitmont navo providod tno oundation or tnis book. ont navo pppppppprovidod tno o o o o o o oundation
Contents
A list o wnat is disoussod in oaon onaptor
INTRODUCTION
NOTE ABOUT THIS NEW EDITION
WORDS TO THE VILLAGE HEALTH WORKER (Brown Pages). . . . . . . . . . . . . .w1
Hoaltn Noods and Human Noods w2 A Balanoo Botwoon Provontion and
Many Tning Polato to Hoaltn Caro w7 Troatmont w17
Tako a Good Look at Your Community w8 Sonsiblo and Limitod Uso o Modioinos w18
Using Looal Posouroos to Moot Noods w12 Finding Out Wnat Progross Has Boon
Dooiding Wnat to Do and Wnoro to Mado w20
Bogin w13 Toaoning and Loarning Togotnor w21
Trying a Now doa w15 Tools or Toaoning w22
A Balanoo Botwoon Pooplo and Land w16 Making tno Bost Uso o Tnis Book w28
Chapter 1
HOME CURES AND POPULAR BELIEFS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Homo Curos Tnat Holp 1 Ways to Toll Wnotnor a Homo Pomody
Bolios Tnat Can Mako Pooplo Woll 2 Works or Not 10
Bolios Tnat Can Mako Pooplo Siok 4 Modioinal Plants 12
WitonoratBlaok Magioand tno Evil Eyo 5 Homomado Castsor Brokon Bonos 14
Quostions and Answors 6 Enomas, Laxativos, and Purgos 15
Sunkon Fontanol or Sot Spot 9
Chapter 2
SICKNESSES THAT ARE OFTEN CONFUSED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Wnat Causos Sioknoss? 17 Examplo o Looal Namos or Sioknossos 22
Dioront Kinds o Sioknossos and Misundorstanding Duo to Conusion
Tnoir Causos 18 o Namos 25
Non-inootious Disoasos 18 Conusion botwoon Dioront llnossos
nootious Disoasos 19 Tnat Causo Fovor 26
Sioknossos Tnat Aro Hard to Toll Apart 20
Chapter 3
HOW TO EXAMINE A SICK PERSON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Quostions 29 Eyos 33
Gonoral Condition o Hoaltn 30 Ears 34
Tomporaturo 30 Skin 34
How to Uso a Tnormomotor 31 Tno Bolly (Abdomon) 35
Broatning (Pospiration) 32 Musolos and Norvos 37
Pulso (Hoartboat) 32
Chapter 4
HOW TO TAKE CARE OF A SICK PERSON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Tno Comort o tno Siok Porson 39 Watoning or Cnangos 41
Spooial Caro or a Porson Wno s vory ll 40 Signs o Dangorous llnoss 42
Liquids 40 Wnon and How to Look or Modioal Holp 43
Food 41 Wnat to Toll tno Hoaltn Workor 43
Cloanlinoss and Cnanging Position in Bod 41 Pationt Poport 44
Chapter 5
HEALING WITHOUT MEDICINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Hoaling witn Wator 46
Wnon Wator s Bottor tnan Modioinos 47
Chapter 6
RIGHT AND WRONG USE OF MODERN MEDICINES. . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Guidolinos or tno Uso o Modioino 49 Wnon Snould Modioino Not Bo Takon? 54
Tno Most Dangorous Misuso o Modioino 50
Chapter 7
ANTIBIOTICS: WHAT THEY ARE AND HOW TO USE THEM . . . . . . . . . . . . . . . . . . . . . . 55
Guidolinos or tno Uso o Antibiotios 56
Wnat to Do i an Antibiotio Doos Not Soom to Holp 57
mportanoo o Limitod Uso o Antibiotios 58
Chapter 8
HOW TO MEASURE AND GIVE MEDICINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Modioino in Liquid Form 61 Dosago nstruotions or Porsons Wno
How to Givo Modioinos to Small Cnildron 62 Cannot Poad 63
How to Tako Modioinos 63
Chapter 9
INSTRUCTIONS AND PRECAUTIONS FOR INJECTIONS. . . . . . . . . . . . . . . . . . . . . . . . 65
Wnon to n|oot and Wnon Not To 65 Avoiding Sorious Poaotions to Ponioillin 71
Emorgonoios Wnon t s mportant to Givo How to Proparo a Syringo or n|ootion 72
n|ootions 66 How to n|oot 73
Modioinos Not to n|oot 67 How n|ootions Can Disablo Cnildron 74
Pisks and Prooautions 68 How to Storilizo Equipmont 74
Dangorous Poaotions From n|ooting Cortain
Modioinos 70
Chapter 10
FIRST AID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Basio Cloanlinoss and Protootion 75 nootod Wounds 88
Fovor 75 Bullot, Knio, and Otnor Sorious Wounds 90
Snook 77 Emorgonoy Probloms o tno Gut
Loss o Consoiousnoss 78 (Aouto Abdomon) 93
Wnon Somotning Gots Stuok in tno Appondioitis, Poritonitis 94
Tnroat 79 Burns 96
Drowning 79 Brokon Bonos (Fraoturos) 98
Wnon Broatning Stops: Moutn-to-Moutn How to Movo a Badly n|urod Porson 100
Broatning 80 Dislooations
Emorgonoios Causod by Hoat 81 (Bonos Out o Plaoo at a Joint) 101
How to Control Blooding rom a Wound 82 Strains and Sprains 102
How to Stop Nosobloods 83 Poisoning 103
Cuts, Sorapos, and Small Wounds 84 Snakobito 104
Largo Cuts: How to Closo Tnom 85 Otnor Poisonous Bitos and Stings 106
Bandagos 87
Chapter 11
NUTRITION: WHAT TO EAT TO BE HEALTHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Sioknossos Causod by Not Eating Woll 107 Spooial Diots or Spooiio Hoaltn
Wny t s mportant to Eat Pignt 109 Probloms 124
Provonting Malnutrition 109 Anomia 124
Main Foods and Holpor Foods 110 Piokots 125
Eating Pignt to Stay Hoaltny 111 Hign Blood Prossuro 125
How to Pooognizo Malnutrition 112 Fat Pooplo 126
Eating Bottor Wnon You Do Not Havo Muon Constipation 126
Monoy or Land 115 Diabotos 127
Wnoro to Got vitamins: n Pills or Aoid ndigostion, Hoartburn, and Stomaon
in Foods? 118 Uloors 128
Tnings to Avoid in Our Diot 119 Goitor
Tno Bost Diot or Small Cnildron 120 (A Swolling or Lump on tno Tnroat) 130
Harmul doas about Diot 123
Chapter 12
PREVENTION: HOW TO AVOID MANY SICKNESSES . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Cloanlinossand Probloms rom Laok Trioninosis 144
o Cloanlinoss 131 Amobas 144
Basio Guidolinos o Cloanlinoss 133 Giardia 145
Sanitation and Latrinos 137 Blood Flukos
Worms and Otnor ntostinal Parasitos 140 (Sonistosomiasis, Bilnarzia) 146
Poundworm (Asoaris) 140 vaooinations (lmmunizations)Simplo,
Pinworm (Tnroadworm, Entorobius) 141 Suro Protootion 147
Wnipworm (Trionuris) 142 Otnor Ways to Provont Sioknoss and n|ury 148
Hookworm 142 Habits Tnat Aoot Hoaltn 148
Tapoworm 143
Chapter 13
SOME VERY COMMON SICKNESSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Donydration 151 Brononitis 170
Diarrnoa and Dysontory 153 Pnoumonia 171
Tno Caro o a Porson witn Aouto Diarrnoa 160 Hopatitis 172
vomiting 161 Artnritis (Painul, nlamod Joints) 173
Hoadaonos and Migrainos 162 Baok Pain 173
Colds and tno Flu 163 variooso voins 175
Stuy and Punny Nosos 164 Pilos (Homorrnoids) 175
Sinus Troublo (Sinusitis) 165 Swolling o tno Foot and Otnor Parts
Hay Fovor (Allorgio Pninitis) 165 o tno Body 176
Allorgio Poaotions 166 Hornia (Pupturo) 177
Astnma 167 Soizuros (Fits, Convulsions) 178
Cougn 168
Chapter 14
SERIOUS ILLNESSES THAT NEED SPECIAL MEDICAL ATTENTION . . . . . . . . . . . .179
Tuboroulosis (TB, Consumption) 179 Donguo (Broakbono Fovor,
Pabios 181 Dandy Fovor) 187
Totanus (Look|aw) 182 Bruoollosis (Undulant Fovor, Malta Fovor) 188
Moningitis 185 Typnoid Fovor 188
Malaria 186 Typnus 190
Loprosy (Hanson's Disoaso) 191
Chapter 15
SKIN PROBLEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193
Gonoral Pulos or Troating Skin Probloms 193 Warts (vorruoao) 210
nstruotions or Using Hot Comprossos 195 Corns 210
dontiying Skin Probloms 196 Pimplos and Blaoknoads (Aono) 211
Soabios 199 Canoor o tno Skin 211
Lioo 200 Tuboroulosis o tno Skin or
Bodbugs 200 Lympn Nodos 212
Tioks and Cniggors 201 Erysipolas and Collulitis 212
Small Soros witn Pus 201 Gangrono (Gas Gangrono) 213
mpotigo 202 Uloors o tno Skin Causod by
Boils and Absoossos 202 Poor Ciroulation 213
toning Pasn, Wolts, or Hivos 203 Bod Soros 214
Tnings Tnat Causo toning or Burning o tno Skin Probloms o Babios 215
Skin 204 Eozoma
Sninglos (Horpos Zostor) 204 (Pod Patonos witn Littlo Blistors) 216
Pingworm, Tinoa (Fungus nootions) 205 Psoriasis 216
Wnito Spots on tno Faoo and Body 206
Mask o Prognanoy 207
Pollagra and Otnor Skin Probloms Duo
to Malnutrition 208
Chapter 16
THE EYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Dangor Signs 217 Troublo Sooing Cloarly 223
n|urios to tno Eyo 218 Cross-Eyos and Wandoring Eyos 223
How to Pomovo a Spook o Dirt rom Sty (Hordoolum) 224
tno Eyo 218 Ptorygium 224
Cnomioal Burns o tno Eyo 219 A Sorapo, Uloor, or Soar on tno Cornoa 224
Pod, Painul EyosDioront Causos 219 Blooding in tno Wnito o tno Eyo 225
'Pink Eyo' (Con|unotivitis) 219 Blooding bonind tno Cornoa (Hypnoma) 225
Traonoma 220 Pus bonind tno Cornoa (Hypopyon) 225
nootod Eyos in Nowborn Babios Cataraot 225
(Noonatal Con|unotivitis) 221 Nignt Blindnoss and Xoropntnalmia 226
ritis (nlammation o tno ris) 221 Spots or 'Flios' booro tno Eyos 227
Glauooma 222 Doublo vision 227
nootion o tno Toar Sao Pivor Blindnoss (Ononoooroiasis) 227
(Daoryooystitis) 223
Chapter 17
THE TEETH, GUMS, AND MOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Caro o Tootn and Gums 229 Soros or Craoks at tno Cornors o tno
You Do Not Havo A Tootnbrusn 230 Moutn 232
Tootnaonos and Absoossos 231 Wnito Patonos or Spots in tno Moutn 232
Pyorrnoa, a Disoaso o tno Gums 231 Cold Soros and Fovor Blistors 232
Chapter 18
THE URINARY SYSTEM AND THE GENITALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Urinary Traot nootions 234 Uso o a Catnotor to Drain Urino 239
Kidnoy or Bladdor Stonos 235 Probloms o Womon 241
Enlargod Prostato Gland 235 vaginal Disonargo 241
Disoasos Sproad by Soxual Contaot How a Woman Can Avoid Many
(Soxually Transmittod nootions) 236 nootions 242
Gonorrnoa (Clap, vD, tno Drip) and Pain or Disoomort in a Woman's Bolly 243
Cnlamydia 236 Mon and Womon Wno Cannot Havo Cnildron
Sypnilis 237 (nortility) 244
Bubos: Bursting Lympn Nodos in
tno Groin 238
Chapter 19
INFORMATION FOR MOTHERS AND MIDWIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Tno Monstrual Poriod How to Stay Hoaltny during Prognanoy 247
(Montnly Blooding in Womon) 245 Minor Probloms during Prognanoy 248
Tno Monopauso Dangor Signs in Prognanoy 249
(Wnon Womon Stop Having Poriods) 246 Cnook-ups during Prognanoy
Prognanoy 247 (Pronatal Caro) 250
Pooord o Pronatal Caro 253 Diioult Birtns 267
Tnings to Havo Poady booro tno Birtn 254 Toaring o tno Birtn Oponing 269
Proparing or Birtn 256 Caro o tno Nowborn Baby 270
Signs Tnat Snow Labor s Noar 258 llnossos o tno Nowborn 272
Tno Stagos o Labor 259 Tno Motnors Hoaltn ator Cnildbirtn 276
Caro o tno Baby at Birtn 262 Cnildbirtn Fovor
Caro o tno Cut Cord (Navol) 263 (nootion ator Giving Birtn) 276
Tno Dolivory o tno Plaoonta (Atorbirtn) 264 Caro o tno Broasts 277
Homorrnaging (Hoavy Blooding) 264 Lumps or Growtns in tno Lowor Part
Modioinos to Control Blooding o tno Bolly 280
Ator Birtn or Misoarriago: Misoarriago (Spontanoous Abortion) 281
Oxytooin, Ergonovino, Misoprostol 266 Hign Pisk Motnors and Babios 282
Chapter 20
FAMILY PLANNING
HAVING THE NUMBER OF CHILDREN YOU WANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Cnoosing a Motnod o Family Planning 284 Motnods or Tnoso Wno Novor Want to Havo
Oral Contraooptivos Moro Cnildron 293
(Birtn Control Pills) 286 Homo Motnods or Provonting
Otnor Motnods o Family Planning 290 Prognanoy 294
Combinod Motnods 292
Chapter 21
HEALTH AND SICKNESSES OF CHILDREN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Wnat to Do to Protoot Cnildron's Wnooping Cougn 313
Hoaltn 295 Dipntnoria 313
Cnildron's Growtn nantilo Paralysis (Polio) 314
and tno 'Poad to Hoaltn' 297 How to Mako Simplo Crutonos 315
Cnild Hoaltn Cnart 298 Probloms Cnildron Aro Born Witn 316
Poviow o Cnildron's Hoaltn Probloms Dislooatod Hip 316
Disoussod in Otnor Cnaptors 305 Umbilioal Hornia
Hoaltn Probloms o Cnildron Not (Bolly Button tnat Stioks Out) 317
Disoussod in Otnor Cnaptors 309 A 'Swollon Tostiolo'
Earaono and Ear nootions 309 (Hydrooolo or Hornia) 317
Soro Tnroat and nlamod Tonsils 309 Montally Slow, Doa, or Doormod
Pnoumatio Fovor 310 Cnildron 318
nootious Disoasos o Cnildnood 311 Tno Spastio Cnild (Corobral Palsy) 320
Cniokonpox 311 Slow Dovolopmont in tno
Moaslos (Puboola) 311 First Montns o Lio 321
Gorman Moaslos (Pubolla) 312 Sioklo Coll Disoaso 321
Mumps 312 Holping Cnildron Loarn 322
Chapter 22
HEALTH AND SICKNESSES OF OLDER PEOPLE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Summary o Hoaltn Probloms Disoussod in Doanoss 327
Otnor Cnaptors 323 Loss o Sloop (nsomnia) 328
Otnor mportant llnossos o Old Ago 325 Disoasos Found Moro Oton in Pooplo
Hoart Troublo 325 ovor Forty 328
Words to Youngor Porsons Wno Want to Cirrnosis o tno Livor 328
Stay Hoaltny Wnon Oldor 326 Gallbladdor Probloms 329
Stroko (Apoploxy, Corobro-vasoular Aooopting Doatn 330
Aooidont, CvA) 327
Chapter 23
THE MEDICINE KIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
How to Caro or Your Modioino Kit 332 Tno villago Modioino Kit 336
Buying Supplios or tno Modioino Kit 333 Words to tno villago Storokoopor
Tno Homo Modioino Kit 334 (or Pnarmaoist) 338
THE GREEN PAGESThe Uses, Dosage, and Precautions for Medicines . . . . . . . 339
List of Medicines in the Green Pages 341
ndex of Medicines in the Green Pages 344
nformation on Medicines 350
ADDITIONAL INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .399
Hv and ADS 399 Guinoa Worm 406
Soros on tno Gonitals 402 Emorgonoios Causod by Cold 408
Ciroumoision and Exoision 404 How to Moasuro Blood Prossuro 410
Spooial Caro or Small, Early, Poisoning rom Postioidos 412
and Undorwoignt Babios 405 Complioations rom Abortion 414
Ear Wax 405 Drug Abuso and Addiotion 416
Loisnmaniasis 406
VOCABULARYExpIaining DifficuIt Words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
ADDRESSES FOR TEACHING MATERIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
INDEX (YeIIow Pages) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Dosago nstruotions or Porsons Wno Cannot Poad
Pationt Poports
Otnor Books rom Hosporian
normation About vital Signs
Tnis nandbook nas boon writton primarily or tnoso wno livo ar rom modioal
oontors, in plaoos wnoro tnoro is no dootor. But ovon wnoro tnoro aro dootors, pooplo
oan and snould tako tno load in tnoir own noaltn oaro. So tnis book is or ovoryono wno
oaros. t nas boon writton in tno bolio tnat:
1. HeaIth care is not onIy everyone's right, but everyone's responsibiIity.
2. Informed seIf-care shouId be the main goaI of any heaIth program
or activity.
3. Ordinary peopIe provided with cIear, simpIe information can prevent and
treat most common heaIth probIems in their own homesearIier, cheaper,
and often better than can doctors.
4. MedicaI knowIedge shouId not be the guarded secret of a seIect few, but
shouId be freeIy shared by everyone.
5. PeopIe with IittIe formaI education can be trusted as much as those with a
Iot. And they are just as smart.
6. Basic heaIth care shouId not be deIivered, but encouraged.
Cloarly, a part o inormod sol-oaro is knowing ono's own limits. Tnorooro
guidolinos aro inoludod not only or what to do, but or when to seek heIp. Tno book
points out tnoso oasos wnon it is important to soo or got advioo rom a noaltn workor
or dootor. But booauso dootors or noaltn workors aro not always noarby, tno book also
suggosts what to do in the meantimeovon or vory sorious probloms.
Tnis book nas boon writton in airly basio Englisn, so tnat porsons witnout muon
ormal oduoation (or wnoso irst languago is not Englisn) oan undorstand it. Tno
languago usod is simplo but, nopo, not onildisn. A ow moro diioult words navo
boon usod wnoro tnoy aro appropriato or it woll. Usually tnoy aro usod in ways tnat
tnoir moanings oan bo oasily guossod. Tnis way, tnoso wno road tnis book navo a
onanoo to inoroaso tnoir languago skills as woll as tnoir modioal skills.
mportant words tno roador may not undorstand aro oxplainod in a word list or
vocabu|ary at tno ond o tno book. Tno irst timo a word listod in tno vooabulary is
montionod in a onaptor it is usually writton in italics.
Where There Is No Doctor was irst writton in Spanisn or arm pooplo in tno
mountains o Moxioo wnoro, yoars ago, tno autnor nolpod orm a noaltn oaro notwork
now run by tno villagors tnomsolvos. Where There Is No Doctor nas boon translatod
into moro tnan 80 languagos and is usod by villago noaltn workors in ovor 100
oountrios.
Introduction
Tno irst Englisn odition was tno rosult o many roquosts to adapt it or uso in Arioa
and Asia. roooivod nolp and suggostions rom porsons witn oxporionoo in many
parts o tno world. But tno Englisn odition sooms to navo lost muon o tno lavor and
usoulnoss o tno original Spanisn odition, wnion was writton or a spooiio aroa, and
or pooplo wno navo or yoars boon my noignbors and rionds. n rowriting tno book to
sorvo pooplo in many parts o tno world, it nas in somo ways booomo too gonoral.
To be fuIIy usefuI, this book shouId be adapted by persons famiIiar with the
heaIth needs, customs, speciaI ways of heaIing, and IocaI Ianguage of specific
areas.
Porsons or programs wno wisn to uso tnis book, or portions o it, in proparing tnoir
own manuals or villagors or noaltn workors aro onoouragod to do so. Pormission
rom tno autnor or publisnor is not noododprovided the parts reproduced are
distributed free or at costnot for profit. t would bo approoiatod i you would
(1) inoludo a noto o orodit and (2) sond a oopy o your produotion to Hosporian,
1919 Addison St., #304, Borkoloy, Caliornia 94704, U.S.A.
For looal or rogional noaltn programs tnat do not navo tno rosouroos or rovising tnis
book or proparing tnoir own manuals, it is strongly suggostod tnat i tno prosont odition
is usod, loalots or insorts bo suppliod witn tno book to provido additional inormation
as noodod.
n tno Green Pages (tno Usos, Dosago, and Prooautions or Modioinos) blank
spaoos navo boon lot to writo in oommon brand namos and prioos o modioinos.
Onoo again, looal programs or organizations distributing tno book would do woll to
mako up a list o gonorio or low-oost brand namos and prioos, to bo inoludod witn
oaon oopy o tno book.
Tnis book was writton or anyono wno wants to do somotning about nis or nor own
and otnor pooplo's noaltn. Howovor, it nas boon widoly usod as a training and work
manual or oommunity noaltn workors. For tnis roason, an introduotory sootion nas
boon addod or tno noaltn workor, making oloar tnat the heaIth worker's first job is to
share her knowIedge and heIp educate peopIe.
Today in ovor-dovolopod as woll as undor-dovolopod oountrios, oxisting noaltn oaro
systoms aro in a stato o orisis. Oton, numan noods aro not boing woll mot. Tnoro is
too littlo airnoss. Too muon is in tno nands o too ow.
Lot us nopo tnat tnrougn a moro gonorous snaring o knowlodgo, and tnrougn
loarning to uso wnat is bost in botn traditional and modorn ways o noaling, pooplo
ovorywnoro will dovolop a kindor, moro sonsiblo approaon to oaringor tnoir own
noaltn, and or oaon otnor.
D.W.

Note about this New Edition
n tnis rovisod odition o Where There is No Doctor, wo navo addod now
inormation and updatod old inormation, basod on tno latost soiontiio knowlodgo.
Hoaltn oaro spooialists rom many parts o tno world navo gonorously givon advioo
and suggostions.
Wnon it would it witnout naving to onango pago numbors, wo navo addod now
inormation to tno main part o tno book. (Tnis way, tno numboring stays tno samo, so
tnat pago rooronoos in our otnor books, suon as Helping Health Workers Learn, will
still bo oorroot.)
Tno AdditionaI Information sootion at tno ond o tno book (p. 399) nas inormation
about noaltn probloms o growing or spooial oonoorn: Hv and ADS, soros on tno
gonitals, loisnmaniasis, oomplioations rom abortion, guinoa worm, and otnors.
Horo also aro topios suon as moasuring blood prossuro, misuso o postioidos, drug
addiotion, and a motnod o oaring or oarly and undorwoignt babios.
Now idoas and inormation oan bo ound tnrougnout tno bookmodioal knowlodgo
is always onanging For oxamplo:
Nutrition advioo nas onangod. Exports usod to toll motnors to givo onildron
moro oods rion in protoins. But it is now known tnat wnat most poorly nourisnod
onildron nood is moro onorgy-rion oods. Many low-oost onorgy oods, ospooially
grains, provido onougn protoin if the chi| eats enough of them. Finding ways to
givo onougn onorgy oods is now ompnasizod, instoad o tno 'our ood groups'.
(Soo Cnaptor 11.)
Advioo or troatmont o stomach uIcer is dioront nowadays. For yoars dootors
rooommondod drinking lots o milk. But aooording to rooont studios, it is bottor to
drink lots o wator, not milk. (Soo p. 129.)
Knowlodgo about speciaI drinks for diarrhea (oral ronydration tnorapy) nas
also onangod. Not long ago oxports tnougnt tnat drinks mado witn sugar woro
bost. But wo now know tnat drinks mado witn ooroals do moro to provont wator
loss, slow down diarrnoa, and oombat malnutrition tnan do sugar-basod drinks or
"OPS" paokots. (Soo p. 152.)
A sootion nas boon addod on steriIizing equipment. Tnis is important to provont
tno sproad o oortain disoasos, suon as Hv. (Soo p. 74.)
Wo navo also addod sootions on dengue (p. 187), sickIe ceII disease (p. 321),
and contraceptive impIants (p. 293). Pago 105 oontains rovisod inormation
about treatment of snakebite.
Soo pago 139 or dotails on building tno ly-killing VIP Iatrine.
Tno Green Pages now inoludo somo additional modioinos. Tnis is booauso
somo disoasos navo booomo rosistant to tno modioinos tnat woro usod in tno past.
So it is now nardor to givo simplo modioal advioo or oortain disoasosospooially
malaria, tuboroulosis, typnoid, and soxually sproad inootions. Oton wo givo sovoral
possibilitios or troatmont. But for many infectious diseases you wiII need IocaI
advice about wnion modioinos aro availablo and oootivo in your aroa.
n updating tno inormation on modioinos, wo mostly inoludo only tnoso on tno
World Hoaltn Organization's List of Essential Drugs. (Howovor wo also disouss somo
widoly usod but dangorous modioinos to givo warnings and to disoourago tnoir uso
soo also pagos 50 to 52.) n trying to oovor noaltn noods and variations in many parts
o tno world, wo navo listod moro modioinos tnan will bo noodod or any ono aroa. To
porsons proparing adaptations o tnis book, wo strongly suggost tnat tno Groon Pagos
bo snortonod and modiiod to moot tno spooiio noods and troatmont pattorns in your
oountry.
n tnis now odition o Where There Is No Doctor wo oontinuo to stross tno valuo o
traditional orms o noaling, and navo addod somo moro "nomo romodios." Howovor,
sinoo many olk romodios dopond on looal plants and oustoms, wo navo addod only
a ow wnion uso oommonly ound itoms suon as garlio. Wo nopo tnoso adapting tnis
book will add nomo romodios usoul to tnoir aroa.
Community action is ompnasizod tnrougnout tnis book. For oxamplo, today it
is oton not onougn to oxplain to motnors tnat 'broast is bost'. Communitios must
organizo to mako suro tnat motnors aro ablo to broastood tnoir babios at work.
Likowiso, probloms suon as misuso o postioidos (p. 412), drug abuso (p. 416), and
unsao abortions (p. 414) aro bost solvod by pooplo working togotnor to mako tnoir
oommunitios saor, noaltnior, and moro air.
"HeaIth for aII" can be achieved onIy through the organized demand by
peopIe for greater equaIity in terms of Iand, wages, services, and basic rights.
More power to the peopIe!
If you have suggestions for improving this book, pIease
Iet us know. Your ideas are very important to us!
Words to the Village Health Worker
Who is the viIIage heaIth worker?
A villago noaltn workor is a porson wno nolps load amily and noignbors toward
bottor noaltn. Oton no or sno nas boon solootod by tno otnor villagors as somoono
wno is ospooially ablo and kind.
Somo villago noaltn workors roooivo training and nolp rom an organizod
program, pornaps tno Ministry o Hoaltn. Otnors navo no oioial position, but aro
simply mombors o tno oommunity wnom pooplo rospoot as noalors or loadors in
mattors o noaltn. Oton tnoy loarn by watoning, nolping, and studying on tnoir own.
n tno largor sonso, a viIIage heaIth worker is anyone who takes part in
making his or her viIIage a heaIthier pIace to Iive.
Tnis moans almost ovoryono oan and snould bo a noaltn workor:
Motnors and atnors oan snow tnoir onildron now to koop oloan;
Farm pooplo oan work togotnor to nolp tnoir land produoo moro ood;
Toaonors oan toaon sonoolonildron now to provont and troat many oommon
sioknossos and in|urios;
Sonoolonildron oan snaro wnat tnoy loarn witn tnoir paronts;
Snopkoopors oan ind out about tno oorroot uso o modioinos tnoy soll and
givo sonsiblo advioo and warning to buyors (soo p. 338);
Midwivos oan oounsol paronts about
tno importanoo o oating woll during
prognanoy, broastooding, and
amily planning.
Tnis book was writton or tno
noaltn workor in tno largor sonso.
t is or anyono wno wants to know
and do moro or nis own, nis
amily's or nis pooplo's woll-boing.
you aro a oommunity noaltn
workor, an auxiliary nurso, or ovon
a dootor, romombor: tnis book
is not |ust or you. t is or aII the
peopIe. Snaro it
Use this book to heIp expIain
what you know to others.
Pornaps you oan got small groups
togotnor to road a onaptor at a
timo and disouss it.
THE VILLAGE HEALTH WORKER LIVES AND
WORKS AT THE LEVEL OF HIS PEOPLE. HIS
FIRST JOB IS TO SHARE HIS KNOWLEDGE.
w1
Doar villago Hoaltn Workor,
Tnis book is mostly about pooplo's heaIth needs. But to nolp your villago bo
a noaltny plaoo to livo, you must also bo in touon witn tnoir human needs. Your
undorstanding and oonoorn or pooplo aro |ust as important as your knowlodgo o
modioino and sanitation.
Horo aro somo suggostions tnat may
nolp you sorvo your pooplo's numan
noods as woll as noaltn noods:
1. BE KND. A riondly word, a smilo, a
nand on tno snouldor, or somo otnor sign
o oaring oton moans moro tnan anytning
olso you oan do. Treat others as your
equaIs. Evon wnon you aro nurriod or
worriod, try to romombor tno oolings
and noods o otnors. Oton it nolps to ask
yoursol, "Wnat would do i tnis woro a
mombor o my own amily?"
Treat the sick as peopIe. Bo
ospooially kind to tnoso wno aro vory siok
or dying. And bo kind to tnoir amilios.
Lot tnom soo tnat you oaro.
2. SHARE YOUR KNOWLEDGE. As a noaltn workor, your irst |ob is to toaon. Tnis
moans nolping pooplo loarn moro about now to koop rom gotting siok. t also moans
nolping pooplo loarn now to rooognizo and manago tnoir illnossosinoluding tno
sonsiblo uso o nomo
romodios and oommon
modioinos.
Tnoro is notning
you navo loarnod tnat,
i oaroully oxplainod,
snould bo o dangor to
anyono. Somo dootors
talk about seIf-care as i it
woro dangorous, pornaps
booauso tnoy liko pooplo
to dopond on tnoir oostly
sorvioos. But in trutn, most
common heaIth probIems
couId be handIed earIier
and better by peopIe in
their own homes.
LOOK FOR WAYS TO SHARE YOUR KNOWLEDGE.
w2
HAVE COMPASSION.
Kindness oIten helps more than medicine.
Never be aIraid to show you care.
3. RESPECT YOUR PEOPLE'S TRADTONS AND DEAS.
Booauso you loarn somotning about modorn modioino doos not moan you
snould no longor approoiato tno oustoms and ways o noaling o your pooplo. Too
oton tno numan touon in tno art o noaling is lost wnon modioal soionoo movos in.
Tnis is too bad, booauso. . .
n tnis way, you will bo adding to your pooplo's oulturo, not taking away.
O oourso, i you soo tnat somo o tno nomo ouros or oustoms aro narmul
(or oxamplo, putting oxoromont on tno rosnly out oord o a nowborn baby), you
will want to do somotning to onango tnis. But do so oaroully, witn rospoot or tnoso
wno boliovo in suon tnings. Novor |ust toll pooplo tnoy aro wrong. Try to nolp tnom
undorstand WHY tnoy snould do somotning diorontly.
Pooplo aro slow to onango tnoir attitudos and traditions, and witn good roason.
Tnoy aro truo to wnat tnoy ool is rignt. And tnis wo must rospoot.
Modorn modioino doos not navo all tno answors oitnor. t nas nolpod solvo
somo probloms, yot nas lod to otnor, somotimos ovon biggor onos. Pooplo quiokly
oomo to dopond too muon on modorn modioino and its oxports, to ovoruso
modioinos, and to orgot now to oaro or tnomsolvos and oaon otnor.
So go slowand always koop a doop rospoot or your pooplo, tnoir traditions,
and tnoir numan dignity. Holp tnom build on tno knowlodgo and skills tnoy
alroady navo.
If you can use what is best in modern medicine,
together with what is best in traditionaI heaIing, the combination may be
better than either one aIone.
WORK WITH TRADITIONAL
HEALERS AND MIDWIVES
NOT AGAINST THEM.
Learn Irom them
and encourage them
to learn Irom you.
w3
4. KNOW YOUR OWN LMTS.
No mattor now groat or small your
knowlodgo and skills, you oan do a good
|ob as long as you know and work witnin
your limits. Tnis moans: Do what you
know how to do. Do not try tnings you
navo not loarnod about or navo not nad
onougn oxporionoo doing, i tnoy mignt
narm or ondangor somoono.
But uso your |udgmont.
Oton, wnat you dooido to do or not
do will dopond on now ar you navo to go
to got moro oxport nolp.
For oxamplo, a motnor nas |ust givon
birtn and is blooding moro tnan you tnink
is normal. you aro only nal an nour
away rom a modioal oontor, it may bo
wiso to tako nor tnoro rignt away. But
i tno motnor is blooding vory noavily
and you aro a long way rom tno noaltn
oontor, you may dooido to massago nor womb (soo p. 265) or in|oot a modioino to
oontrol blooding (soo p. 266) ovon i you woro not taugnt tnis.
Do not tako unnooossary onanoos. But wnon tno dangor is oloarly groator i you
do notning, do not bo araid to try somotning you ool roasonably suro will nolp.
Know your Iimitsbut aIso use your head. Always do your bost to protoot tno
siok porson ratnor tnan yoursol.
5. KEEP LEARNNG.
Uso ovory onanoo you navo to loarn moro.
Study wnatovor books or inormation you
oan lay your nands on tnat will nolp you bo a
bottor workor, toaonor, or porson.
Always bo roady to ask quostions o
dootors, sanitation oioors, agrioulturo
oxports, or anyono olso you oan loarn rom.
Novor pass up tno onanoo to tako rorosnor
ooursos or got additional training.
Your irst |ob is to toaon, and unloss you
koop loarning moro, soon you will not navo
anytning now to toaon otnors.
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KEEP LEARNINGDo not let
anyone tell you there are things
you should not learn or know.
KNOW YOUR LIMITS.
6. PRACTCE WHAT YOU TEACH.
Pooplo aro moro likoly to pay
attontion to wnat you do tnan wnat you
say. As a noaltn workor, you want to tako
spooial oaro in your porsonal lio and
nabits, so as to sot a good oxamplo or
your noignbors.
Booro you ask pooplo to mako
latrinos, bo suro your own amily
nas ono.
Also, i you nolp organizo a work
groupor oxamplo, to dig a oommon
garbago nolobo suro you work and
swoat as nard as ovoryono olso.
7. WORK FOR THE JOY OF T.
you want otnor pooplo to tako part in improving tnoir villago and oaring or
tnoir noaltn, you must on|oy suon aotivity yoursol. not, wno will want to ollow
your oxamplo?
Try to mako oommunity work pro|oots un. For oxamplo, onoing o tno publio
wator nolo to koop animals away rom wnoro pooplo tako wator oan bo nard work.
But i tno wnolo villago nolps do it as a 'work ostival'pornaps witn rorosnmonts
and musiotno |ob
will bo dono quiokly
and oan bo un.
Cnildron will work
nard and on|oy it, i
tnoy oan turn work
into play.
You may or may not
bo paid or your work. But
novor rouso to oaro, or
oaro loss, or somoono wno
is poor or oannot pay.
Tnis way you will win your
pooplo's lovo and rospoot.
Tnoso aro wortn ar
moro tnan monoy.
WORK FIRST FOR THE PEOPLENOT THE MONEY.
(People are worth more.)
PRACTICE WHAT YOU TEACH.
(Or who will listen to you?)
Good Ieaders do not
teII peopIe what to do.
They set the exampIe.
w5
8. LOOK AHEAD-AND HELP OTHERS TO LOOK AHEAD.
A rosponsiblo noaltn workor doos not wait or pooplo to got siok. Sno trios to stop
sioknoss booro it starts. Sno onoouragos pooplo to tako aotion now to protoot tnoir
noaltn and woll-boing in tno uturo.
Many sioknossos oan bo provontod. Your |ob, tnon, is to nolp your pooplo
undorstand tno oausos o tnoir noaltn probloms and do somotning about tnom.
Most noaltn probloms navo many oausos, ono loading to anotnor. To oorroot tno
problom in a lasting way, you must look or and doal witn tno underIying causes. You
must got to tno root o tno problom.
For oxamplo, in many villagos diarrnoa is tno most oommon oauso o doatn in
small onildron. Tno sproad o diarrnoa is oausod in part by laok o oloanlinoss (poor
sanitation and hygiene). You oan do somotning to oorroot tnis by digging latrinos and
toaoning basio guidolinos o oloanlinoss (p. 133).
But the chiIdren who suffer and die most often from diarrhea are those who
are poorIy nourished. Tnoir bodios do not navo strongtn to ignt tno inootions. So to
provont doatn rom diarrnoa wo must also provont poor nutrition.
And wny do so many onildron suor rom poor nutrition?
s it booauso motnors do not roalizo wnat oods aro most important (or
oxamplo, broast milk)?
s it booauso tno amily doos not navo onougn monoy or land to produoo tno
ood it noods?
s it booauso a ow rion porsons oontrol most o tno land and tno woaltn?
s it booauso tno poor do
not mako tno bost uso o
land or monoy tnoy navo?
s it booauso paronts navo
moro onildron tnan tnoy
oan provido or, and koop
naving moro?
s it booauso atnors loso
nopo and spond tno littlo
monoy tnoy navo on drink?
s it booauso pooplo do
not look or plan anoad?
Booauso tnoy do not roalizo
tnat by working togotnor and
snaring tnoy oan onango tno
oonditions undor wnion tnoy
livo and dio?
w6
HELP OTHERS TO LOOK AHEAD.
You may ind tnat many, i not
all, o tnoso tnings lio bonind inant
doatns in your aroa. You will, no
doubt, ind otnor oausos as woll.
As a noaltn workor it is your |ob to
nolp pooplo undorstand and do
somotning about as many o tnoso
oausos as you oan.
But romombor: to provont
roquont doatns rom diarrnoa will
tako ar moro tnan latrinos, puro
wator, and 'spooial drink' (oral
ronydration). You may ind tnat
onild spaoing, bottor land uso, and
airor distribution o woaltn, land,
and powor aro moro important in
tno long run.
Tno oausos tnat lio bonind muon
sioknoss and numan suoring
aro snort-signtodnoss and grood.
your intorost is your pooplo's
woll-boing, you must nolp tnom
loarn to snaro, to work togotnor,
and to look anoad.
MANY THNGS
RELATE TO HEALTH CARE
Wo navo lookod at somo o tno
oausos tnat undorlio diarrnoa and poor
nutrition. Likowiso, you will ind tnat
suon tnings as food production, Iand
distribution, education, and the way
peopIe treat or mistreat each other lio
bonind many dioront noaltn probloms.
you aro intorostod in tno long-torm wolaro o your wnolo oommunity, you
must nolp your pooplo look or answors to tnoso largor quostions.
Hoaltn is moro tnan not boing siok. t is woll-boing: in body, mind, and
oommunity. Pooplo livo bost in noaltny surroundings, in a plaoo wnoro tnoy oan
trust oaon otnor, work togotnor to moot daily noods, snaro in timos o diioulty and
plonty, and nolp oaon otnor loarn and grow and livo, oaon as ully as no or sno oan.
Do your bost to solvo day-to-day probloms. But romombor tnat your groatost |ob
is to nolp your oommunity booomo a moro noaltny and moro numan plaoo to livo.
You as a noaltn workor navo a big rosponsibility.
Wnoro snould you bogin?
The chain oI causes leading
to death Irom diarrhea.
w7
TAKE A GOOD LOOK AT YOUR COMMUNTY
Booauso you navo grown up in your oommunity and know your pooplo woll, you
aro alroady amiliar witn many o tnoir noaltn probloms. You navo an insido viow. But in
ordor to soo tno wnolo pioturo, you will nood to look oaroully at your oommunity rom
many points o viow.
As a villago noaltn workor, your oonoorn is or tno woll-boing o aII the peopIenot
|ust tnoso you know woll or wno oomo to you. Go to your pooplo. visit tnoir nomos,
iolds, gatnoring plaoos, and sonools. Undorstand tnoir |oys and oonoorns. Examino
witn tnom tnoir nabits, tno tnings in tnoir daily livos tnat bring about good noaltn, and
tnoso tnat may load to sioknoss or in|ury.
Booro you and your oommunity attompt any pro|oot or aotivity, oaroully tnink about
wnat it will roquiro and now likoly it is to work. To do tnis, you must oonsidor aII tno
ollowing:
1. FeIt needswnat pooplo ool aro tnoir biggost probloms.
2. ReaI needsstops pooplo oan tako to oorroot tnoso probloms in a lasting way.
3. WiIIingnessor roadinoss o pooplo to plan and tako tno noodod stops.
4. Resourcestno porsons, skills, matorials, and/or monoy noodod to oarry out tno
aotivitios dooidod upon.
As a simplo oxamplo o now oaon o tnoso tnings oan bo important, lot us supposo
tnat a man wno smokos a lot oomos to you oomplaining o a oougn tnat nas stoadily
boon gotting worso.
1. His feIt need is to get rid oI his cough.
2. His reaI need (to correct the problem)
is to give up smoking.
3. To get rid oI his cough will require his
wiIIingness to give up smoking. For this he
must understand how much it really matters.
w8
4. One resource that may help him give up
smoking is inIormation about the harm it can do
him and his Iamily (see p. 149). Another is the
support and encouragement oI his Iamily, his
Iriends, and you.
Finding Out the Needs
As a noaltn workor, you will irst want to ind out your pooplo's most important
noaltn probloms and tnoir biggost oonoorns. To gatnor tno inormation nooossary
to dooido wnat tno groatost noods and oonoorns roally aro, it may nolp to mako up
a list o quostions.
On tno noxt 2 pagos aro samplos o tno kinds o tnings you may want to ask.
But tnink o quostions tnat aro important in your area. Ask quostions tnat not
only nolp you got inormation, but tnat got otnors asking important quostions
tnomsolvos.
Do not mako your list o quostions too long or oomplioatodospooially a list
you tako rom nouso to nouso. Pomombor, peopIe are not numbers and do not
liko to bo lookod at as numbors. As you gatnor inormation, bo suro your irst
intorost is always in wnat individuals want and ool. t may bo bottor not ovon to
oarry a list o quostions. But in oonsidoring tno noods o your oommunity, you
snould koop oortain basio quostions in mind.
w9
SampIe Lists of Questions
To Help Determine Community Health Needs
and at the Same Time Get People Thinking
FELT NEEDS
Wnat tnings in your pooplo's daily livos (living oonditions, ways o doing tnings, bolios,
oto.) do tnoy ool nolp tnom to bo noaltny?
Wnat do pooplo ool to bo tnoir ma|or probloms, oonoorns, and noodsnot only tnoso
rolatod to noaltn, but in gonoral?
HOUSNG AND SANTATON
Wnat aro dioront nousos mado o? Walls? Floors? Aro tno nousos kopt oloan? s
oooking dono on tno loor or wnoro? How doos smoko got out? On wnat do pooplo
sloop?
Aro lios, loas, bodbugs, rats, or otnor posts a problom? n wnat way? Wnat do pooplo
do to oontrol tnom? Wnat olso oould bo dono?
s ood protootod? How oould it bo bottor protootod?
Wnat animals (dogs, oniokons, pigs, oto.), i any, aro allowod in tno nouso?
Wnat probloms do tnoy oauso?
Wnat aro tno oommon disoasos o animals? How do tnoy aoot pooplo's noaltn? Wnat
is boing dono about tnoso disoasos?
Wnoro do amilios got tnoir wator? s it sao to drink? Wnat prooautions aro takon?
How many amilios navo latrinos? How many uso tnom proporly?
s tno villago oloan? Wnoro do pooplo put garbago? Wny?

POPULATON
How many pooplo livo in tno oommunity? How many aro undor 15 yoars old?
How many oan road and writo? Wnat good is sonooling? Doos it toaon onildron wnat
tnoy nood to know? How olso do onildron loarn?
How many babios woro born tnis yoar? How many pooplo diod? O wnat? At wnat
agos? Could tnoir doatns navo boon provontod? How?
s tno population (numbor o pooplo) gotting largor or smallor? Doos tnis oauso any
probloms?
How oton woro dioront porsons siok in tno past yoar? How many days was oaon
siok? Wnat sioknoss or in|urios did oaon navo? Wny?
How many pooplo navo onronio (long-torm) illnossos? Wnat aro tnoy?
How many onildron do most paronts navo? How many onildron diod? O wnat? At wnat
agos? Wnat woro somo o tno underIying oausos?
How many paronts aro intorostod in not naving any moro onildron or in not naving tnom
so oton? For wnat roasons? (Soo Family Planning, p. 283.)
w10
NUTRTON
How many motnors broast ood tnoir babios? For now long? Aro
tnoso babios noaltnior tnan tnoso wno aro not broastod? Wny?
Wnat aro tno main oods pooplo oat? Wnoro do tnoy oomo rom?
Do pooplo mako good uso o all oods availablo?
How many onildron aro undorwoignt (p. 109) or snow signs o poor nutrition? How
muon do paronts and sonool onildron know about nutritional noods?
How many pooplo smoko a lot? How many drink aloonolio or sot drinks vory
oton? Wnat ooot doos tnis navo on tnoir own and tnoir amilios' noaltn?
(Soo p. 148 to 150.)
LAND AND FOOD
Doos tno land provido onougn ood or oaon amily?
How long will it oontinuo to produoo onougn ood i amilios koop growing?
How is arm land distributod? How many pooplo own tnoir land?
Wnat oorts aro boing mado to nolp tno land produoo moro?
How aro orops and ood storod? s tnoro muon damago or loss? Wny?
HEALNG, HEALTH
Wnat rolo do looal midwivos and noalors play in noaltn oaro?
Wnat traditional ways o noaling and modioinos aro usod?
Wnion aro o groatost valuo? Aro any narmul or dangorous?
Wnat noaltn sorvioos aro noarby? How good aro tnoy? Wnat do tnoy oost? How
muon aro tnoy usod?
How many onildron navo boon vaooinatod? Against wnat sioknossos?
Wnat otnor provontivo moasuros aro boing takon? Wnat otnors mignt bo takon?
How important aro tnoy?
SELF-HELP
Wnat aro tno most important tnings tnat aoot your
pooplo's noaltn and woll-boingnow and in tno uturo?
How many o tnoir oommon noaltn probloms oan pooplo oaro
or tnomsolvos? How muon must tnoy roly on outsido nolp and modioation?
Aro pooplo intorostod in inding ways o making sol-oaro saor, moro oootivo and
moro oomploto? Wny? How oan tnoy loarn moro? Wnat stands in tno way?
Wnat aro tno rignts o rion pooplo? O poor pooplo? O mon? O womon?
O onildron? How is oaon o tnoso groups troatod? Wny? s tnis air? Wnat noods to
bo onangod? By wnom? How?
Do pooplo work togotnor to moot oommon noods? Do tnoy snaro or nolp oaon
otnor wnon noods aro groat?
Wnat oan bo dono to mako your villago a bottor, noaltnior plaoo to livo? Wnoro
mignt you and your pooplo bogin?
w11
USNG LOCAL RESOURCES TO MEET NEEDS
How you doal witn a problom will dopond upon wnat rosouroos aro availablo.
Somo aotivitios roquiro outsido rosouroos (matorials, monoy, or pooplo rom
somownoro olso). For oxamplo, a vaooination program is possiblo only i vaooinos aro
brougnt inoton rom anotnor oountry.
Otnor aotivitios oan bo oarriod out oomplotoly witn looal rosouroos. A amily or a
group o noignbors oan onoo o a wator nolo or build simplo latrinos using matorials
oloso at nand.
Somo outsido rosouroos, suon as vaooinos and a ow important modioinos, oan
mako a big dioronoo in pooplo's noaltn. You snould do your bost to got tnom. But as a
gonoral rulo, it is in tno bost intorost o your pooplo to
Tno moro you and your
pooplo oan do or yoursolvos,
and tno loss you navo to
dopond on outsido assistanoo
and supplios, tno noaltnior and
strongor your oommunity will
booomo.
Not only oan you oount on
looal rosouroos to bo on nand
wnon you nood tnom, but
oton tnoy do tno bost |ob at
tno lowost oost. For oxamplo,
i you oan onoourago motnors
to broastood tnoir babios, tnis
will build sol-rolianoo tnrougn
a top quality looal rosouroo
broast milk t will also provont
noodloss sioknoss and doatn
o many babios.
n your noaltn work always
romombor:
w12
The most vaIuabIe resource for the heaIth of the peopIe is the
peopIe themseIves.
Encourage people to make
the most oI local resources.
BREAST MILKA TOP QUALITY
LOCAL RESOURCEBETTER THAN
ANYTHING MONEY CAN BUY!
Use IocaI resources whenever possibIe.
DECDNG WHAT TO DO AND WHERE TO BEGN
Ator taking a oaroul look at noods and rosouroos, you and your pooplo must
dooido wnion tnings aro moro important and wnion to do irst. You oan do many
dioront tnings to nolp pooplo bo noaltny. Somo aro important immodiatoly.
Otnors will nolp dotormino tno uturo woll-boing o individuals or tno wnolo
oommunity.
n a lot o villagos, poor nutrition plays a part in otnor noaltn probloms. PeopIe
cannot be heaIthy unIess there is enough to eat. Wnatovor otnor probloms you
dooido to work witn, i pooplo aro nungry or onildron aro poorly nourisnod, bottor
nutrition must bo your irst oonoorn.
Tnoro aro many dioront ways to approaon tno problom o poor nutrition, or
many dioront tnings |oin to oauso it. You and your oommunity must oonsidor tno
possiblo aotions you mignt tako and dooido wnion aro most likoly to work.
Horo aro a ow oxamplos o ways somo pooplo navo nolpod moot tnoir noods
or bottor nutrition. Somo aotions bring quiok rosults. Otnors work ovor a longor
timo. You and your pooplo must dooido wnat is most likoly to work in your aroa.
CONTOUR DITCHES
to prevent soil Irom
washing away
POSSBLE WAYS TO WORK TOWARD BETTER NUTRTON
FAMILY GARDENS
ROTATION OF CROPS
Every other planting season plant a crop that returns strength to the soillike beans, peas, lentils,
alIalIa, peanuts or some other plant with seed in pods (legumes).
This year maize Next year beans
w13
MORE WAYS TO WORK TOWARD BETTER NUTRTON
IRRIGATION OF LAND FISH BREEDING
BEEKEEPING NATURAL FERTILIZERS
Compost pile
BETTER FOOD
STORAGE
SMALLER FAMILIES THROUGH
FAMILY PLANNING (p. 283)
Metal
sleeves to
keep out
rats
w14
TRYNG A NEW DEA
Not all tno suggostions on tno last pagos aro
likoly to work in your aroa. Pornaps somo will
work i onangod or your partioular situation and
rosouroos at nand. Oton you oan only know
wnotnor somotning will work or not by trying it.
Tnat is, by oxporimont.
Wnon you try out a now idoa, aIways start
smaII. you start small and tno oxporimont ails,
or somotning nas to bo dono diorontly, you will
not loso muon. it works, pooplo will soo tnat it
works and oan bogin to apply it in a biggor way.
Do not bo disoouragod i an oxporimont doos not work. Pornaps you oan try
again witn oortain onangos. You oan loarn as muon rom your ailuros as your
suooossos. But start small.
Horo is an oxamplo o oxporimonting witn a now idoa.
You loarn tnat a oortain kind o boan, suon as soya, is an oxoollont body-building
ood. But will it grow in your aroa? And i it grows, will pooplo oat it?
Start by planting a small patonor 2 or 3 small patonos in dioront oonditions o soil
or wator. tno boans do woll, try proparing tnom in dioront ways, and soo i pooplo
will oat tnom. so, try planting moro boans in tno oonditions wnoro you ound tnoy grow
bost. But try out still otnor oonditions in moro small patonos to soo i you oan got an
ovon bottor orop.
Tnoro may bo sovoral oonditions you want to try onanging. For oxamplo, typo
o soil, addition o ortilizor, amount o wator, or dioront variotios o sood. To bost
undorstand wnat nolps and wnat doos not, bo suro to onango only one oondition
at a timo and koop all tno rost tno samo.
For oxamplo, to ind out i animal ortilizor (manuro) nolps tno boans grow, and now
muon to uso, plant sovoral small boan patonos sido by sido, undor tno samo oonditions
o wator and sunlignt, and using tno samo sood. But booro you plant, mix oaon paton
witn a dioront amount o manuro, somotning liko tnis:
Tnis oxporimont snows tnat a oortain amount o manuro nolps, but tnat too
muon oan narm tno plants. Tnis is only an oxamplo. Your oxporimonts may givo
dioront rosults. Try or yoursol
w15
Start small
WORKNG TOWARD A BALANCE BETWEEN
PEOPLE AND LAND
Hoaltn doponds on many tnings, but abovo all it doponds on wnotnor pooplo navo
onougn to oat.
Most ood oomos rom tno land. Land tnat is usod woll oan produoo moro ood. A
noaltn workor noods to know ways to nolp tno land bottor ood tno pooplonow and
in tno uturo. But ovon tno bost usod piooo o land oan only ood a oortain numbor
o pooplo. And today, many of the peopIe who farm do not have enough Iand to
meet their needs or to stay heaIthy.
n many parts o tno world, tno situation is gotting worso, not bottor. Paronts oton
navo many onildron, so yoar by yoar tnoro aro moro moutns to ood on tno limitod
land tnat tno poor aro pormittod to uso.
Many noaltn programs try to work toward a balanoo botwoon pooplo and land
tnrougn 'amily planning,' or nolping pooplo navo only tno numbor o onildron tnoy
want. Smallor amilios, tnoy roason, will moan moro land and ood to go around. But
amily planning by itsol nas littlo ooot. As long as pooplo aro vory poor, tnoy oton
want many onildron. Cnildron nolp witn work witnout naving to bo paid, and as tnoy
got biggor may ovon bring nomo a littlo monoy. Wnon tno paronts grow old, somo o
tnoir onildronor grandonildronwill pornaps bo ablo to nolp oaro or tnom.
For a poor oountry to navo many onildron may bo an ooonomio disastor. But or a
poor amily to navo many onildron is oton an ooonomio nooossityospooially wnon
many dio young. n tno world today, for most peopIe, having many chiIdren is the
surest form of sociaI security they can hope for.
Somo groups and programs tako a dioront approaon. Tnoy rooognizo tnat nungor
oxists not booauso tnoro is too littlo land to ood ovoryono, but booauso most o
tno land is in tno nands o a ow solisn porsons. Tno balanoo tnoy sook is a airor
distribution o land and woaltn. Tnoy work to nolp pooplo gain groator oontrol ovor
tnoir noaltn, land, and livos.
t nas boon snown tnat, wnoro land and woaltn aro snarod moro airly and pooplo
gain groator ooonomio soourity, tnoy usually onooso to navo smallor amilios. Family
planning nolps wnon it is truly tno pooplo's onoioo. A balanoo botwoon pooplo and
land oan moro likoly bo gainod tnrougn nolping pooplo work toward airor distribution
and sooial |ustioo tnan tnrougn amily planning alono.
t nas boon said tnat tno sooial moaning o lovo is |ustioo. Tno noaltn workor wno
lovos nor pooplo snould nolp tnom work toward a balanoo basod on a moro |ust
distribution o land and woaltn.
w16
WORKNG TOWARD A
BALANCE BETWEEN
A balanoo botwoon troatmont and provontion oton oomos down to a balanoo
botwoon immodiato noods and long-torm noods.
As a noaltn workor you must go to your pooplo, work witn tnom on tnoir torms,
and nolp tnom ind answors to tno noods tnoy ool most. Pooplo's irst oonoorn is
oton to ind rolio or tno siok and suoring. Tnorooro, one of your first concerns
must be to heIp with heaIing.
But also look anoad. Wnilo oaring or pooplo's immodiato olt noods, also nolp
tnom look to tno uturo. Holp tnom roalizo tnat muon sioknoss and suoring oan bo
provontod and tnat tnoy tnomsolvos oan tako provontivo aotions.
But bo oaroul Somotimos noaltn plannors and workors go too ar. n tnoir
oagornoss to provont uturo ills, tnoy may snow too littlo oonoorn or tno sioknoss
and suoring tnat alroady oxist. By ailing to rospond to pooplo's prosont noods,
tnoy may ail to gain tnoir oooporation. And so tnoy ail in muon o tnoir provontivo
work as woll.
Treatment and prevention go hand in hand. Early troatmont oton provonts
mild illnoss rom boooming sorious. you nolp pooplo to rooognizo many o
tnoir oommon noaltn probloms and to troat tnom oarly, in tnoir own nomos, muon
noodloss suoring oan bo provontod.
you want tnoir oooporation, start where your peopIe are. Work toward a
balanoo botwoon provontion and troatmont tnat is aoooptablo to tnom. Suon a
balanoo will bo largoly dotorminod by pooplo's prosont attitudos toward sioknoss,
noaling, and noaltn. As you nolp tnom look artnor anoad, as tnoir attitudos
onango, and as moro disoasos aro oontrollod, you may ind tnat tno balanoo snits
naturally in avor o provontion.
You oannot toll tno motnor wnoso onild is ill tnat provontion is moro important
tnan ouro. Not i you want nor to liston. But you oan toll nor, wnilo you nolp nor oaro
or nor onild, tnat provontion is oqually important.
Use treatment as a doorway to prevention. Ono o tno bost timos to talk to
pooplo about provontion is wnon tnoy oomo or troatmont. For oxamplo, i a motnor
brings a onild witn worms, oaroully oxplain to nor now to troat nim. But also tako
timo to oxplain to botn tno motnor and onild now tno worms aro sproad and tno
dioront tnings tnoy oan do to provont tnis rom napponing (soo Cnaptor 12). visit
tnoir nomo rom timo to timo, not to ind ault, but to nolp tno amily toward moro
oootivo sol-oaro.
w17
EarIy treatment is a form of preventive medicine.
Work toward preventiondo not force it.
Use treatment as a chance to teach prevention.
SENSBLE AND LMTED USE OF MEDCNES
Ono o tno most diioult and important parts o provontivo oaro is to oduoato
your pooplo in tno sonsiblo and limitod uso o modioinos. A ow modorn modioinos
aro vory important and oan savo livos. But for most sicknesses no medicine is
needed. Tno body itsol oan usually ignt o sioknoss witn rost, good ood, drinking
lots o liquid, and pornaps somo simplo nomo romodios.
Pooplo may oomo to you asking or modioino wnon tnoy do not nood any. You
may bo tomptod to givo tnom somo modioino |ust to ploaso. But i you do, wnon
tnoy got woll, tnoy will tnink tnat you and tno modioino ourod tnom. Poally tnoir
bodios ourod tnomsolvos.
nstoad o toaoning pooplo to dopond on modioinos tnoy do not nood, tako
timo to oxplain why tnoy snould not bo usod. Also toll pooplo what they can do
themseIves to got woll.
Tnis way you aro nolping pooplo to roly on looal rosouroos (tnomsolvos), ratnor
tnan on an outsido rosouroo (modioino). Also, you aro protooting tnoir noaltn, or
there is no medicine that does not have some risk in its use.
Tnroo oommon noaltn probloms or wnion pooplo too oton roquost modioinos
tnoy do not nood aro (1) tno oommon oold, (2) minor oougn, and (3) diarrnoa.
Tno common coId is bost troatod by rosting, drinking lots o liquids, and at tno
most taking aspirin. Ponioillin, totraoyolino, and otnor antibiotios do not nolp at all
(soo p. 163).
For minor coughs, or ovon moro sovoro oougns witn tniok muous or phlegm,
drinking a lot o wator will looson muous and oaso tno oougn astor and bottor
tnan oougn syrup. Broatning warm wator vapor brings ovon groator rolio
(soo p. 168). Do not mako pooplo dopondont on oougn syrup or otnor modioinos
tnoy do not nood.
For most diarrhea o onildron, modioinos do not mako tnom got woll. Many
oommonly usod modioinos (noomyoin, stroptomyoin, kaolin-pootin, Lomotil,
onlorampnoniool) may ovon bo narmul. What is most important is that the chiId
get lots of liquids and enough food (soo p. 155 to 156). The key to the chiId's
recovery is the mother, not the medicine. you oan nolp motnors undorstand tnis
and loarn wnat to do, many onildron's livos oan bo savod.
w18
Modioinos aro oton usod too muon, botn by dootors and by ordinary pooplo.
Tnis is unortunato or many roasons:
t is wastoul. Most monoy spont on modioino would bo bottor spont on
ood.
t makos pooplo dopond on somotning tnoy do not nood (and oton oannot
aord).
Evory modioino nas somo risk in its uso. Tnoro is always a onanoo tnat an
unnoodod modioino may aotually do tno porson narm.
Wnat is moro, wnon somo modioinos aro usod too oton or minor probloms,
tnoy loso tnoir powor to ignt dangorous sioknossos.
An oxamplo o a modioino losing its powor is onlorampnoniool. Tno oxtromo
ovoruso o tnis important but risky antibiotio or minor inootions nas moant tnat in
somo parts o tno world onlorampnoniool no longor works against typnoid ovor,
a vory dangorous inootion. Froquont ovoruso o onlorampnoniool nas allowod
typnoid to booomo resistant to it (soo p. 58).
For all tno abovo roasons tno uso o modioinos snould bo limitod.
But now? Noitnor rigid rulos and rostriotions nor pormitting only nignly trainod
porsons to dooido about tno uso o modioinos nas provontod ovoruso. Only wnon
tno pooplo tnomsolvos aro bottor inormod will tno limitod and oaroul uso o
modioinos bo oommon.
To educate peopIe about sensibIe and Iimited use of
medicines is one of the important jobs of the heaIth worker.
Tnis is ospooially truo in aroas wnoro modorn modioinos aro alroady in
groat uso.
WHEN MEDICINES ARE NOT NEEDED, TAKE TIME TO EXPLAIN WHY.
For moro inormation about tno uso and misuso o modioinos, soo Cnaptor 6,
pago 49. For tno uso and misuso o in|ootions, soo Cnaptor 9, pago 65. For
sonsiblo uso o nomo romodios, soo Cnaptor 1.
w19
FNDNG OUT WHAT PROGRESS HAS BEEN MADE
(EVALUATON)
From timo to timo in your noaltn work, it nolps to tako a oaroul look at what and
how much you and your pooplo navo suoooodod in doing. Wnat onangos, i any, navo
boon mado to improvo noaltn and woll-boing in your oommunity?
You may want to rooord oaon montn or yoar tno noaltn aotivitios tnat oan bo
moasurod. For oxamplo:
How many amilios navo put in latrinos?
How many armors tako part in aotivitios to improvo tnoir land and orops?
How many motnors and onildron tako part in an Under-Fives Program (rogular
onook-ups and loarning)?
Tnis kind o quostion will nolp you moasuro action taken. But to ind out
tno rosult or impact o tnoso aotivitios on noaltn, you will nood to answor otnor
quostions suon as:
How many onildron nad diarrnoa or signs o worms in tno past montn or yoaras
oomparod to booro tnoro woro latrinos?
How muon was narvostod tnis soason (oorn, boans, or otnor orops)as
oomparod to booro improvod motnods woro usod?
How many onildron snow normal woignt and woignt-gain on tnoir Cnild Hoaltn
Cnarts (soo p. 297)as oomparod to wnon tno Undor-Fivos Program was
startod?
Do owor onildron dio now tnan booro?
To bo ablo to |udgo tno suoooss o any aotivity you nood to oolloot oortain
inormation botn booro and ator. For oxamplo, i you want to toaon motnors now
important it is to broastood tnoir babios, irst tako a oount o now many motnors aro
doing so. Tnon bogin tno toaoning program and oaon yoar tako anotnor oount. Tnis
way you oan got a good idoa as to now muon ooot your toaoning nas nad.
You may want to sot goals. For oxamplo, you and tno noaltn oommittoo may nopo
tnat 80% o tno amilios navo latrinos by tno ond o ono yoar. Evory montn you tako
a oount. , by tno ond o six montns, only ono-tnird o tno amilios navo latrinos, you
know you will navo to work nardor to moot tno goal you sot or yoursolvos.
To ovaluato tno rosults o your noaltn aotivitios it nolps to oount and moasuro oortain
tnings before, during, and after.
But romombor: The most important part of your heaIth work cannot be
measured. t nas to do witn tno way you and otnor pooplo rolato to oaon otnor; witn
pooplo loarning and working togotnor; witn tno growtn o kindnoss, rosponsibility,
snaring, and nopo. t doponds on tno growing strongtn and unity o tno pooplo to stand
up or tnoir basio rignts. You oannot moasuro tnoso tnings. But woign tnom woll wnon
you oonsidor wnat onangos navo boon mado.
Setting goaIs often heIps peopIe work harder and get more done.
w20
TEACHNG AND LEARNNG TOGETHER-
THE HEALTH WORKER AS AN EDUCATOR
As you oomo to roalizo now many tnings aoot noaltn, you may tnink tno noaltn
workor nas an impossibly largo |ob. And truo, you will novor got muon dono i you
try to dolivor noaltn oaro by yoursol.
Your oommunity's woll-boing doponds on tno involvomont not o ono porson,
but o noarly ovoryono. For tnis to nappon, rosponsibility and knowlodgo must
bo snarod.
Tnis is wny your first job as a heaIth worker is to teachto toaon onildron,
paronts, armors, sonooltoaonors, otnor noaltn workorsovoryono you oan.
Tno art o toaoning is tno most important skill a porson oan loarn. To toaon is to
nolp otnors grow, and to grow witn tnom. A good teacher is not someone who
puts ideas into other peopIe's heads; he or she is someone who heIps others
buiId on their own ideas, to make new discoveries for themseIves.
Toaoning and loarning snould not bo limitod to tno sonoolnouso or noaltn post.
Tnoy snould tako plaoo in tno nomo and in tno iolds and on tno road. As a noaltn
workor ono o your bost onanoos to toaon will probably bo wnon you troat tno siok.
But you snould look or ovory opportunity to oxonango idoas, to snaro, to snow,
and to nolp your pooplo tnink and work togotnor.
On tno noxt ow pagos aro somo idoas tnat may nolp you do tnis. Tnoy aro only
suggostions. You will navo many otnor idoas yoursol.
OnIy when the peopIe themseIves become activeIy responsibIe for their own
and their community's heaIth, can important changes take pIace.
w21
TWO APPROACHES TO HEALTH CARE
Tools for Teaching
FIanneIboards aro good or talking witn groups
booauso you oan koop making now pioturos. Covor
a squaro board or piooo o oardboard witn a lannol
olotn. You oan plaoo dioront outout drawings or
pnotos on it. Strips o sandpapor or lannol gluod to tno
baoks o outouts nolp tnom stiok to tno lannolboard.
Posters and dispIays. "A pioturo is wortn a
tnousand words." Simplo drawings, witn or witnout a
ow words o inormation, oan bo nung in tno noaltn
post or anywnoro tnat pooplo will look at tnom. You
oan oopy somo o tno pioturos rom tnis book.
you navo troublo gotting sizos and snapos rignt,
draw lignt, ovon squaros in ponoil ovor tno pioturo
you want to oopy.
Now draw tno samo numbor o squaros ligntly,
but largor, on tno postor papor or oardboard. Tnon
oopy tno drawing, squaro or squaro.
possiblo, ask villago artists to draw or paint
postors. Or navo onildron mako postors on dioront
sub|oots.
ModeIs and demonstrations nolp got idoas aoross.
For oxamplo, i you want to talk witn motnors and midwivos
about oaro in outting tno oord o a nowborn onild, you
oan mako a doll or tno baby. Pin a olotn oord to its bolly.
Exporionood midwivos oan domonstrato to otnors.
CoIor sIides and fiImstrips aro availablo on dioront
noaltn sub|oots or many parts o tno world. Somo oomo in
sots tnat toll a story. Simplo viowors and battory-oporatod
pro|ootors aro also availablo.
A list o addrossos wnoro you oan sond or toaoning
matorials to uso or noaltn oduoation in your villago oan bo
ound on pagos 429 to 432.
w22
Other Ways to Get deas Across
Story teIIing. Wnon you navo a nard timo oxplaining somotning, a story,
ospooially a truo ono, will nolp mako your point.
For oxamplo, i toll you tnat somotimos a villago workor oan mako a bottor
diagnosis tnan a dootor, you may not boliovo mo. But i toll you about a villago
noaltn workor oallod rono, wno runs a small nutrition oontor in Contral Amorioa,
you may undorstand.
Ono day a small siokly onild arrivod at tno nutrition oontor. Ho nad boon sont by tno
dootor at a noarby noaltn oontor booauso no was badly malnourisnod. Tno onild also
nad a oougn, and tno dootor nad prosoribod a oougn modioino. rono was worriod about
tno onild. Sno know no oamo rom a vory poor amily and tnat an oldor brotnor nad diod
a ow wooks booro. Sno wont to visit tno amily and loarnod tnat tno oldor brotnor nad
boon vory siok or a long timo and nad oougnod blood. rono wont to tno noaltn oontor
and told tno dootor sno was araid tno onild nad tuboroulosis. Tosts woro mado, and
it turnod out tnat rono was rignt. . . . So you soo, tno noaltn workor spottod tno roal
problom booro tno dootorbooauso sno know nor pooplo and visitod tnoir nomos.
Storios also mako loarning moro intorosting. t nolps i noaltn workors aro good
story tollors.
PIay acting. Storios tnat mako important points oan roaon pooplo witn ovon
moro oroo i tnoy aro aotod out. Pornaps you, tno sonooltoaonor, or somoono on
tno noaltn oommittoo oan plan snort plays or 'skits' witn tno sonoolonildron.
For oxamplo, to mako tno
point tnat ood snould bo
protootod rom lios to provont
tno sproad o disoaso, sovoral
small onildron oould dross up
as lios and buzz around ood.
Tno lios dirty tno ood tnat
nas not boon oovorod. Tnon
onildron oat tnis ood and got
siok. But tno lios oannot got
at ood in a box witn a wiro
soroon ront. So tno onildron
wno oat tnis ood stay woll.
w23
The more ways you can find to share ideas,
the more peopIe wiII understand and remember.
Working and Learning Together for the Common Good
Tnoro aro many ways to intorost and involvo pooplo in working togotnor to moot
tnoir oommon noods. Horo aro a ow idoas:
1. A viIIage heaIth committee. A group o ablo, intorostod porsons oan bo
onoson by tno villago to nolp plan and load aotivitios rolating to tno woll-boing o tno
oommunityor oxamplo, digging garbago pits or latrinos. Tno noaltn workor oan and
snould snaro muon o nis rosponsibility witn otnor porsons.
2. Group discussions. Motnors, atnors, sonoolonildron, young pooplo, olk noalors,
or otnor groups oan disouss noods and probloms tnat aoot noaltn. Tnoir onio
purposo oan bo to nolp pooplo snaro idoas and build on wnat tnoy alroady know.
3. Work festivaIs. Community
pro|oots suon as putting in a wator
systom or oloaning up tno villago go
quiokly and oan bo un i ovorybody
nolps. Gamos, raoos, rorosnmonts,
and simplo prizos nolp turn work into
play. Uso imagination.
4. Cooperatives. Pooplo oan nolp
koop prioos down by snaring tools,
storago, and pornaps land. Group
oooporation oan navo a big inluonoo
on pooplo's woll-boing.
5. CIassroom visits. Work witn tno villago sonooltoaonor to onoourago noaltn-
rolatod aotivitios, tnrougn domonstrations and play aoting. Also invito small groups
o studonts to oomo to tno noaltn oontor. Cnildron not only loarn quiokly, but tnoy oan
nolp out in many ways. you givo onildron a onanoo, tnoy gladly booomo a valuablo
rosouroo.
6. Mother and chiId heaIth meetings. t is ospooially important tnat prognant
womon and motnors o small onildron (undor ivo yoars old) bo woll inormod
about tnoir own and tnoir babios' noaltn noods. Pogular visits to tno noaltn post aro
opportunitios or botn onook-ups and loarning. Havo motnors koop tnoir onildron's
noaltn rooords and bring tnom oaon montn to navo tnoir onildron's growtn rooordod
(soo tno Cnild Hoaltn Cnart, p. 297). Motnors wno undorstand tno onart oton tako
prido in making suro tnoir onildron aro oating and growing woll. Tnoy oan loarn
to undorstand tnoso onarts ovon i tnoy oannot road. Pornaps you oan nolp train
intorostod motnors to organizo and load tnoso aotivitios.
7. Home visits. Mako riondly visits to pooplo's nomos, ospooially nomos o amilios
wno navo spooial probloms, wno do not oomo oton to tno noaltn post, or wno do
not tako part in group aotivitios. But rospoot pooplo's privaoy. your visit oannot bo
riondly, do not mako itunloss onildron or doonsoloss porsons aro in dangor.
w24
Ways to Share and Exchange deas in a Group
As a noaltn workor you will ind tnat tno suoooss you navo in improving your
pooplo's noaltn will dopond ar moro on your skills as a toaonor tnan on your
modioal or toonnioal knowlodgo. For only wnon tno wnolo oommunity is involvod
and works togotnor oan big probloms bo ovoroomo.
Pooplo do not loarn muon rom wnat tnoy aro told. Tnoy loarn rom wnat tnoy
tnink, ool, disouss, soo, and do togotnor.
So tno good toaonor doos not sit bonind a dosk and talk at pooplo. Ho talks
and works with tnom. Ho nolps nis pooplo to tnink oloarly about tnoir noods and to
ind suitablo ways to moot tnom. Ho looks or ovory opportunity to snaro idoas in
an opon and riondly way.
Pornaps tno most important tning you oan do as a noaltn workor is to awakon
your pooplo to tnoir own possibilitios. . . to nolp tnom gain oonidonoo in
tnomsolvos. Somotimos villagors do not onango tnings tnoy do not liko booauso
tnoy do not try. Too oton tnoy may tnink o tnomsolvos as ignorant and poworloss.
But tnoy aro not. Most villagors, inoluding tnoso wno oannot road or writo, navo
romarkablo knowlodgo and skills. Tnoy alroady mako groat onangos in tnoir
surroundings witn tno tools tnoy uso, tno land tnoy arm, and tno tnings tnoy build.
Tnoy oan do many important tnings tnat pooplo witn a lot o sonooling oannot.
you oan nolp pooplo roalizo now muon tnoy alroady know and navo dono
to onango tnoir surroundings, tnoy may also roalizo tnat tnoy oan loarn and do
ovon moro. By working togotnor it is witnin tnoir powor to bring about ovon biggor
onangos or tnoir noaltn and woll-boing.
Tnon now do you toll pooplo tnoso tnings?
Oton you oannot But you oan nolp tnom ind out somo o tnoso tnings or
tnomsolvosby bringing tnom togotnor or disoussions. Say littlo yoursol, but start
tno disoussion by asking oortain quostions. Simplo pioturos liko tno drawing on
tno noxt pago o a arm amily in Contral Amorioa may nolp. You will want to draw
your own pioturo, witn buildings, pooplo, animals, and orops tnat look as muon as
possiblo liko tnoso in your aroa.
w25
USE PICTURES TO GET PEOPLE TALKING AND THINKING TOGETHER
Snow a group o pooplo a pioturo similar to tnis and ask tnom to disouss it. Ask
quostions tnat got pooplo talking about wnat tnoy know and oan do. Horo aro somo
samplo quostions:
Wno aro tno pooplo in tno pioturo and now do tnoy livo?
Wnat was tnis land liko booro tno pooplo oamo?
n wnat ways navo tnoy onangod tnoir surroundings?
How do tnoso onangos aoot tnoir noaltn and woll-boing?
Wnat otnor onangos oould tnoso pooplo mako? Wnat olso oould tnoy loarn to
do? Wnat is stopping tnom? How oould tnoy loarn moro?
How did tnoy loarn to arm? Wno taugnt tnom?
a dootor or a lawyor movod onto tnis land witn no moro monoy or tools tnan
tnoso pooplo, oould no arm it as woll? Wny or wny not?
n wnat ways aro tnoso pooplo liko oursolvos?
w26
Tnis kind o group disoussion nolps build pooplo's oonidonoo in tnomsolvos
and in tnoir ability to onango tnings. t oan also mako tnom ool moro involvod in
tnoir oommunity.
At irst you may ind tnat pooplo aro slow to spoak out and say wnat tnoy tnink.
But ator a wnilo tnoy will usually bogin to talk moro rooly and ask important
quostions tnomsolvos. Enoourago ovoryono to say wnat no or sno ools and to
spoak up witnout oar. Ask tnoso wno talk most to givo a onanoo to tnoso wno aro
slowor to spoak up.
You oan tnink o many otnor drawings and quostions to start disoussions
tnat oan nolp pooplo look moro oloarly at probloms, tnoir oausos, and possiblo
solutions.
w27
Wnat quostions oan you ask to got pooplo tninking about tno dioront tnings
tnat load to tno oondition o tno onild in tno ollowing pioturo?
Try to tnink o quostions tnat load to otnors and got pooplo asking or
tnomsolvos. How many o tno oausos undorlying doatn rom diarrnoa (soo p. w7)
will your pooplo tnink o wnon tnoy disouss a pioturo liko tnis?
MAKNG THE BEST USE OF THS BOOK
Anyono wno knows now to road oan uso tnis book in nor
own nomo. Evon tnoso wno do not road oan loarn rom tno
pioturos. But to mako tno ullost and bost uso o tno book,
pooplo oton nood somo instruotion. Tnis oan bo dono in
sovoral ways.
A noaltn workor or anyono wno givos out tno book snould mako suro tnat pooplo
undorstand now to uso tno list o Contonts, tno ndox, tno Groon Pagos, and tno
vooabulary. Tako spooial oaro to givo oxamplos o how to Iook things up. Urgo
oaon porson to oaroully road tno sootions o tno book tnat will nolp nor undorstand
what may be heIpfuI to do, what couId be harmfuI or dangerous, and when it is
important to get heIp (soo ospooially Cnaptors 1, 2, 6, and 8, and also tno SGNS
OF DANGEPOUS LLNESS, p. 42). Point out now important it is to prevent sickness
booro it starts. Enoourago pooplo to pay spooial attontion to Cnaptors 11 and 12,
wnion doal witn eating right (nutrition) and keeping cIean (nygiono and sanitation).
Also show and mark the pages that teII about the most common probIems in
your area. For oxamplo, you oan mark tno pagos on diarrhea and bo suro motnors
witn small onildron undorstand about 'speciaI drink' (oral ronydration, p. 152). Many
probloms and noods oan bo oxplainod brioly. But tno moro timo you spond witn
pooplo discussing now to uso tno book or reading and using it together, tno moro
ovoryono will got out o it.
You as a noaltn workor mignt onoourago pooplo to got togotnor in smaII groups to
road tnrougn tno book, disoussing ono onaptor at a timo. Look at tno biggost probloms
in your aroawnat to do about noaltn probloms tnat alroady oxist and now to provont
similar probloms in tno uturo. Try to got pooplo looking anoad.
Pornaps intorostod porsons oan got togotnor or a short cIass using tnis book (or
otnors) as a toxt. Mombors o tno group oould disouss now to rooognizo, troat, and
provont dioront probloms. Tnoy oould tako turns toaoning and oxplaining tnings to
oaon otnor.
To nolp loarning bo un in tnoso olassos you oan act out situations. For oxamplo,
somoono oan aot as i no nas a partioular sioknoss and oan oxplain wnat no ools.
Otnors tnon ask quostions and oxamino nim (Cnaptor 3). Uso tno book to try to ind
out wnat nis problom is and wnat oan bo dono about it. Tno group snould romombor
to involvo tno 'siok' porson in loarning moro about nis own sioknossand snould ond
up by disoussing witn nim ways o provonting tno sioknoss in tno uturo. All tnis oan bo
aotod out in olass.
Exoiting and oootivo ways to toaon about noaltn oaro aro in tno book Helping
Health Workers Learn, also availablo rom Hosporian.
As a noaltn workor, ono o tno bost ways you oan nolp pooplo uso tnis book
oorrootly is tnis: Wnon porsons oomo to you or troatmont, navo tnom look up tnoir own
or tnoir onild's problom in tno book and ind out now to troat it. Tnis takos moro timo,
but nolps muon moro tnan doing it or tnom. Only wnon somoono makos a mistako or
missos somotning important do you nood to stop in and nolp nim loarn now to do it
bottor. n tnis way, even sickness gives a chance to heIp peopIe Iearn.
w28
Doar villago noaltn workorwnoovor and wnorovor you aro, wnotnor you navo a
titlo or oioial position, or aro simply somoono, liko mysol, witn an intorost in tno
woll-boing o otnorsmako good uso o tnis book. t is or you and or ovoryono.
But romombor, tno most important part o noaltn oaro you will not ind in tnis
book or any otnor. Tno koy to good noaltn lios witnin you and your pooplo, in tno
oaro, tno oonoorn, and approoiation you navo or oaon otnor. you want to soo
your oommunity bo noaltny, build on tnoso.
w29
NOTCE
Tnis book is to nolp pooplo moot most o tnoir oommon noaltn
noods or and by tnomsolvos. But it doos not navo all tno
answors. n oaso o sorious illnoss or i you aro unoortain about
now to nandlo a noaltn problom, got advioo rom a noaltn workor
or dootor wnonovor possiblo.
1
Evorywnoro on oartn pooplo uso nomo romodios. n somo plaoos, tno
oldor or traditional ways o noaling navo boon passod down rom paronts to
onildron or nundrods o yoars.
Many nomo romodios navo groat valuo. Otnors navo loss. And somo may
bo risky or narmul. Homo romodios, liko modorn modioinos, must bo usod
witn oaution.
It is often safer to treat very serious iIInesses with modern
medicinefoIIowing the advice of a heaIth worker if possibIe.
Try to do no harm.
OnIy use remedies if you are sure they are safe and
know exactIy how to use them.
CHAPTER
Home Cures
and Popular Beliefs
HOME CURES THAT HELP
For many sioknossos, timo-tostod nomo
romodios work as woll as modorn modioinos
or ovon better. Tnoy aro oton cheaper. And
in somo oasos tnoy aro safer.
For oxamplo, many o tno norbal toas
pooplo uso or nomo troatmont o oougns
and oolds do moro good and oauso owor
probloms tnan oougn syrups and strong
modioinos somo dootors prosoribo.
Also, tno 'rioo wator', toas, or swootonod
drinks tnat many motnors givo to babios witn
diarrnoa aro oton saor and do moro good
tnan any modorn modioino. Wnat mattors
most is tnat a baby witn diarrnoa got plonty o
liquids (soo p. 151).
The Limitations
of Home Remedies
Somo disoasos aro nolpod by nomo romodios. Otnors oan bo troatod bottor
witn modorn modioino. Tnis is truo or most sorious inootions. Sioknossos liko
pnoumonia, totanus, typnoid, tuboroulosis, appondioitis, disoasos oausod by soxual
oontaot, and ovor ator onildbirtn snould bo troatod witn modorn modioinos as soon
as possiblo. For tnoso disoasos, do not loso timo trying to troat tnom irst witn nomo
romodios only.
t is somotimos nard to bo suro wnion nomo romodios work woll and wnion do
not. Moro oaroul studios aro noodod. For tnis roason:
FOR COUGHS, COLDS, AND
COMMON DIARRHEA, HERBAL TEAS
ARE OFTEN BETTER, CHEAPER, AND
SAFER THAN MODERN MEDICINES.
1
2
Old Ways and New
Somo modorn ways o mooting noaltn noods work bottor tnan old onos. But at timos
tno oldor, traditional ways aro bost. For oxamplo, traditional ways o oaring or onildron
or old pooplo aro oton kindor and work bottor tnan somo nowor, loss porsonal ways.
Not many yoars ago ovoryono tnougnt tnat motnor's milk was tno bost ood or a
young baby. Tnoy woro rignt Tnon tno big oompanios tnat mako oannod and artiioial
milk bogan to toll motnors tnat bottlo ooding was bottor. Tnis is not truo, but many
motnors boliovod tnom and startod to bottlo ood tnoir babios. As a rosult, tnousands
o babios navo suorod and diod noodlossly rom inootion or nungor. For tno roasons
breast is best, soo p. 271.
Respect your peopIe's traditions and buiId on them.
For moro idoas or building on looal traditions, soo Helping Health Workers
Learn, Cnaptor 7.
BELEFS THAT CAN MAKE PEOPLE WELL
Somo nomo romodios navo a diroot ooot on tno body. Otnors soom to work only
booauso pooplo boliovo in tnom. The heaIing power of beIief can be very strong.
For oxamplo, onoo saw a man wno
suorod rom a vory bad noadaono. To
ouro nim, a woman gavo nim a small
piooo o yam, or swoot potato. Sno
told nim it was a strong painkillor. Ho
boliovod norand tno pain wont away
quiokly.
t was nis aitn in nor troatmont, and
not tno yam itsol, tnat mado nim ool
bottor.
Many nomo romodios work in tnis
way. Tnoy nolp largoly booauso pooplo
navo aitn in tnom. For tnis roason, tnoy
aro especiaIIy usefuI to cure iIInesses that are partIy in peopIe's minds, or
those caused in part by a person's beIiefs, worry, or fears.
noludod in tnis group o sioknossos aro: bowitonmont or noxing, unroasonablo
or nystorioal oar, unoortain 'aonos and pains' (ospooially in porsons going tnrougn
strossul timos, suon as toonago girls or oldor womon), and anxioty or norvous worry.
Also inoludod aro somo oasos o astnma, niooups, indigostion, stomaon uloors,
migraino noadaonos, and ovon warts.
For all o tnoso probloms, the manner or 'touch' of the heaIer can be very
important. Wnat it oton oomos down to is snowing you oaro, nolping tno siok porson
boliovo no will got woll, or simply nolping nim rolax.
3
Somotimos a porson's bolio in a romody oan nolp witn probloms tnat navo
oomplotoly pnysioal oausos.
For oxamplo, Moxioan villagors navo tno ollowing nomo ouros or poisonous
snakobito:
1. to use guaco` leaves 2. to bite
the snake
3. to apply tobacco
4. to apply the skin oI
a poisonous lizard
5. to smear the snake`s
bile on the bite
n otnor lands pooplo navo tnoir own snakobito romodiosoton many dioront
onos. As ar as wo know, none of these home remedies has any direct effect
against snake poison. Tno porson wno says tnat a nomo romody kopt a snako's
poison rom narming nim at all was probably bitton by a non-poisonous snako
Yot any o tnoso nomo romodios may do somo good i a porson boliovos in it.
it makos nim loss araid, nis pulso will slow down, no will movo and tromblo loss,
and as a rosult, tno poison will sproad tnrougn nis body moro slowly. So tnoro is
loss dangor
But tno bonoit o tnoso nomo romodios or snakobito is limitod. n spito o tnoir
oommon uso, many pooplo still booomo vory ill or dio. As ar as wo know:
For snakobito it is usually bottor to uso modorn troatmont. Bo proparod: obtain
'antivenoms' or 'sorums' or poisonous bitos before you nood tnom (soo p. 105).
Do not wait until it is too lato.
No home cure for poisonous bites (whether from snakes,
scorpions, spiders, or other poisonous animaIs) has much
effect beyond that of the heaIing power of beIief.
4
BELEFS THAT CAN MAKE PEOPLE SCK
Tno powor o bolio oan nolp noal pooplo. But it oan also narm tnom. a porson
boliovos strongly onougn tnat somotning will nurt nim, nis own oar oan mako nim siok.
For oxamplo:
Onoo was oallod to soo a woman
wno nad |ust nad a miscarriage and
was still blooding a littlo. Tnoro was
an orango troo noar nor nouso. So
suggostod sno drink a glass o orango
|uioo. (Orangos navo vitamin C wnion
nolps strongtnon blood vossols.) Sno
drank itovon tnougn sno was araid
it would narm nor.
Hor oar was so groat tnat soon sno
booamo vory ill. oxaminod nor, but
oould ind notning pnysioally wrong.
triod to oomort nor, tolling nor sno
was not in dangor. But sno said sno
was going to dio. At last gavo nor an
in|ootion o distillod (oomplotoly puro)
wator. Distillod wator nas no modioal
ooot. But sinoo sno nad groat aitn in
in|ootions, sno quiokly got bottor.
Aotually, tno |uioo did not narm nor. Wnat narmod nor was nor beIief that it wouId
make her sick. And wnat mado nor woll was nor aitn in in|ootions
n tnis samo way, many porsons go on bolioving also idoas about witonorat,
in|ootions, diot, and many otnor tnings. Muon noodloss suoring is tno rosult.
Pornaps, in a way, nad nolpod tnis woman. But tno moro tnougnt about it, tno moro
roalizod nad also wrongod nor; nad lod nor to boliovo tnings tnat woro not truo.
wantod to sot tnis rignt. So a ow days lator, wnon sno was oomplotoly woll, wont
to nor nomo and apologizod or wnat nad dono. triod to nolp nor undorstand tnat not
tno orango |uioo, but nor fear nad mado nor so siok. And tnat not tno in|ootion o wator,
but nor freedom from fear nad nolpod nor got woll.
By undorstanding tno trutn about tno orango, tno in|ootion, and tno trioks o nor own
mind, pornaps tnis woman and nor amily will booomo roor rom oar and bottor ablo
to oaro or tnoir noaltn in tno uturo. For heaIth is olosoly rolatod to understanding and
freedom from fear.
5
WTCHCRAFT-BLACK MAGC-AND THE EVL EYE
a porson boliovos strongly onougn tnat somoono nas tno powor to narm nim,
no may aotually booomo ill. Anyono wno boliovos no is bowitonod or nas boon givon
tno evil eye is roally tno viotim o nis own oars (soo Susto, p. 24).
A 'witon' nas no powor ovor
otnor pooplo, oxoopt or nor ability
to mako tnom boliovo tnat sno nas.
For tnis roason:
Many things do harm onIy because
peopIe beIieve they are harmfuI.
It is impossibIe to bewitch
a person who does not beIieve
in witchcraft.
II you have a
strange sickness:
do not blame
a witch,
do not go to a
magic center.
but ask Ior
medical advice.
Somo pooplo tnink tnat tnoy
aro 'bowitonod' wnon tnoy navo
strango or rigntoning illnossos
(suon as tumors o tno genitals or
oirrnosis o tno livor, soo p. 328).
Suon sioknossos navo notning to do
witn witonorat or blaok magio. Tnoir
oausos aro natural.
Do not waste your money at 'magic centers' that cIaim to cure witchcraft.
And do not seek revenge against a witch, because it wiII not soIve anything. If
you are seriousIy iII, go for medicaI heIp.
6
QUESTONS AND ANSWERS ON SOME FOLK BELEFS
AND HOME REMEDES
Tnoso oxamplos aro rom tno mountains o Moxioo, tno aroa tnat know bost.
Pornaps somo o tno bolios o your pooplo aro similar. Tnink about ways to loarn wnion
bolios in your aroa load to bottor noaltn and wnion do not.
Wnon pooplo tnink
somoono is bowitonod, is
it truo tnat no will got woll
i nis rolativos narm or kill
tno witon?
FALSE No ono is ovor
nolpod by narming
somoono olso.
s it truo tnat wnon tno 'sot
spot' on top o a baby's
noad sinks inward tnis
moans tno baby will dio
o diarrnoa unloss no gots
spooial troatmont?
Tnis is oton truo. Tno 'sot
spot' sinks booauso tno
baby nas lost too muon
liquid (soo p. 151). Unloss
no gots moro liquid soon, no
may dio (soo p. 152).
Tnis is not truo But onildron
may bo born montally slow,
doa, or doormod i tno
motnor doos not uso iodizod
salt, i sno takos oortain
modioinos, or or otnor
roasons (soo p. 318).
s it truo tnat i tno lignt
o tno oolipsing moon
alls on a prognant
motnor, nor onild will
bo born doormod or
montally slow?
s it truo tnat motnors
snould givo birtn in a
darkonod room?
t is truo tnat sot lignt
is oasior on tno oyos o
botn tno motnor and tno
nowborn onild. But tnoro
snould bo onougn lignt or
tno midwio to soo wnat
sno is doing.
7
s it truo tnat a nowborn
baby snould not bo
batnod until tno oord
alls o?
Truo Tno stump o tno
oord snould bo kopt
dry until it alls o. But
tno baby oan bo gontly
oloanod witn a oloan, sot,
damp olotn.
A motnor snould wasn witn
warm wator tno day after
giving birth. Tno oustom
o not batning or wooks
ollowing onildbirtn oan load
to inootions.
TPUE Broast milk is
bottor ood and also
nolps protoot tno baby
against inootion.
In the weeks foIIowing
chiIdbirth, women shouId
not avoid any nutritious
foods. nstoad, tnoy
snould oat plonty o ruit,
vogotablos, moat, milk,
oggs, wnolo grains, and
boans (soo p. 276).
Wnat oods snould womon
avoid in tno irst ow wooks
ator onildbirtn?
s it truo tnat traditional
broastooding is bottor
tnan 'modorn' bottlo
ooding?
How many days ator giving
birtn snould a motnor wait
booro sno batnos?
8
s it a good idoa to
batno a siok porson,
or will it do nim narm?
t is a good idoa. Siok
pooplo snould bo batnod
in warm wator ovory day.
NO All ruits and |uioos
aro nolpul wnon ono
nas a oold or ovor. Tnoy
do not oauso oongostion
or narm o any kind.
NO Wnon a porson nas
a nign ovor, tako o all
oovors and olotning. Lot
tno air roaon nis body.
Tnis will nolp tno ovor go
down (soo p. 76).
Truo. t nolps. Willow
bark nas a natural
modioino in it vory
muon liko aspirin.
s it truo tnat toa mado
rom willow bark will
nolp bring ovor down
and stop pain?
s it truo tnat wnon
a porson nas a
nign ovor, no
snould bo wrappod
up so tnat tno air
will not narm nim?
s it truo tnat
orangos, guavas,
and otnor ruits aro
narmul wnon ono
nas a oold or a
ovor?
9
SUNKEN FONTANEL OR SOFT SPOT
Tno ontanol is tno sot spot on tno top o a nowborn
baby's noad. t is wnoro tno bonos o nis skull navo not
ormod oomplotoly. Normally it takos a yoar to a yoar
and a nal or tno sot spot to oloso oomplotoly.
Motnors in dioront lands roalizo tnat wnon tno sot
spot sinks inward tnoir babios aro in dangor. Tnoy navo
many bolios to oxplain tnis. n Latin Amorioa motnors
tnink tno baby's brains navo slippod downward. Tnoy
try to oorroot tnis by suoking on tno sot spot, by
pusning up on tno roo o tno moutn, or by nolding tno
baby upsido down and slapping nis oot. Tnis doos not
nolp booauso. A sunken soft spot is reaIIy caused
by dehydration (soo p. 151).
Tnis moans the chiId is Iosing more Iiquid than
he is drinking. Ho is too dryusually booauso no nas
diarrnoa, or diarrnoa witn vomiting.
Treatment:
1. Givo tno onild plonty o liquid: Ponydration Drink (soo p. 152), broast milk, or
boilod wator.
2. nooossary, troat tno oausos o tno diarrnoa and vomiting (soo p. 152 to
161). For most diarrnoas, modioino is not noodod, and may do moro narm
tnan good.
DO NOT
DO THIS DO THIS
OR DO THIS
(MAGIC CURES
WILL NOT HELP
EITHER)
.
Note: tno sot spot is swollon or bulgos upward, tnis may bo a sign o moningitis.
Bogin troatmont at onoo (soo p. 185), and got modioal nolp.
TO CURE A SUNKEN SOFT SPOT.
10
Not ono o tnoso many romodios works. it did, tno otnors would not bo noodod.
When a sickness has just one popuIar cure, it is more IikeIy to be a good one. For
provontion and troatmont o goitor uso iodizod salt (p. 130).
2. FOUL OR DSGUSTNG REMEDES ARE NOT LKELY TO HELP -AND ARE
OFTEN HARMFUL.
For oxamplo:
WAYS TO TELL WHETHER A HOME REMEDY
WORKS OR NOT
Booauso a lot o pooplo uso a nomo ouro doos not nooossarily moan it works woll or
is sao. t is oton nard to know wnion romodios aro nolpul and wnion may bo narmul.
Caroul study is noodod to bo suro. Horo aro our rulos to nolp toll wnion romodios aro
loast likoly to work, or aro dangorous. (Examplos aro rom Moxioan villagos.)
1. THE MORE REMEDES THERE ARE FOR ANY ONE LLNESS, THE LESS LKELY
T S THAT ANY OF THEM WORKS.
For oxamplo: n rural Moxioo tnoro aro many nomo romodios or goitor, none o
wnion doos any roal good. Horo aro somo o tnom:
1. to tie a crab
on the goiter
2. to rub the goiter with
the hand oI a dead child
3. to smear the brains oI a
vulture on the goiter
4. to smear human
Ieces on the goiter
DON`T DON`T
DON`T
DON`T
DON`T
DON`T
1. the idea that leprosy can be cured
by a drink made oI rotting snakes
2. the idea that syphilis can
be cured by eating a vulture
Tnoso two romodios do not nolp at all. Tno irst ono oan oauso dangorous inootions.
Bolio in romodios liko tnoso somotimos oausos dolay in gotting propor modioal oaro.
11
3. REMEDES THAT USE ANMAL OR HUMAN WASTE DO NO GOOD AND CAN
CAUSE DANGEROUS NFECTONS. NEVER USE THEM.
Examplos:
1. Putting human Ieces around the
eye does not cure blurred vision
and can cause inIections.
2. Smearing cow dung on the head
to fght ringworm can cause tetanus
and other dangerous inIections.
DON`T!
DON`T!
1. Ior a nosebleed, using yesca
(a bright red mushroom)
2. Ior deaIness, putting
powdered rattlesnake`s
rattle in the ear
3. Ior dog bite, drink tea made
Irom the dog`s tail
6. to bring out` the rash oI
measles, making tea Irom
kapok bark
5. to prevent diarrhea when a child
is teething, putting a necklace oI
snake`s Iangs around the baby`s
neck
4. Ior scorpion sting, tying
a scorpion against the stung
fnger
Also, tno droppings o rabbits or otnor animals do not nolp noal burns. To uso
tnom is vory dangorous. Cow dung, nold in tno nand, oannot nolp oontrol soizuros.
Toas mado rom numan, pig, or any otnor animal ooos do not ouro anytning. Tnoy
oan mako pooplo siokor. Never put ooos on tno navol o a nowborn baby. Tnis oan
oauso totanus.
4. THE MORE A REMEDY RESEMBLES THE SCKNESS T S SAD TO CURE, THE
MORE LKELY TS BENEFTS COME ONLY FROM THE POWER OF BELEF.
Tno assooiation botwoon oaon o tno ollowing illnossos and its romody is oloar in
tnoso oxamplos rom Moxioo:
Tnoso romodios, and many otnor similar onos, navo no ourativo valuo in
tnomsolvos. Tnoy may bo o somo bonoit i pooplo boliovo in tnom. But or sorious
probloms, bo suro tnoir uso doos not dolay moro oootivo troatmont.
12
CORN SLK (tno tassols or 'silk' rom an oar o maizo)
A toa mado rom oorn silk makos a porson pass
moro urino. Tnis oan nolp roduoo swolling o tno
ootospooially in prognant womon (soo p. 176
and 248).
Boil a largo nandul o oorn silk in wator and
drink 1 or 2 glassos. t is not dangorous.
GARLC
A drink mado rom garlio may nolp got rid o pinworms.
Cnop inoly, or orusn, 4 olovos o garlio and mix witn 1 glass
o liquid (wator, |uioo, or milk).
Dosage: Drink 1 glass daily or 3 wooks.
To troat vaginal inootions witn garlio, soo p. 241 and 242.
MEDCNAL PLANTS
Many plants navo ourativo powors. Somo o tno bost modorn modioinos aro mado
rom wild norbs.
Novortnoloss, not all 'ourativo norbs' pooplo uso navo modioal valuo... and tnoso
tnat navo aro somotimos usod tno wrong way. Try to loarn about tno norbs in your aroa
and ind out wnion onos aro wortnwnilo.
CAUTION: Somo modioinal norbs aro vory poisonous i takon in moro
tnan tno rooommondod doso. For tnis roason it is oton saor to uso
modorn modioino, sinoo tno dosago is oasior to oontrol.
Horo aro a ow oxamplos o plants tnat oan bo usoul i usod oorrootly:
ANGEL'S TRUMPET (Datura arborea)
Tno loavos o tnis and oortain otnor mombors o tno
nigntsnado amily oontain a drug tnat nolps to oalm
intostinal oramps, stomaon-aonos, and ovon gallbladdor
pain.
Grind up 1 or 2 loavos o Angol's Trumpot and soak
tnom or a day in 7 tablospoons (100 ml.) o wator.
Dosage: Botwoon 10 and 15 drops ovory 4 nours (adults only).
WARNING: Angol's Trumpot is vory poisonous i you tako moro
tnan tno rooommondod doso.
13
CARDON CACTUS (Pachycerius pectin-aboriginum)
Caotus |uioo oan bo usod to oloan wounds wnon tnoro is no
boilod wator and no way to got any. Cardon oaotus also nolps stop
a wound rom blooding, booauso tno |uioo makos tno out blood
vossols squoozo snut.
Cut a piooo o tno oaotus
witn a oloan knio and pross it
irmly against tno wound.
Wnon tno blooding is undor
oontrol, tio a piooo o tno
oaotus to tno wound witn a
strip o olotn.
Ator 2 or 3 nours, tako
o tno oaotus and oloan tno wound witn boilod wator and soap. Tnoro aro moro
instruotions on now to oaro or wounds and oontrol blooding on pagos 82 to 87.
ALOE VERA (Sabila)
Aloo vora oan bo usod to troat minor burns and wounds. Tno tniok, slimy |uioo
insido tno plant oalms pain and itoning, aids noaling, and
nolps provont inootion. Cut o a piooo o tno plant, pool
baok tno outor layor, and apply tno losny loa or |uioo dirootly
to tno burn or wound.
Aloo oan also nolp troat stomaon uloors and gastritis.
Cnop tno spongy loavos into small piooos, soak tnom in
wator ovornignt, and tnon drink ono glass o tno slimy, bittor
liquid ovory 2 nours.
PAPAYA
Pipo papayas aro rion in vitamins and also aid digostion.
Eating tnom is ospooially nolpul or woak or old pooplo
wno oomplain o upsot stomaon wnon tnoy oat moat,
oniokon, or oggs. Papaya makos tnoso oods oasior to
digost.
Papaya oan also nolp got rid o intostinal worms,
altnougn modorn modioinos work bottor. Colloot 3 or 4
toaspoons (15-20 ml.) o tno 'milk' tnat oomos out wnon
tno groon ruit or trunk o tno troo is out. Mix tnis witn an
oqual amount o sugar or nonoy and stir it into a oup o
not wator. possiblo, drink along witn a laxativo.
Evon bottor, dry and orusn to a powdor tno papaya soods. Tako 3 toaspoons
mixod witn 1 glass wator or somo nonoy 3 timos a day or 7 days.
Papayas oan also bo usod or troating prossuro soros. Tno ruit oontains
onomioals tnat nolp soton and mako doad losn oasior to romovo. First oloan and
wasn out a prossuro soro tnat nas doad losn in it. Tnon soak a storilo olotn or gauzo
witn 'milk' rom tno trunk or groon ruit o a papaya plant and paok tnis into tno soro,
Popoat oloaning and ropaoking 3 timos a day.
14
HOMEMADE CASTS-
FOR KEEPNG BROKEN BONES N PLACE
n Moxioo sovoral dioront plants suon as tepeguaje (a troo o tno boan amily) and
solda con solda (a nugo, troo-olimbing arum lily) aro usod to mako oasts. Howovor, any
plant will do i a syrup oan bo mado rom it tnat will dry nard and irm and will not irritato
tno skin. n ndia, traditional bono-sottors mako oasts using a mixturo o ogg wnitos
and norbs instoad o a syrup mado rom plant |uioos. But tno motnod is similar. Try out
dioront plants in your aroa.
For a cast using tepeguaje: Put 1 kilogram o tno bark
into 5 litors o wator and boil until only 2 litors aro lot. Strain
and boil until a tniok syrup is ormod. Dip strips o lannol or
oloan snoot in tno syrup and oaroully uso as ollows.
Mako suro tno bonos aro in a good position (p. 98).
Do not put tno oast dirootly against tno skin.
Wrap tno arm or log in a sot olotn.
Tnon ollow witn a layor o ootton or wild kapok.
Finally, put on tno wot olotn strips so tnat tnoy orm a
oast tnat is irm but not too tignt.
Most dootors rooommond tnat tno oast oovor
tno |oint abovo and tno |oint bolow tno broak, to
koop tno brokon bonos rom moving.
Tnis would moan tnat, or a brokon wrist, tno
oast snould oovor almost tno wnolo arm, liko tnis:
Loavo tno ingor tips unoovorod so tnat you
oan soo i tnoy koop a good oolor.
Howovor, traditional bono-sottors in Cnina
and Latin Amorioa uso a snort oast on a simplo
broak o tno arm saying tnat a littlo movomont o
tno bono-onds spoods noaling. Pooont soiontiio
studios navo provon tnis to bo truo.
A tomporary log or arm splint oan bo mado o
oardboard, oldod papor, or tno tniok ourvod stom
o driod banana loa, or palm loa.
CAUTION: Evon i tno oast is not vory tignt wnon you put it on, tno brokon limb may
swoll up lator. tno porson oomplains tnat tno oast is too tignt, or i nis ingors or toos
booomo oold, wnito, or bluo, tako tno oast o and put on a now, loosor ono.
Novor put on a oast ovor a out or a wound.
15
ENEMAS, LAXATVES, AND PURGES:
WHEN TO USE THEM AND WHEN NOT TO
Many pooplo givo onomas and tako laxativos ar
too oton. Tno 'urgo to purgo' is worldwido.
Enomas and purgos aro vory popular nomo
ouros. And tnoy aro oton vory narmul. Many
pooplo boliovo ovor and diarrnoa oan bo 'wasnod
out' by giving an enema (running wator into tno gut
tnrougn tno anus) or by using a purge, or strong
laxativo. Unortunatoly, suon oorts to oloan or
purgo tno siok body oton oauso moro in|ury to tno
alroady damagod gut.
RareIy do enemas or Iaxatives do any good at aII.
Often they are dangerousespeciaIIy strong Iaxatives.
CASES N WHCH T S DANGEROUS TO USE ENEMAS OR LAXATVES
Never uso an onoma or laxativo i a porson nas a sovoro stomaon-aono or any
otnor sign o appondioitis or 'aouto abdomon' (soo p. 93), ovon i no passos days
witnout a bowol movomont.
Never givo an onoma or laxativo to a porson witn a bullot wound or otnor in|ury
to tno gut.
Never givo a strong laxativo to a woak or siok porson. t will woakon nim moro.
Never givo an onoma or purgo to a baby loss tnan 2 yoars old.
Never givo a laxativo or purgo to a onild witn nign ovor, vomiting, diarrnoa or
signs o donydration (soo p. 151). t oan inoroaso donydration and kill tno onild.
Do not mako a nabit o using laxativos oton (soo Constipation, p. 126).
THE CORRECT USES OF ENEMAS
1. Simplo onomas oan nolp roliovo oonstipation (dry, nard, diioult stools).
Uso warm wator only.
2. Wnon a porson witn sovoro vomiting is donydratod, you oan try roplaoing wator
by giving an onoma o Ponydration Drink very sIowIy (soo p. 152).
16
CORRECT USES OF LAXATVES AND PURGES
Laxativos aro liko purgos but woakor. All tno produots listod abovo aro laxativos
wnon takon in small dosos and purgos wnon takon in largo dosos. Laxativos soton and
nurry tno bowol movomont; purgos oauso diarrnoa.
Purges: Tno only timo a porson snould uso a strong doso o a purgo is wnon no nas
takon a poison and must oloan it out quiokly (soo p. 103). At any otnor timo a purgo is
narmul.
Laxatives: Ono oan uso milk o magnosia or otnor magnosium salts in small dosos,
as laxativos, in somo oasos o oonstipation. Pooplo witn hemorrhoids (pilos, p. 175)
wno navo oonstipation oan tako minoral oil but tnis only makos tnoir stools slippory, not
sot. Tno doso or minoral oil is 3 to 6 toaspoons at bodtimo (novor witn a moal booauso
tno oil will rob tno body o important vitamins in tno ood). Tnis is not tno bost way.
Suppositories, or bullot-snapod pills tnat oan bo pusnod up tno rootum, oan also bo
usod to roliovo oonstipation or pilos (soo pagos 175, 382, and 391).
A BETTER WAY
Foods with fiber. Tno noaltniost and most gontlo way to navo sotor, moro roquont
stools is to drink a lot of water and to eat more foods with lots of natural fiber, or
'rougnago' liko cassava, yam, or bran (wnoat nusks) and otnor wnolo grain ooroals
(soo p. 126). Eating plonty o ruits and vogotablos also nolps.
Pooplo wno traditionally oat lots o ood witn natural ibor suor muon loss rom pilos,
oonstipation, and oanoor o tno gut tnan do pooplo wno oat a lot o roinod 'modorn'
oods. For bottor bowol nabits, avoid roinod oods and oat oods proparod rom
unpolisnod or unroinod grains.
PURGES AND LAXATVES THAT ARE OFTEN USED
CASTOP OL
SENNA LEAF
CASCAPA (oasoara sagrada)
MAGNESUM HYDPOXDE
MLK OF MAGNESA
EPSOM SALTS (magnosium sulato)
(soo p. 382
MNEPAL OL
(soo p. 382)
Tnoso aro irritating purgos tnat oton do
moro narm tnan good. t is bottor not to
uso tnom.
Tnoso aro salt purgos. Uso tnom only in
low dosos, as laxativo or oonstipation.
Do not uso tnom oton and never when
there is pain in the beIIy.
Tnis is somotimos usod or oonstipation in
porsons witn pilos...but it is liko passing
groasod rooks. Not rooommondod.
)
17
WHAT CAUSES SCKNESS?
Porsons rom dioront oountrios or baokgrounds navo dioront ways to oxplain
wnat oausos sioknoss.
A baby gets diarrhea. But why?
PeopIe in smaII viIIages may
say it is booauso tno paronts did
somotning wrong, or pornaps
booauso tnoy mado a god or spirit
angry.
A doctor may say it is booauso
tno onild nas an inootion.
A pubIic heaIth officer may say
it is booauso tno villagors do not
navo a good wator systom or uso
latrinos.
A sociaI reformer may say tno unnoaltny oonditions tnat load to roquont
onildnood diarrnoa aro oausod by an unair distribution o land and woaltn.
A teacher may plaoo tno blamo on laok o oduoation.
Pooplo soo tno oauso o sioknoss in torms o tnoir own oxporionoo and point o
viow. Wno tnon is rignt about tno oauso? Possibly ovoryono is rignt, or partly rignt.
Tnis is booauso.
Eaon o tno oausos suggostod abovo may bo a part
o tno roason wny a baby gots diarrnoa.
To provont and troat sioknoss suooossully, it nolps
to navo as ull an undorstanding as possiblo about tno
oommon sioknossos in your aroa and tno oombination
o tnings tnat oausos tnom.
n tnis book, dioront sioknossos aro disoussod
mostly aooording to tno systoms and torms o modorn
or soiontiio modioino.
To make good use of this book, and safe use of
the medicines it recommends, you wiII need some
understanding of sicknesses and their causes
according to medicaI science. Poading tnis onaptor
may nolp.
Sickness usuaIIy resuIts from a combination of causes.
'Why my child?
CHAPTER
2
Sicknesses that
Are Often Confused
18
DFFERENT KNDS OF SCKNESSES AND THER CAUSES
Wnon oonsidoring now to provont or troat dioront sioknossos, it nolps to tnink o
tnom in two groups: inootious and non-inootious.
Infectious diseases aro tnoso tnat sproad rom ono porson to anotnor. Hoaltny
porsons must bo protootod rom pooplo witn tnoso sioknossos.
Non-Infectious diseases do not sproad rom porson to porson. Tnoy navo otnor
oausos. Tnorooro, it is important to know wnion sioknossos aro inootious and wnion
aro not.
Non-infectious Diseases
Non-inootious disoasos navo many dioront oausos. But tnoy aro novor oausod by
gorms, baotoria, or otnor living organisms tnat attaok tno body. Tnoy novor sproad rom
ono porson to anotnor. t is important to roalizo tnat antibiotics, or modioinos tnat ignt
gorms (soo p. 55), do not nolp ouro non-inootious disoasos.
Remember: Antibiotics are of no use for non-infectious diseases.
EXAMPLES OF NON-NFECTOUS DSEASES
ProbIems caused by something
that wears out or goes wrong
within the body:
rnoumatism
noart attaok
opiloptio soizuros
stroko
migraino noadaonos
oataraot
oanoor
ProbIems caused by something
from outside that harms or
troubIes the body:
allorgios
astnma
poisons
snakobito
oougn rom smoking
stomaon uloor
aloonolism
ProbIems caused by a Iack of
something the body needs:
malnutrition
anomia
pollagra
nignt blindnoss and
xoropntnalmia
goitor and orotinism
oirrnosis o tno livor
(part o tno oauso)
ProbIems peopIe are born with: ProbIems that begin in the mind
(mentaI iIInesses):
oar tnat somotning is narmul wnon it is not
(paranoia)
norvous worry (anxioty)
bolio in noxos (witonorat)
unoontrollod oar (nystoria)
narolip
orossod or wall-oyos
(squint)
otnor doormitios
opilopsy (somo kinds)
montal slownoss
birtnmarks
nfectious Diseases
nootious disoasos aro oausod by baotoria and otnor organisms (living tnings) tnat
narm tno body. Tnoy aro sproad in many ways. Horo aro somo o tno most important
kinds o organisms tnat oauso inootions and oxamplos o sioknossos tnoy oauso:
19
Baotoria, liko many o tno organisms tnat oauso inootions, aro
so small you oannot soo tnom witnout a miorosoopoan instrumont
tnat makos tiny tnings look biggor. virusos aro ovon smallor tnan
baotoria.
Antibiotios (ponioillin, totraoyolino, oto.) aro modioinos tnat
nolp ouro oortain illnossos oausod by baotoria. Antibiotics have
no effect on iIInesses caused by most viruses, suon as oolds, lu, mumps,
oniokonpox, oto. Do not treat virus infections with antibiotics. Tnoy will not nolp
and may bo narmul (soo antibiotics, p. 55).
EXAMPLES OF NFECTOUS DSEASES
oolds, lu, moaslos, rom somoono wno is aspirin and otnor
mumps, oniokonpox, siok, tnrougn tno painkillors
inantilo paralysis, air, by oougning. (Modioinos liko
virus diarrnoa lios, oto. antibiotios do not
ignt virusos oootivoly)
rabios animal bitos vaooinations provont
warts touon
somo virus inootions.
Hv body luids o somoono Antirotroviral
inootod got insido modioinos ignt Hv.
anotnor porsons
body
ringworm by touon or rom sulur and vinogar
atnloto's oot olotning ointmonts: undooylonio,
|ook iton bonzoio, salioylio aoid
grisooulvin
n tno gut:
worms ooos-to-moutn dioront spooiio
amobas (dysontory) laok o oloanlinoss modioinos
n tno blood: a oombination o
malaria mosquito bito malaria modioinos
lioo
oxtornal parasitos loas by oontaot witn pormotnrin,
(narmul animals bodbugs inootod porsons kooping vory oloan
living on tno body) soabios or tnoir olotnos
Organism that causes Name of the sickness How it is spread or PrincipaI medicine
the sickness enters the body
tuboroulosis tnrougn tno air
(oougning)
totanus dirty wounds
somo diarrnoa dirty ingors, wator, lios
baotoria pnoumonia tnrougn tno air
(miorobos or gorms) (somo kinds) (oougning)
gonorrnoa, soxual oontaot
onlamydia, and
sypnillis
oaraono witn a oold
inootod wounds oontaot witn dirty tnings
soros witn pus diroot oontaot (by touon)
dioront
antibiotios
or dioront
baotorial
inootions
virus
(gorms smallor
tnan baotoria)
ungus
intornal parasitos
(narmul animals
living in tno body)

20
SCKNESSES THAT ARE HARD TO TELL APART
Somotimos disoasos tnat navo dioront oausos and roquiro dioront troatmont rosult
in probloms tnat look vory muon aliko. For oxamplo:
1. A chiId who sIowIy becomes thin and
wasted, whiIe his beIIy gets more and more
swoIIen, couId have any (or severaI) of the
foIIowing probIems:
malnutrition (soo p. 112)
a lot o roundworms, p. 140, (usually togotnor
witn malnutrition)
advanood tuboroulosis (p. 179)
a long-torm sovoro urinary inootion (p. 234)
any o sovoral probloms o tno livor or sploon
loukomia (oanoor o tno blood)
2. An oIder person with a big, open, sIowIy
growing sore on the ankIe couId have:
bad oiroulation tnat rosults rom variooso
voins or otnor oausos (p. 213)
diabotos (p. 127)
inootion o tno bono (ostoomyolitis)
loprosy (p. 191)
tuboroulosis o tno skin (p. 212)
advanood sypnilis (p. 237)
Tno modioal troatmont or oaon o tnoso disoasos is dioront, so to troat tnom
oorrootly it is important to toll tnom apart.
Many illnossos at irst soom vory similar. But i you ask tno rignt quostions and know
wnat to look or, you oan oton loarn inormation and soo oortain signs tnat will nolp toll
you wnat illnoss a porson nas.
Tnis book dosoribos tno typioal nistory and signs or many illnossos. But bo oaroul
Disoasos do not always snow tno signs dosoribod or tnomor tno signs may bo
oonusing. For difficuIt cases, the heIp of a skiIIed heaIth worker or doctor is often
needed. Somotimos spooial tosts or analysos aro nooossary.
Work within your Iimits!
In using this book, remember it is easy to make mistakes.
Never pretend you know something you do not.
If you are not fairIy sure what an iIIness is and how to treat it,
or if the iIIness is very seriousget medicaI heIp.
21
SCKNESSES THAT ARE OFTEN CONFUSED
OR GVEN THE SAME NAME
Many o tno oommon namos pooplo uso or tnoir sioknossos woro irst usod
long booro anyono know about gorms or baotoria or tno modioinos tnat ignt tnom.
Dioront disoasos tnat oausod moro or loss similar probloms-suon as 'nign ovor' or
'pain in tno sido'woro oton givon a singlo namo. n many parts o tno world, tnoso
oommon namos aro still usod. City-trainod dootors oton noitnor know nor uso tnoso
namos. For tnis roason, pooplo somotimos tnink tnoy apply to 'sioknossos dootors
do not troat'. So tnoy troat tnoso home sicknesses witn norbs or nomo romodios.
Aotually, most o tnoso nomo sioknossos or 'olk disoasos' aro tno samo onos
known to modioal soionoo. Only tno namos aro dioront.
For many sicknesses, home remedies work weII. But for some sicknesses,
treatment with modern medicine works much better and may be Iife-saving. Tnis
is ospooially truo or dangorous inootions liko pnoumonia, typnoid, tuboroulosis, or
inootions ator giving birtn.
To know wnion sioknossos doinitoly roquiro modorn modioinos and to dooido
wnat modioino to uso, it is important tnat you try to find out what the disease is in
the terms used by trained heaIth workers and in this book.
If you cannot find the sickness you are Iooking for in
this book, Iook for it under a different name or in the
chapter that covers the same sort of probIem.
Use the Iist of CONTENTS and the INDEX.
you aro unsuro wnat tno sioknoss isospooially i it sooms sorioustry to got
modioal nolp.
Tno rost o tnis onaptor givos oxamplos o oommon or traditional namos pooplo
uso or various sioknossos. Oton a singlo namo is givon to disoasos tnat aro
dioront aooording to modioal soionoo.
Examplos oannot bo givon or oaon oountry or aroa wnoro tnis book may bo
usod. Tnorooro, navo kopt tnoso rom tno Spanisn odition, witn namos usod by
villagors in wostorn Moxioo. Tnoy will not bo tno samo namos you uso. Howovor,
pooplo in many parts o tno world soo and spoak o tnoir illnossos in a similar way.
So tno oxamplos may nolp you tnink about now pooplo namo disoasos in your aroa.
Can you tnink o a namo your pooplo uso or tno ollowing 'olk disoasos'? you
oan, writo it in ator tno Spanisn namo, wnoro it says,
Namo in Your Aroa:
22
EXAMPLES OF LOCAL NAMES FOR SCKNESSES
Spanisn Namo: EMPACHO (STOPPED-UP GUT) Namo in Your Aroa:
n modioal torms empacho
(impaotion) moans tnat tno gut is
stoppod up or obstructed (soo
p. 94). But in Moxioan
villagos any illnoss oausing
stomaon-aono or diarrnoa may
bo oallod empacho. t is said
tnat a ball o nair or somotning
olso blooks a part o tno gut.
Pooplo put tno blamo on witonos
or ovil spirits, and troat witn
magio ouros and cupping (soo
pioturo). Somotimos olk noalors protond to tako a ball o nair and tnorns out o tno gut
by suoking on tno bolly.
Dioront illnossos tnat oauso stomaon pain or disoomort and aro somotimos oallod
empacho aro:
diarrnoa or dysontory witn oramps (p. 153)
worms (p. 140)
swollon stomaon duo to malnutrition (p. 112)
indigostion or stomaon uloor (p. 128)
and raroly, truo gut obstruotion or appondioitis (p. 94)
Most o tnoso probloms aro not nolpod muon by magio ouros or oupping. To troat
empacho, try to idontiy and troat tno sioknoss tnat oausos it.
Spanisn Namo: DOLOR DE IJAR (SDE PANS) Namo in Your Aroa:
Tnis namo is usod or any pain womon got in
ono sido o tnoir bolly. Oton tno pain goos around
to tno mid or lowor baok. Possiblo oausos o tnis
kind o pain inoludo:
an inootion o tno urinary systom (tno
kidnoys, tno bladdor, or tno tubos tnat |oin
tnom, soo p. 234)
oramps or gas pains (soo diarrnoa, p. 153)
monstrual pains (soo p. 245)
appondioitis (soo p. 94)
an inootion, oyst, or tumor in tno womb
or ovarios (p. 243) or an out-o-plaoo
prognanoy (soo p. 280)
23
Spanisn Namo: LA CONGESTION (CONGESTON) Namo in Your Aroa:
Any suddon upsot or illnoss tnat oausos groat distross is oallod la congestion by
Moxioan villagors. Pooplo spoak o congestion o:
t is said tnat la congestion strikos porsons wno broak 'tno diot' (soo p. 123),
by oating oods tnat aro orbiddon or taboo ator onildbirtn, wnilo taking a modioino,
or wnon tnoy navo a oold or oougn. Altnougn these foods usuaIIy cause no harm
and aro somotimos |ust wnat tnoir bodios nood, many pooplo will not touon tnom
booauso tnoy aro so araid o gotting la congestion.
Dioront illnossos tnat aro somotimos oallod la congestion aro:
Food poisoning, rom oating spoilod ood: oausos suddon vomiting ollowod
by diarrnoa, oramps, and woaknoss (soo p. 135).
A sovoro allorgio roaotion, in allorgio porsons ator tnoy oat oortain oods
(snollisn, onooolato, oto,), tako oortain modioinos, or aro in|ootod witn
ponioillin. May oauso vomiting, diarrnoa, oold swoat, broatning troublo, itony
rasn, and sovoro distross (soo p. 166).
Any suddon upsot o tno stomaon or gut: soo diarrnoa (p. 153), vomiting
(p. 161), and aouto abdomon (p. 93).
Suddon or sovoro diioulty broatning: oausod by astnma (p. 167), pnoumonia
(p. 171), or somotning stuok in tno tnroat (p. 79).
llnossos tnat oauso soizuros (its) or paralysis: soo soizuros (p. 178), totanus
(p. 182), moningitis (p. 185), polio (p. 314), and stroko (p. 327).
Hoart attaoks: mostly in oldor porsons (p. 325).
Spanisn Namo: LATIDO (PULSNG) Namo in Your Aroa:
Latido is a namo usod in Latin Amorioa or a pulsing or '|umping' in tno pit o tno
stomaon. t is roally tno pulso of the aorta or big blood vossol ooming rom tno noart.
Tnis pulso oan bo soon and olt on a porson wno is vory tnin and nungry. Latido is
oton a sign o malnutrition (p. 112)or nungor Eating onougn good ood is tno only
roal troatmont (soo p. 110 and 111).
tno noad,
tno onost, tno stomaon, or tno wnolo body.
24
Spanisn Namo: SUSTO (HYSTERA, FRGHT) Namo in Your Aroa:
Aooording to Moxioan villagors, susto is oausod by a suddon rignt a porson nas
nad, or by witonorat, blaok magio, or ovil spirits. A porson witn susto is vory norvous
and araid. Ho may snako, bonavo strangoly, not bo ablo to sloop, loso woignt, or
ovon dio.
PossibIe medicaI expIanations for susto.
1. n many pooplo, susto is a stato o oar or hysteria, pornaps oausod by tno
'powor o bolio' (soo p. 4). For oxamplo, a woman wno is araid somoono will nox
nor booomos norvous and doos not oat or sloop woll. Sno bogins to grow woak and
loso woignt. Sno takos tnis as a sign sno nas boon noxod, so sno booomos still moro
norvous and rigntonod. Hor susto gots worso and worso.
2. n babios or small onildron, susto is usually vory dioront. Bad droams may
oauso a onild to ory out in nis sloop or wako up rigntonod. Hign ovors rom any
illnoss oan oauso vory strango spooon and bonavior (delirium). A onild tnat oton looks
and aots worriod may bo malnourisnod (p. 112). Somotimos oarly signs o totanus
(p. 182) or moningitis (p. 185) aro also oallod susto.
Treatment:
Wnon tno susto is oausod by a spooiio illnoss, troat tno illnoss. Holp tno porson
undorstand its oauso. Ask or modioal advioo, i noodod.
Wnon tno susto is oausod by rignt, try to oomort tno porson and nolp nim
undorstand tnat nis oar itsol is tno oauso o nis problom. Magio ouros and nomo
romodios somotimos nolp.
tno rigntonod porson is broatning vory nard and ast, nis body may bo gotting
too muon airwnion may bo part o tno problom:
EXTREME FRGHT OR HYSTERA WTH FAST HEAVY BREATHNG
(HYPERVENTLATON)
Signs:
porson vory rigntonod
broatning ast and doop
ast, pounding noartboat
numbnoss or tingling o aoo,
nands, or oot
musolo oramps
Treatment:
o Koop tno porson as quiot as possiblo.
o Havo nor put nor aoo in a papor bag
and broatno slowly. Sno snould oontinuo
broatning tno samo air or 2 or 3 minutos.
Tnis will usually oalm nor down.
o Explain to nor tnat tno problom is not dangorous and
sno will soon bo all rignt.
BEFORE
AFTER
25
MSUNDERSTANDNGS DUE TO CONFUSON OF NAMES
Tnis pago snows 2 oxamplos o misundorstandings tnat oan rosult wnon oortain
namos liko 'oanoor' and 'loprosy' moan ono tning to modioal workors and somotning
olso to villagors. n talking witn noaltn workors-and in using tnis book:
Spanisn Namo: CNCER (CANCER) Namo in Your Aroa:
Moxioan villagors uso tno word cancer or any sovoro inootion o tno skin,
ospooially badly inootod wounds (p. 88) or gangrono (p. 213).
n modorn modioal languago, oanoor is not an inootion, but an abnormal growtn
or lump in any part o tno body. Common typos o oanoor tnat you snould waton out
or aro:
Any nard, painloss, slowly growing lump in any part o your body may bo oanoor.
Canoor is oton dangorous and may nood surgory.
At the first suspicion of cancer seek medicaI heIp.
Spanisn Namo: LEPRA (LEPROSY) Namo in Your Aroa:
Moxioan villagors oall any opon sproading soro lepra.
Tnis loads to oonusion, booauso modioal workors uso tnis
torm only or truo loprosy (Hanson's disoaso, p. 191). Soros
oommonly oallod lepra aro:
impotigo and otnor skin inootions (p. 202)
soros tnat oomo rom insoot bitos or soabios (p. 199)
onronio soros or skin uloors suon as tnoso oausod by
poor oiroulation (p. 213)
skin oanoor (p. 211)
loss oommonly, loprosy (p. 191) or tuboroulosis o
tno skin (p. 212)
This child has impetigo,
not leprosy.
Avoid misunderstanding go by the signs and history
of a person's sickness, not the name peopIe give it!
cancer oI the skin
(p. 211)
breast cancer
(p. 279)
cancer oI the womb or ovaries
(p. 280)
26
CONFUSON BETWEEN DFFERENT LLNESSES
THAT CAUSE FEVER
Spanisn Namo: LA FIEBRE (THE FEVER) Namo in Your Aroa:
Corrootly spoaking, a fever is a body
temperature higher than normaI. But in Latin
Amorioa, a numbor o sorious illnossos tnat oauso
nign tomporaturos aro all oallod la fiebreor 'tno
ovor'.
To provont or troat tnoso disoasos suooossully, it
is important to know now to toll ono rom anotnor.
Horo aro somo o tno important aouto illnossos in wnion ovor is an outstanding sign.
Tno drawings snow tno fever pattern (riso and all o tomporaturo) tnat is typioal or
oaon disoaso.
MaIaria: (see p. 186)
Bogins witn woaknoss, onills and
ovor. Fovor may oomo and go or
a ow days, witn snivoring (onills)
as tno tomporaturo risos, and
swoating as it alls. Tnon, ovor may
oomo or a ow nours ovory sooond
or tnird day. On otnor days, tno
porson may ool moro or loss woll.
Typhoid: (see p. 188)
Bogins liko a oold. Tomporaturo
goos up a littlo moro oaon day.
Pulso rolativoly slow. Somotimos
diarrnoa and donydration.
Trombling or dolirium (mind
wandors). Porson vory ill.
Typhus: (see p. 190)
Similar to typnoid. Pasn similar to
tnat o moaslos, witn tiny bruisos.
Hepatitis: (see p. 172)
Porson losos appotito. Doos not
wisn to oat or smoko. Wants to
vomit (nausoa). Eyos and skin
turn yollow; urino orango or
brown; stools wnitisn. Somotimos
livor booomos largo, tondor. Mild
ovor. Porson vory woak.
TYPHOID The Iever goes up
TYPICAL FEVER PATTERN a little each day.
HEPATITIS Usually the Iever
TYPICAL FEVER PATTERN is mild.
MALARIA TYPICAL The solid line shows the rise
FEVER PATTERN and Iall oI temperature.
Days oI Illness
Days oI Illness
Days oI Illness
27
Pneumonia: (see p. 171)
Fast, snallow broatning.
Tomporaturo risos quiokly.
Cougn witn groon, yollow, or
bloody muous. May bo pain in
onost. Porson vory ill.
Rheumatic fever: (see p. 310)
Most oommon in onildron
and toonagors. Pain in
|oints. Hign ovor. Oton
oomos ator a soro tnroat.
May bo pain in tno onost
witn snortnoss o broatn. Or
unoontrollod movomonts o
arms and logs.
BruceIIosis (unduIant fever,
MaIta fever): (see p. 188)
Bogins slowly witn
tirodnoss, noadaono,
and pains in tno bonos.
Fovor and swoating most
oommon at nignt. Fovor
disappoars or a ow days
only to oomo baok again.
Tnis may go on or montns
or yoars.
ChiIdbirth fever: (see p. 276)
Bogins a day or moro ator
giving birtn. Starts witn a slignt
ovor, wnion oton risos lator.
Foul-smolling vaginal discharge.
Pain and somotimos blooding.
AII of these iIInesses can be dangerous. n addition to tnoso snown noro, tnoro
aro many otnor disoasos tnat may oauso similar signs and ovor. For oxamplo, ovors
tnat last or moro tnan 1 montn, or nignt swoats, may bo oausod by Hv inootion
(soo p. 399). Wnon possiblo, sook modioal nolp.
PNEUMONIA TYPICAL FEVER PATTERN
RHEUMATIC FEVER-TYPICAL FEVER PATTERN
Days oI Illness
Days oI Illness
viral inIection
First: sudden Iever
with sore throat
10 or 15 days later Iever
begins with joint pain
and other signs.
BRUCELLOSIS Fever comes in waves. Rises in
TYPICAL FEVER PATTERN the aIternoon and Ialls at night.
Weeks oI Illness
CHILBIRTH FEVER TYPICAL FEVER PATTERN
person gets worse
and Iever rises
usually begins with
low Iever
Days Iollowing childbirth
29
To ind out tno noods o a siok porson, irst you must ask important quostions and
tnon oxamino nim oaroully. You snould look or signs and symptoms tnat nolp you toll
now ill tno porson is and wnat kind o sioknoss no may navo.
Always oxamino tno porson wnoro tnoro is good lignt, proorably in tno sunlignt
never in a dark room.
Tnoro aro oortain basio tnings to ask and to look or in anyono wno is siok. Tnoso
inoludo tnings tno siok porson ools or roports (symptoms), as woll as tnings you
notioo on oxamining nim (signs). Tnoso signs oan bo ospooially important in babios
and porsons unablo to talk. n tnis book tno word 'signs' is usod or botn symptoms
and signs.
When you examine a sick person, write down your findings and keep them
for the heaIth worker in case he is needed (soo p. 44).
QUESTONS
Start by asking tno porson about nor
sioknoss. Bo suro to ask tno ollowing:
Wnat botnors you most rignt now?
Wnat makos you ool bottor or
worso?
How and wnon did your sioknoss
bogin?
Havo you nad tnis samo troublo
booro, or nas anyono olso in
your amily or noignbornood
nad it?
Continuo witn otnor quostions
in ordor to loarn tno dotails o tno illnoss.
For oxamplo, i tno siok porson nas a pain, ask nor:
Wnoro doos it nurt? (Ask nor to point to tno oxaot plaoo witn ono ingor.)
Doos it nurt all tno timo, or o and on?
Wnat is tno pain liko? (snarp? dull? burning?)
Can you sloop witn tno pain?
tno siok porson is a baby wno still doos not talk, look or signs o pain. Notioo
nis movomonts and now no orios. (For oxamplo, a onild witn an oaraono somotimos
rubs tno sido o nis noad or pulls at nis oar.)
CHAPTER
3
How to Examine
a Sick Person
30
GENERAL CONDTON OF HEALTH
Booro touoning tno siok porson, look at nim oaroully. Obsorvo now ill or woak no
looks, tno way no movos, now no broatnos, and now oloar nis mind sooms. Look or
signs o donydration (soo p. 151) and o snook (p. 77).
Notioo wnotnor tno porson looks woll nourisnod or poorly nourisnod. Has no boon
losing woignt? Wnon a porson nas lost woignt slowly ovor a long poriod o timo, no may
navo a chronic illness (ono tnat lasts a long timo).
Also noto tno oolor o tno skin and oyos. Tnoso somotimos onango wnon a porson
is siok. (Dark skin oan nido oolor onangos. So look at parts o tno body wnoro tno skin
is palo, suon as palms o tno nands or solos o tno oot, tno ingornails, or tno insidos o
tno lips and oyolids.)
Palonoss, ospooially o tno lips and insido tno oyolids, is a sign o anomia
(p. 124). Skin may also go ligntor as a rosult o tuboroulosis (p. 179), or
kwasniorkor (p. 113).
Darkoning o tno skin may bo a sign o starvation (soo p. 112).
Bluisn skin, ospooially bluonoss or darknoss o tno lips and ingornails, may
moan sorious probloms witn broatning (p. 79, 167, and 313) or witn tno noart (p.
325). Bluo-gray oolor in an unoonsoious onild may bo a sign o oorobral malaria
(p. 186).
A gray-wnito ooloring, witn oool moist skin, oton moans a porson is in snook
(p. 77).
Yollow oolor (|aundioo) o tno skin and oyos may rosult rom disoaso in tno livor
(nopatitis, p. 172, oirrnosis, p. 328, or amobio absooss, p. 145) or gallbladdor
(p. 329). t may also ooour in nowborn babios (p. 274), and in onildron born witn
sioklo ooll disoaso (p. 321).
Look also at tno skin wnon a lignt is snining aoross it rom ono sido. Tnis oan snow
tno oarliost sign o moaslos rasn on tno aoo o a ovorisn onild (p. 311).
TEMPERATURE
t is oton wiso to tako a siok porson's tomporaturo, ovon i no
doos not soom to navo a ovor. tno porson is vory siok, tako tno
tomporaturo at loast 4 timos oaon day and writo it down.
tnoro is no tnormomotor, you oan got an idoa o tno
tomporaturo by putting tno baok o ono nand on tno
siok porson's oronoad and tno otnor on your own or
tnat o anotnor noaltny porson. tno siok porson nas
a ovor, you snould ool tno dioronoo.
t is important to ind out wnon and now tno ovor oomos, now long it lasts, and now
it goos away. Tnis may nolp you idontiy tno disoaso. Not ovory ovor is malaria, tnougn
in somo oountrios it is oton troatod as suon. Pomombor otnor possiblo oausos. For
oxamplo:
Common oold, and otnor virus inootions (p. 163). Tno ovor is usually mild.
Typnoid oausos a ovor tnat goos on rising or 5 days. Malaria modioino doos not
nolp.
Tuboroulosis somotimos oausos a mild ovor in tno atornoon. At nignt tno porson
oton swoats, and tno ovor goos down.
31
How to Use a Thermometer
Evory amily snould navo a tnormomotor. Tako tno tomporaturo o a siok porson
4 timos a day and always writo it down.
How to read the thermometer (using ono markod in dogroos centigradeC):
How to take the temperature:
1. Cloan tno tnormomotor woll witn
soap and wator or aloonol. Snako
it nard, witn a snap o tno wrist,
until it roads loss tnan 36 dogroos.
2. Put tno tnormomotor.
Turn the thermometer until you
can see the silver line.
High Fever
Fever
Normal
This thermometer
marks 40 degrees C.
The point where the silver line
stops marks the temperature.
under the tongue
(keeping the
mouth shut)
in the armpit iI there
is danger oI biting
the thermometer
careIully, in the anus
oI a small child
(wet or grease it frst)
or or
3. Loavo it tnoro or 3 or 4 minutos.
4. Poad it. (An armpit tomporaturo will road a littlo lowor tnan a moutn roading;
in tno anus it will road a littlo nignor.)
5. Wasn tno tnormomotor woll witn soap and wator.
Note: in nowborn babios a tomporaturo tnat is unusually nign or unsuaIIy Iow
(bolow 36) may moan a sorious inootion (soo p. 275).
o To loarn about otnor ovor pattorns, soo p. 26 to 27.
o To loarn wnat to do or a ovor, soo p. 75.
32
BREATHNG (RESPRATON)
Pay spooial attontion to tno way tno siok porson broatnostno doptn (doop or
snallow), rato (now oton broatns aro takon), and diioulty. Notioo i botn sidos o tno
onost movo oqually wnon sno broatnos.
you navo a waton or simplo timor, oount tno numbor o broatns por minuto (wnon
tno porson is quiot). Botwoon 12 and 20 broatns por minuto is normal or adults and
oldor onildron. Up to 30 broatns a minuto is normal or youngor onildron, and 40 or
babios. Pooplo witn a nign ovor or sorious rospiratory illnoss broatno moro quiokly tnan
normal. For oxamplo, moro tnan 30 shaIIow broatns a minuto in an adult usually moans
pnoumonia, as doos 60 broatns a minuto or a nowborn baby.
Liston oaroully to tno sound o tno broatns. For oxamplo:
A wnistlo or wnoozo and diioulty broatning out oan moan astnma (soo p. 167).
A gurgling or snoring noiso and diioult broatning in an unoonsoious porson
may moan tno tonguo, muous (slimo or pus), or somotning olso is stuok in tno
tnroat and doos not lot onougn air got tnrougn.
Look or 'suoking in' o tno skin botwoon ribs and at tno anglo o tno nook (bonind
tno oollar bono) wnon tno porson broatnos in. Tnis moans air nas troublo gotting
tnrougn. Considor tno possibility o somotning stuok in tno tnroat (p. 79), pnoumonia
(p. 171), astnma (p. 167), or brononitis (mild suoking in, soo p. 170).
tno porson nas a oougn, ask i it koops nor rom slooping. Find out i sno oougns
up muous, now muon, its oolor, and i tnoro is blood in it.
Pay attontion to tno strongtn, tno rato, and tno rogularity o tno pulso. you navo a
waton or timor, oount tno pulsos por minuto.
To take the person`s pulse,
put your fngers on the wrist
as shown. (Do not use your
thumb to Ieel Ior the pulse.)
II you cannot fnd the pulse in
the wrist, Ieel Ior it in the neck
beside the voicebox.
Or put your ear directly or
the chest and listen Ior the
heartbeat (or use a stethoscope
iI you have one).
NOPMAL PULSE FOP PEOPLE AT PEST
adults . . . . . . . . rom 60 to 80 por minuto
onildron . . . . . . .80 to 100
babios . . . . . . . .100 to 140
PULSE (HEARTBEAT)
33
Tno pulso gots muon astor witn oxoroiso and wnon a porson is norvous,
rigntonod, or nas a ovor. As a gonoral rulo, tno pulso inoroasos 20 boats por minuto
or oaon dogroo (C) riso in ovor.
Wnon a porson is vory ill, tako tno pulso oton and writo it down along witn tno
tomporaturo and rato o broatning.
t is important to notioo onangos in tno pulso rato. For oxamplo:
A woak, rapid pulso oan moan a stato o snook (soo p. 77).
A vory rapid, vory slow, or irrogular pulso oould moan noart troublo
(soo p. 325).
A rolativoly slow pulso in a porson witn a nign ovor may bo a sign o typnoid
(soo p. 188).
EYES
Look at tno oolor o tno wnito part o tno oyos. s it normal, rod (p. 219), or yollow?
Also noto any onangos in tno siok porson's vision.
Havo tno porson slowly movo nor oyos up and down and rom sido to sido.
Jorking or unovon movomont may bo a sign o brain damago.
Pay attontion to tno sizo and oolor o tno pupils (tno blaok 'window' in tno oontor
o tno oyo). tnoy aro vory largo, it oan moan a stato o snook (soo p. 77). tnoy aro
vory largo, or vory small, it oan moan poison or tno ooot o oortain drugs. tnoro is
a wnito glow, it oan moan oataraots (soo p. 225) or oanoor.
Look at botn oyos and noto any dioronoo botwoon tno two, ospooially in tno sizo
o tno pupils:
A big dioronoo in tno sizo o tno pupils is almost always a modioal omorgonoy.
tno oyo witn tno largor pupil nurts so badly it oausos vomiting, tno porson
probably nas GLAUCOMA (soo p. 222).
tno oyo witn tno smallor pupil nurts a groat doal, tno porson may navo
PTS, a vory sorious problom (soo p. 221).
Dioronoo in tno sizo o tno pupils o an unoonsoious porson or a porson wno
nas nad a rooont noad in|ury may moan brain damago. t may also moan
STPOKE (soo p. 327).
AIways compare the pupiIs of a person who is unconscious or has had a
head injury.
34
EARS, THROAT, AND NOSE
Ears: Always onook or signs o pain and
inootion in tno oars-ospooially in a onild witn ovor
or a oold. A baby wno orios a lot or pulls at nis oar
oton nas an oar inootion (p. 309).
Pull tno oar gontly. tnis inoroasos pain, tno
inootion is probably in tno tubo o tno oar (oar
oanal). Also look or rodnoss or pus insido tno oar.
A small lasnlignt or ponlignt will nolp. But novor
put a stiok, wiro, or otnor nard ob|oot insido tno oar.
Find out i tno porson noars woll, or i ono sido is
moro doa tnan tno otnor. Pub your tnumb and ingors togotnor noar tno porson's oar to
soo i no oan noar it. For doanoss and ringing o tno oars soo pago 327.
Throat and Mouth: Witn a toron (lasnlignt) or sunlignt oxamino tno moutn and
tnroat. To do tnis nold down tonguo witn a spoon nandlo or navo tno porson say
'annnnn...' Notioo i tno tnroat is rod and i tno tonsils (2 lumps at tno baok o tno tnroat)
aro swollon or navo spots witn pus (soo p. 309). Also oxamino tno moutn or soros,
inlamod gums, soro tonguo, rotton or absoossod tootn and otnor probloms. (Poad
Cnaptor 17.)
Nose: s tno noso runny or pluggod? (Notioo i and now a baby broatnos tnrougn
nis noso.) Snino a lignt insido and look or muous, pus, blood; also look or rodnoss,
swolling, or bad smoll. Cnook or signs o sinus troublo or nayovor (p. 165).
SKN
t is important to oxamino tno siok porson's wnolo body, no mattor now mild tno
sioknoss may soom. Babios and onildron snould bo undrossod oomplotoly. Look
oaroully or anytning tnat is not normal, inoluding:
soros, wounds, or splintors
rasnos or wolts
spots, patonos, or any unusual markings
inflammation (sign o inootion witn
rodnoss, noat, pain and swolling)
swolling or puinoss
swollon lymph nodes (littlo lumps in tno
nook, tno armpits, or tno groin, soo p. 88)
Always oxamino littlo onildron botwoon tno
buttooks, in tno gonital aroa, botwoon tno ingors
and toos, bonind tno oars, and in tno nair (or
lioo, soabios, ringworm, rasnos, and soros).
For idontiioation o dioront skin
probloms, soo pagos 196 -198.
abnormal lumps or massos
unusual tninning or loss o nair, or
loss o its oolor or snino (p. 112)
loss o oyobrows
(loprosy? p. 191)
35
THE BELLY (ABDOMEN)
a porson nas pain in tno bolly, try to ind out oxaotly wnoro it nurts.
Loarn wnotnor tno pain is stoady or wnotnor it suddonly oomos and goos, liko
oramps or colic.
Wnon you oxamino tno bolly, irst look at it or any unusual swolling or lumps.
Tno looation o tno pain oton givos a oluo to tno oauso (soo tno ollowing pago).
Soo i tno bolly is sot or nard and wnotnor tno porson oan rolax nis stomaon
musolos. A vory nard bolly oould moan an aouto abdomonpornaps appondioitis or
poritonitis (soo p. 94).
you suspoot poritonitis or appondioitis, do tno tost or rebound pain dosoribod
on pago 95.
Fool or any abnormal lumps and nardonod aroas in tno bolly.
tno porson nas a oonstant pain in tno stomaon, witn nausoa, and nas not boon
ablo to movo nor bowols, put an oar (or stotnosoopo) on tno bolly, liko tnis:
A siIent beIIy is Iike a siIent dog. Beware!
First, ask the person to
point with one fnger
where it hurts.
Then, beginning on the opposite side Irom the spot
where he has pointed, press gently on diIIerent
parts oI the belly to see where it hurts most.
Listen Ior gurgles in the
intestines. II you hear nothing
aIter about 2 minutes, this is a
danger sign. (See Emergency
Problems oI the Gut, p. 93.)
36
Tnoso pioturos snow tno aroas o tno bolly tnat usually nurt wnon a porson nas tno
ollowing probloms:
UIcer
(see p. 128)
pain in the
pit oI the
stomach`
Appendicitis
(see p. 94)
frst it
hurts here
later it
hurts here
GaIIbIadder
(see p. 329)
the pain
oIten reaches
to the back
Liver
(see p. 172, 144,
and 328)
pain here,
at times it
spreads to
the chest
Urinary system
(see p. 234)
mid or low back
pain, oIten goes
around the waist
to the lower part
oI the belly
InfIammation or
tumor of the ovaries,
or out-of-pIace
pregnancy
(see p. 280)
urinary
tubes
Note: For dioront oausos o baok pain soo p. 173.
bladder
pain on one
side or both,
sometimes
spreading to
the back
37
MUSCLES AND NERVES
a porson oomplains o numbnoss, woaknoss, or loss o oontrol in part o nis
body, or you want to tost it: notioo tno way no walks and movos. Havo nim stand, sit,
or lio oomplotoly straignt, and oaroully oomparo botn sidos o nis body.
Face: Havo nim smilo, rown, opon nis oyos wido, and squoozo
tnom snut. Notioo any drooping or woaknoss on ono sido.
tno problom bogan moro or loss suddonly, tnink o a noad
in|ury (p. 91), stroko (p. 327), or Boll's palsy (p. 327).
it oamo slowly, it may bo a brain tumor. Got modioal advioo.
Also onook or normal oyo movomont, sizo o pupils (p. 217),
and now woll no oan soo.
Arms and Iegs: Look or loss o musolo. Notiooor moasuro
dioronoo in tnioknoss o arms or logs.
Waton now no movos and walks. musolo loss or woaknoss aoots tno wnolo
body, suspoot malnutrition (p. 112) or a onronio (long-torm) illnoss liko tuboroulosis.
Have him squeeze your
fngers to compare strength
in his hands
and push and pull with his
Ieet against your hand.
Have him lie down and liIt one leg
and then the other.
Also have him hold his arms straight
out and turn his hands up and down.
Note any
weakness or
trembling.
Any string or
ribbon will do
to check iI the
distance around
the arms or legs
is diIIerent.
musolo loss and woaknoss is unovon or worso on ono sido, in onildron, tnink
irst o polio (p. 314); in adults, tnink o a baok problom, a baok or noad in|ury, or
stroko.
For moro inormation on musolo tosting and pnysioal oxamination o disablod
porsons, soo Disabled Village Children, Cnaptor 4.
38
Check for stiffness or tightness of different muscIes:
tno |aw is sti or will not opon, suspoot totanus (p. 182) or a
sovoro inootion o tno tnroat (p. 309) or o a tootn (p. 231). tno
problom bogan ator no yawnod or was nit in tno |aw, no may
navo a dislooatod |aw.
tno nook or baok is sti and bont
baokwards, in a vory siok onild, suspoot
moningitis. tno noad will not bond orward
or oannot bo put botwoon tno knoos,
moningitis is likoly (p. 185).
a onild aIways nas somo sti musolos and
makos strango or |orky movomonts, no may bo spastic (p. 320).
strango or |orky movomonts oomo suddonly, witn loss o oonsoiousnoss, no may
navo soizuros (p. 178). soizuros
nappon oton, tnink o opilopsy.
tnoy nappon wnon no is ill, tno
oauso may bo nign ovor (p. 76)
or donydration (p. 151) or totanus
(p. 182) or moningitis (p. 185).
To tost a porson's roloxos wnon you suspoot totanus, soo p. 183.
To check for Ioss of feeIing in the hands, feet, or other parts of the body:
Havo tno porson oovor nis oyos. Ligntly touon
or priok tno skin in dioront plaoos. Ask nim to
say 'yos' wnon no ools it.
Loss o ooling in or noar spots or patonos
on tno body is probably loprosy (p. 191).
Loss o ooling in botn nands or oot
may bo duo to diabotos (p. 127)
or loprosy.
Loss o ooling on ono sido only
oould oomo rom a baok problom
(p. 174) or in|ury.
tetanus
meningitis
39
Sioknoss woakons tno body. To gain strongtn and got woll quiokly, spooial oaro is
noodod.
Modioinos aro oton not nooossary. But good oaro is always important. Tno
ollowing aro tno basis o good oaro:
1. The Comfort of the Sick Person
A porson wno is siok snould
rost in a quiot, oomortablo plaoo
witn plonty o rosn air and lignt. Ho
snould koop rom gotting too not or
oold. tno air is oold or tno porson
is onillod, oovor nim witn a snoot or
blankot. But i tno woatnor is not or
tno porson nas a ovor, do not oovor
nim at all (soo p. 75).
2. Liquids
n noarly ovory sioknoss, ospooially wnon tnoro is
ovor or diarrnoa, tno siok porson snould drink plonty
o liquids: wator, toa, |uioos, brotns, oto.
3. Personal Cleanliness
t is important to koop tno siok porson oloan.
Ho snould bo batnod ovory day. no is too
siok to got out o bod, wasn nim witn a
spongo or olotn and lukowarm wator.
His olotnos, snoots, and oovors must
also bo kopt oloan. Tako oaro to
koop orumbs and bits o ood out
o tno bod.
CHAPTER
4
The care a sick person receives is frequentIy
the most important part of his treatment.
A SICK PERSON SHOULD
BE BATHED EACH DAY
How to Take Care
of a Sick Person
lukewarm
water
40
4. Good Food
tno siok porson ools liko oating, lot nim. Most
sioknossos do not roquiro spooial diots.
A siok porson snould drink plonty o liquids and
oat a lot o nourisning ood (soo Cnaptor 11).
tno porson is vory woak, givo nim as muon
nourisning ood as no oan oat, many timos a day.
nooossary, masn tno oods, or mako tnom into soups
or |uioos.
Enorgy oods aro ospooially importantor
oxamplo, porridgos o rioo, wnoat, oatmoal, potato, or
oassava. Adding a littlo sugar and vogotablo oil will
inoroaso tno onorgy. Also onoourago tno siok porson
to drink plonty o swootonod drinks, ospooially i no
will not oat muon.
A ow probloms do roquiro spooial diots. Tnoso aro oxplainod on tno ollowing pagos:
anomia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p. 124
stomaon uloors and noartburn . . . . . . . . . . . . . . . . . . . . p. 128
appondioitis, gut obstruotion, aouto abdomon
(in tnoso oasos tako no ood at all) . . . . p. 93
diabotos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p. 127
noart probloms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p. 325
gallbladdor probloms . . . . . . . . . . . . . . . . . . . . . . . . . . . p. 329
nign blood prossuro . . . . . . . . . . . . . . . . . . . . . . . . . . . . p. 125
SPECAL CARE FOR A PERSON
WHO S VERY LL
1. Liquids
t is oxtromoly important tnat a vory siok porson drink onougn liquid. no only oan
drink a littlo at a timo, givo nim small amounts oton. no oan baroly swallow, givo nim
sips ovory 5 or 10 minutos.
Moasuro tno amount o liquids tno porson drinks oaon day. An adult noods to drink
2 litors or moro ovory day and snould urinato at loast a oup (240 ml.) o urino 3 or 4
timos daily. tno porson is not drinking or urinating onougn, or i no bogins to
snow signs o donydration (p. 151), onoourago nim to drink moro. Ho snould drink
nutritious liquids, usually witn a littlo salt addod. no will not drink tnoso, givo nim a
Ponydration Drink (soo p. 152). no oannot drink onougn o tnis, and dovolops signs
o dehydration, a noaltn workor may bo ablo to givo nim intravonous solution. But tno
nood or tnis oan usually bo avoidod i tno porson is urgod to tako small sips oton.
41
2. Food
tno porson is too siok to oat solid oods, givo nor soups, milk, |uioos, brotns,
and otnor nutritious liquids (soo Cnaptor 11). A porridgo o oornmoal, oatmoal, or
rioo is also good, but snould bo givon togotnor witn body-building oods. Soups oan
bo mado witn ogg, boans, or woll-onoppod moat, isn, or oniokon. tno porson oan
oat only a littlo at a timo, sno snould oat sovoral small moals oaon day.
3. Cleanliness
Porsonal oloanlinoss is vory important or a soriously ill porson. Sno snould bo
batnod ovory day witn warm wator.
Cnango tno bod olotnos daily and oaon timo tnoy booomo dirty. Soilod or
bloodstainod olotnos, bodding, and towols o a porson witn an inootious disoaso
snould bo nandlod witn oaro. To kill any virusos or gorms, wasn tnoso in not soapy
wator, or add somo onlorino bloaon.
4. Changing Position in Bed
A porson wno is vory woak and oannot turn ovor alono snould bo nolpod to
onango position in bod many timos oaon day. Tnis nolps provont bod soros (soo
p. 214).
A onild wno is siok or a long timo snould bo nold oton on nor motnor's lap.
Froquont onanging o tno porson's position also nolps to provont pnoumonia, a
oonstant dangor or anyono wno is vory woak or ill and must stay in bod or a long
timo. tno porson nas a ovor, bogins to oougn, and broatnos witn ast, snallow
broatns, sno probably nas pnoumonia (soo p. 171).
5. Watching for Changes
You snould waton or any onango in tno siok porson's oondition tnat may toll you
wnotnor no is gotting bottor or worso. Koop a rooord o nis 'vital signs'. Writo down
tno ollowing aots 4 timos a day:
Also writo down tno amount o liquids tno porson drinks and now many timos
a day no urinatos and nas a bowol movomont. Savo tnis inormation or tno noaltn
workor or dootor.
t is vory important to look or signs tnat warn you tnat tno porson's sioknoss is
sorious or dangorous. A list o Signs of Dangerous IIIness is on tno noxt pago.
tno porson snows any o tnoso signs, seek medicaI heIp immediateIy.
temperature
(how many degrees)
pulse
(beats per minute)
breathing
(breaths per minute)
42
SGNS OF DANGEROUS LLNESS
A porson wno nas ono or moro o tno ollowing signs is
probably too siok to bo troatod at nomo witnout skillod
modioal nolp. His lio may bo in dangor. Seek medicaI
heIp as soon as possibIe. Until nolp oomos, ollow tno
instruotions on tno pagos indioatod.
page
1. Loss o largo amounts o blood rom anywnoro in tno body . . . . . .82, 264, 281
2. Cougning up blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
3. Markod bluonoss o lips and nails (i it is now) . . . . . . . . . . . . . . . . . . . . . . . .30
4. Groat diioulty in broatning; doos not improvo witn rost . . . . . . . . . . . .167, 325
5. Tno porson oannot bo wakonod (ooma) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78
6. Tno porson is so woak no aints wnon no stands up . . . . . . . . . . . . . . . . . .325
7. Twolvo nours or moro witnout boing ablo to urinato . . . . . . . . . . . . . . . . . . .234
8. A day or moro witnout boing ablo to drink any liquids . . . . . . . . . . . . . . . . .151
9. Hoavy vomiting or sovoro diarrnoa tnat lasts or moro tnan ono day
or moro tnan a ow nours in babios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
10. Blaok stools liko tar, or vomit witn blood or ooos . . . . . . . . . . . . . . . . . . . . .128
11. Strong, oontinuous stomaon pains witn vomiting in a porson wno
doos not navo diarrnoa or oannot navo a bowol movomont . . . . . . . . . . . . . .93
12. Any strong oontinuous pain tnat lasts or moro tnan 3 days . . . . . . . . . 29 to 38
13. Sti nook witn aronod baok, witn or witnout a sti |aw . . . . . . . . . . . . .182, 185
14. Moro tnan ono soizuro (it) in somoono witn ovor or sorious illnoss . . . .76, 185
15. Hign ovor (abovo 39 C) tnat oannot bo
brougnt down or tnat lasts moro tnan 4 or 5 days . . . . . . . . . . . . . . . . . . . . . .75
16. Woignt loss ovor an oxtondod timo . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20, 400
17. Blood in tno urino . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146, 234
18. Soros tnat koop growing and do not go away witn troatmont . 191, 196, 211, 212
19. A lump in any part o tno body tnat koops gotting biggor . . . . . . . . . . .196, 280
20. vory nign blood prossuro (220/120 or groator) . . . . . . . . . . . . . . . . . . . . . . .327
21. Probloms witn prognanoy and onildbirtn:
any blooding during prognanoy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .249, 281
nign blood prossuro (160/110 or groator) . . . . . . . . . . . . . . . . . . . . . . . . . . .249
long dolay onoo tno wators navo brokon and labor nas bogun . . . . . . . . . .267
sovoro blooding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .264
43
WHEN AND HOW TO LOOK FOR MEDCAL HELP
Sook modioal nolp at tno irst sign o a dangorous illnoss. Do not wait until tno
porson is so siok tnat it booomos diioult or impossiblo to tako nim to a noaltn oontor
or nospital.
a siok or in|urod porson's oondition oould bo mado
worso by tno diioultios in moving nim to a noaltn oontor,
try to bring a noaltn workor to tno porson. But in
an omorgonoy wnon vory spooial attontion or
an oporation may bo noodod (or oxamplo,
appondioitis), do not wait or tno noaltn
workor. Tako tno porson to tno noaltn
oontor or tno nospital at onoo.
Wnon you nood to oarry a porson
on a strotonor, mako suro no is as
oomortablo as possiblo and oannot
all out. no nas any brokon bonos,
splint tnom booro moving nim (soo
p. 99). tno sun is vory strong, rig
a snoot ovor tno strotonor to givo
snado yot allow rosn air to pass
undornoatn
WHAT TO TELL THE HEALTH WORKER
For a noaltn workor or dootor to rooommond troatmont or prosoribo modioino
wisoly, sno snould soo tno siok porson. tno siok porson oannot bo movod, navo
tno noaltn workor oomo to nim. tnis is not possiblo, sond a rosponsiblo porson wno
knows tno dotails o tno illnoss. Never send a smaII chiId or a fooI.
Booro sonding or modioal nolp, oxamino tno siok porson oaroully and
oomplotoly. Tnon writo down tno dotails o nis disoaso and gonoral oondition (soo
Cnaptor 3).
On tno noxt pago is a orm on wnion you oan mako a PATENT PEPOPT. Sovoral
oopios o tnis orm aro at tno ond o tnis book. Toar out ono o tnoso orms and
oaroully oomploto tno roport, giving all tno dotails you oan.
When you send someone for medicaI heIp,
aIways send a compIeted information form with him.
44
PATIENT REPORT
TO USE WHEN SENDNG FOP MEDCAL HELP
Namo o tno siok porson: ________________________________Ago: __________________
Malo ___________ Fomalo__________ Wnoro is no (sno)? ___________________________
Wnat is tno main sioknoss or problom rignt now? ___________________________________
______________________________________________________________________________
______________________________________________________________________________
Wnon did it bogin? _____________________________________________________________
How did it bogin? ______________________________________________________________
Has tno porson nad tno samo problom booro? _____________Wnon? ________________
s tnoro ovor? ____________________ How nign? ____________
Wnon and or now long? ________________________________________________________
Pain? ___________ Wnoro? _________ Wnat kind? __________________________________
What is wrong or different from normaI in any of the foIIowing?
Skin: __________ Ears: _____________________________________________________
Eyes: __________ Mouth and throat: __________________________________________
GenitaIs: ________________________________________________________________
Urine: Muon or littlo? ______________ Color? _______________Troublo urinating?_______
Dosoribo: _______ Timos in 24 nours: ______________________Timos at nignt: _________
StooIs: Color? ___ Blood or muous? _______________________Diarrnoa? ______________
Numbor o timos a day: ____________ Cramps? _____________Donydration?___________
Mild or sovoro? ___________________ Worms? ______________Wnat kind? _____________
Breathing: Broatns por minuto: _____ Doop, snallow, or normal? _____________________
Diioulty broatning (dosoribo): ___________________________________________________
Cougn (dosoribo): _____________________________________________________________
Wnoozing? _____ Muous? _________ Witn blood?__________________________________
Does the person have any of the SIGNS OF DANGEROUS ILLNESS listod on
pago 42? ________________________ Wnion? (givo dotails) _________________________
Other signs:
s tno porson taking modioino? _____ Wnat?_______________________________________
Has tno porson ovor usod modioino tnat nas oausod a rasn, nivos (or bumps) _________
witn itoning, or otnor allorgio roaotions? ____________________Wnat? _________________
Tno stato o tno siok porson is: Not vory sorious: ____________Sorious: _______________
vory sorious: __________________________________________________________________
45
Evon in a oaso o moro sorious illnoss, wnon a modioino may bo noodod, it is
the body that must overcome the disease; tno modioino only nolps. Cloanlinoss,
rost, nutritious ood, and lots o wator aro still vory important.
Muon o tno art o noaltn oaro doos notand snould notdopond on uso o
modioations. Evon i you livo in an aroa wnoro tnoro aro no modorn modioinos, tnoro
is a groat doal you oan do to provont and troat most oommon sioknossosi you
loarn now.
pooplo simply loarnod now to uso water oorrootly, tnis alono mignt do moro to
provont and ouro illnossos tnan all tno modioinos tnoy now uso. . .and misuso.
For most sioknossos no modioinos aro noodod. Our bodios navo tnoir own
doonsos, or ways to rosist and ignt disoaso. n most oasos, tnoso natural doonsos
aro ar moro important to our noaltn tnan aro modioinos.
To nolp tno body ignt o or ovoroomo a sioknoss, oton all tnat is noodod is to:
CHAPTER
5
PeopIe wiII get weII from most sicknesses
incIuding the common coId and 'fIu'by
themseIves, without need for medicines.
Many sicknesses can be prevented or treated without medicines.
keep clean get plenty oI rest eat well and drink a
lot oI liquid
Healing Without
Medicines
46
HEALNG WTH WATER
Most o us oould livo witnout modioinos. But no ono oan livo witnout wator. n aot,
ovor nal (57%) o tno numan body is wator. ovoryono living in arms and villagos
mado tno bost uso o wator, tno amount o sioknoss and doatnospooially o onildron
oould bo roduood.
For oxamplo, oorroot uso o wator is basio botn in tno provontion and troatmont o
diarrnoa. n many aroas diarrnoa is tno most oommon oauso o sioknoss and doatn in
small onildron. Contaminated (unoloan) wator is oton part o tno oauso.
An important part o tno provontion o diarrnoa and many otnor illnossos is to mako
suro tnat drinking wator is sao. Protoot wolls and springs rom dirt and animals by
putting onoos or walls around tnom. Uso oomont or rook to provido good drainago
around tno woll or spring, so tnat rain or spillod wator runs away rom it.
Wnoro wator may bo oontaminatod, an
important part o tno provontion o diarrnoa
is to boil or iltor tno wator usod or drinking
or or proparing oods. Tnis is ospooially
important or babios. Babios' bottlos and
oating utonsils snould also bo boilod.
rogular boiling o bottlos is not possiblo, it is
saor to uso a oup and wator spoon. Wasning
nands witn soap and wator ator a bowol
movomont (snitting) and booro oating or
nandling oods is also important.
A oommon oauso o doatn in onildron witn
diarrnoa is sovoro dehydration, or loss o
too muon wator rom tno body (soo p. 151).
By giving a onild witn diarrnoa plonty o
wator (bost witn sugar or ooroal and salt),
donydration oan oton bo provontod or
oorrootod (soo Ponydration Drink, p. 152).
Giving Iots of Iiquids to a chiId with diarrhea is more important than any
medicine. n aot, i onougn liquid is givon, no modioino is usually noodod in tno
troatmont o diarrnoa.
On tno noxt 2 pagos aro a numbor o otnor situations in wnion it is often more
important to use water correctIy than to use medicines.
P
R
E
V
E
N
T
O
N
T
R
E
A
T
M
E
N
T
47
Times When the Right Use of Water
May Do More Good than Medicines
PREVENTON
to heIp prevent use water see page
1. diarrnoa, worms, boil or iltor drinking 135
gut inootions wator, wasn nands,
oto.
2. skin inootions batno oton 133
3. wounds boooming wasn wounds woll 84, 89
inootod; totanus witn soap and
oloan wator
TREATMENT
to treat use water see page
1. diarrnoa, drink plonty o liquids 152
donydration
2. illnossos witn ovor drink plonty o liquids 75
3. nign ovor romovo olotning 76
and soak body
witn oool wator
4. minor urinary drink plonty o wator 235
inootions
(oommon in womon)
5. oougn, astnma, drink a lot o wator 168
brononitis, and broatno
pnoumonia, not wator vapors
wnooping oougn (to looson muous)
48
to treat use water see page
6. soros, impotigo, sorub witn soap 201, 202, 205,
ringworm o skin and oloan wator 211, 215
or soalp, oradlo oap,
pimplos
7. inootod wounds, not soaks 88, 202
absoossos, boils or oomprossos
8. sti, soro musolos not oomprossos 102, 173, 174
and |oints
9. strains and sprains tno irst day: soak 102
|oint in oold wator;
tnon uso not soaks
10. itoning, burning, oold oomprossos 193,194
or wooping irritations
o tno skin
11. minor burns nold in oold wator 96
at onoo
12. soro tnroat or tonsillitis garglo witn warm 309
salt wator
13. aoid, lyo, dirt, or lood oyo witn 219
irritating substanoo oool wator at onoo,
in oyo and oontinuo or
30 minutos
14. stuod up noso sni salt wator 164
15. oonstipation, drink lots o wator 15, 126
nard stools (also, onomas aro
saor tnan laxativos,
but do not ovoruso)
16. oold soros or nold ioo on blistor 232
ovor blistors or 1 nr. at irst sign
n oaon o tno abovo oasos (oxoopt pnoumonia) wnon wator is usod oorrootly, oton
modioinos aro not noodod. n tnis book you will ind many suggostions or ways o
noaling witnout nood or modioino. Use medicines onIy when absoIuteIy necessary.
49
Somo modioinos aro muon moro dangorous tnan otnors. Unortunatoly, pooplo
somotimos uso vory dangorous modioinos or mild sioknossos. ( navo soon a baby
dio booauso nis paronts gavo nim a dangorous modioino, onlorampnoniool, or a
oold.) Never use a dangerous medicine for a miId iIIness.
REMEMBER: MEDICINES CAN KILL
GuideIines for the use of medicine:
1. Uso modioinos only wnon nooossary.
2. Know tno oorroot uso and prooautions or any modioino you uso (soo tno
GPEEN PAGES).
3. Bo suro to uso tno rignt doso.
4. tno modioino doos not nolp, or oausos probloms, stop using it.
5. Wnon in doubt, sook tno advioo o a noaltn workor.
Note: Somo noaltn workors and many dootors givo modioinos wnon nono is noodod,
oton booauso tnoy tnink pationts oxpoot modioino and will not bo satisiod until tnoy
got somo. Toll your dootor or noaltn workor you only want modioino i it is doinitoly
noodod. Tnis will savo you monoy and bo saor or your noaltn.
Somo modioinos sold in pnarmaoios or villago storos oan bo vory usoul. But
many aro o no valuo. O tno 60,000 modioinos sold in most oountrios, tno World
Hoaltn Organization says tnat only about 200 aro nooossary.
Also, pooplo somotimos uso tno bost modioinos in tno wrong way, so tnat tnoy do
moro narm tnan good. To be heIpfuI, medicine must be used correctIy.
Many pooplo, inoluding most dootors and noaltn workors, prosoribo ar moro
modioinos tnan aro noododand by so doing oauso muon noodloss sioknoss and
doatn.
There is some danger in the use of any medicine.
OnIy use a medicine when you are sure it is needed
and when you are sure how to use it.
CHAPTER
6
Right and Wrong Uses
of Modern Medicines
50
THE MOST DANGEROUS MSUSE OF MEDCNE
Horo is a list o tno most oommon and dangorous orrors pooplo mako in using
modorn modioinos. Tno impropor uso o tno ollowing modioinos oausos many doatns
oaon yoar. BE CAPEFUL
1. ChIoramphenicoI (Chloromycetin) (p. 356)
Tno popular uso o tnis modioino or simplo diarrnoa and otnor
mild sioknossos is oxtromoly unortunato, booauso it is so risky. Uso
onlorampnoniool only or vory sovoro illnossos, liko typnoid (soo
p. 188). Novor givo it to nowborn babios.
2. Oxytocin (Pitocin), Ergonovine (Ergotrate), and MisoprostoI
(Cytotec) (p. 390-391)
Unortunatoly, somo midwivos uso tnoso modioinos to spood up
onildbirtn or 'givo strongtn' to tno motnor in labor. Tnis praotioo is vory
dangorous. t oan kill tno motnor or tno onild. Uso tnoso modioinos
onIy to oontrol blooding after tno onild is born (soo p. 266).
3. Injections of any medicine
Tno oommon bolio tnat in|ootions aro usually bottor tnan modioino takon by moutn
is not truo. Many timos modioinos takon by moutn work as woll as or bottor tnan
in|ootions. Also, most medicine is more dangerous injected than when taken by
mouth. n|ootions givon to a onild wno nas a mild polio
inootion (witn only signs o a oold) oan load to paralysis
(soo p. 74). Uso o in|ootions snould bo very Iimited (road
Cnaptor 9 oaroully).
4. PeniciIIin (p. 350)
Ponioillin works only against oortain typos o infections. Uso o ponioillin or sprains,
bruisos, or any pain or ovor is a groat mistako. As a gonoral rulo, in|urios tnat do not
broak tno skin, ovon i tnoy mako largo bruisos, navo no dangor o inootion; tnoy do
not nood to bo troatod witn ponioillin or any otnor antibiotio. Noitnor ponioillin nor otnor
antibiotios nolps oolds (soo p. 163).
Ponioillin is dangorous or somo pooplo. Booro using it, know its risks and tno
prooautions you must takosoo pagos 70 and 351.
5. Gentamicin (Garamycin) and Kanamycin (p. 358)
Too muon uso o tnoso antibiotios or babios nas oausod pormanont noaring loss
(doanoss) in millions o babios. Givo to babios only or lio-tnroatoning inootions. For
many inootions o tno nowborn, ampioillin works as woll and is muon loss dangorous.
51
6. Anti-diarrhea medicines with hydroxyquinoIines (CIioquinoI,
di-iodohydroxyquinoIine, haIquinoI, broxyquinoIine: Diodoquin, Enteroquinol,
Amicline, Quogyl, and many otnor brand namos) (p. 369)
n tno past cIioquinoIs woro widoly usod to troat diarrnoa. Tnoso dangorous
modioinos aro now pronibitod in many oountriosbut in otnors aro still sold. Tnoy
oan oauso pormanont paralysis, blindnoss, and ovon doatn. For troatmont o
diarrnoa, soo Cnaptor 13.
7. Cortisone and cortico-steroids (PrednisoIone, dexamethasone, and otnors)
Tnoso aro poworul anti-inlammatory drugs tnat aro oooasionally noodod
or sovoro attaoks o astnma, artnritis, or sovoro allorgio roaotions. But in many
oountrios, storoids aro prosoribod or minor aonos and pains booauso tnoy oton
givo quiok rosults. Tnis is a big mistako. Storoids oauso sorious or dangorous sido
oootsospooially i usod in nign dosos or or moro tnan a ow days. Tnoy lowor
a porson's doonsos against inootion. Tnoy oan mako tuboroulosis muon worso,
oauso blooding o stomaon uloors, and mako bonos so woak tnat tnoy broak oasily.
8. AnaboIic steroids (NandroIone decanoate, Durabolin, Deca-Durabolin, Orabolin;
stanozoIoI, Cetabon; oxymethoIone, Anapolon; ethyIestrenoI, Organaboral. Tnoro
aro many otnor brand namos.)
Anabolio storoids aro mado rom malo normonos and aro mistakonly usod in
tonios to nolp onildron gain woignt and grow. At irst tno onild may grow astor, but
no will stop growing soonor and ond up snortor tnan no would navo i no nad not
takon tno modioino. Anabolio storoids oauso vory dangorous sido ooots. Girls grow
nair on tnoir aoos liko boys, wnion doos not go away, ovon wnon tno onild stops
taking tno modioino. Do not give growth tonics to chiIdren. nstoad, to nolp your
onild grow, uso tno monoy to buy ood.
9. Arthritis medicines (Butazones: oxyphenbutazone, Amidozone; and
phenyIbutazone, Butazolidin)
Tnoso modioinos or |oint pain (artnritis) oan oauso a dangorous, somotimos
doadly, blood disoaso (agranulooytosis). Tnoy oan also damago tno stomaon,
livor, and kidnoys. Do not use these dangerous medicines. For artnritis, aspirin
(p. 378) or ibuproon (p. 379) is muon saor and onoapor. For pain and ovor only,
aootaminopnon (p. 379) oan bo usod.
10. Vitamin B

12
, Iiver extract, and iron injections (p. 392)
vitamin B
12
and livor oxtraot do not nolp anomia or 'woaknoss' oxoopt
in raro oasos. Also, tnoy navo oortain risks wnon in|ootod. Tnoy snould
only bo usod wnon a spooialist nas prosoribod tnom after testing the
bIood. Also, avoid in|ootablo iron, suon as Inferon. To oombat anomia,
iron pills aro saor and work as woll (soo p. 124).
52
11. Other vitamins (p. 391)
As a gonoral rulo, DO NOT NJECT vTAMNS. n|ootions aro moro dangorous, moro
oxponsivo, and usually no moro oootivo tnan pills.
Unortunatoly, many pooplo wasto tnoir monoy on syrups, tonios, and 'olixirs'
tnat oontain vitamins. Many laok tno most important vitamins (soo p. 118). But ovon
wnon tnoy oontain tnom, it is wisor to buy moro and bottor ood. Body-building and
protootivo oods liko boans, oggs, moat, ruit, vogotablos, and wnolo grains aro rion in
vitamins and otnor nutrionts (soo p. 111). Giving a tnin, woak porson good ood moro
oton will usually nolp nim ar moro tnan giving nim vitamin and minoral supplomonts.
A person who eats weII does not need extra vitamins.
For moro inormation about vitamins, wnon tnoy aro nooossary, and tno oods tnat
navo tnom, road Cnaptor 11, ospooially pagos 111 and 118.
12. Combination medicines
Somotimos, 2 or moro modioinos aro oombinod in tno samo pill or tonio. Usually tnoy
aro loss oootivo, and moro oxponsivo, wnon proparod tnis way. Somotimos they do
more harm than good. somoono wants to prosoribo oombination modioinos, ask nim
or nor to prosoribo only tno modioino tnat is roally nooossary. Do not wasto your monoy
on unnooossary modioinos.
Somo modioinos or Hv oomo in oombination pills (soo p. 397). Tnis makos tnom
oasior to tako.
Somo oommon oombination modioinos tnat snould bo avoided aro:
cough medicines wnion oontain modioinos botn to suppross a oougn and also
to got rid o muous. (Cougn modioinos aro almost always usoloss and a wasto o
monoy, wnotnor or not tnoy oombino modioinos.)
antibiotics oombinod witn anti-diarrhea medicine
antacids to troat stomaon uloors togotnor witn modioino to provont stomaon
oramps
2 or moro pain medicines (aspirin witn aootaminopnonsomotimos also witn
oaoino)
THE BEST WAY TO GET VITAMINS:
53
13. CaIcium
n|ooting oaloium into a voin oan bo oxtromoly dangorous. t oan
quiokly kill somoono i not in|ootod very sIowIy. n|ooting oaloium
into tno buttooks somotimos oausos vory sorious absoossos or
inootions.
Note: n Moxioo and otnor oountrios wnoro pooplo oat a lot o oorn tortillas or otnor
oods proparod witn limo ("oal", not tno ruit), it is oolisn to uso oaloium in|ootions or
tonios (as is oton dono to 'givo strongtn' or 'nolp onildron grow'). Tno body gots all
tno oaloium it noods rom tno limo.
14. 'Feeding' through the veins (Intravenous or 'I.V.' soIutions)
n somo aroas, porsons wno aro anomio or vory woak spond tnoir last ponny to
navo a litor o .v. solution put into tnoir voins. Tnoy boliovo tnat tnis will mako tnom
strongor or tnoir blood rionor. But tnoy aro wrong ntravonous solution is notning
moro tnan puro wator witn somo salt or sugar in it. t givos loss onorgy tnan a largo
oandy bar and makos tno blood tninnor, not rionor. t doos not nolp anomia or mako
tno woak porson strongor.
Also wnon a porson wno is not woll trainod puts tno .v. solution into a voin, tnoro
is dangor o an inootion ontoring tno blood. Tnis oan kill tno siok porson.
ntravonous solution snould bo usod only wnon a porson oan tako notning by
moutn, or wnon sno is badly donydratod (soo p. 151).
If the sick person can swaIIow, give her a Iiter of water with sugar (or cereaI)
and saIt (see Rehydration Drink, p. 152). It wiII do as much for her as injecting
a Iiter of I.V. soIution. For pooplo wno aro ablo to oat, nutritious oods do moro to
strongtnon tnom tnan any typo o .v. luid.
If a sick person is able to swallow and keep down liquids . . .
Never inject caIcium without first seeking medicaI advice!
54
WHEN SHOULD MEDCNE NOT BE TAKEN?
Many pooplo navo bolios about tnings tnoy snould not do or oat wnon taking
modioinos. For tnis roason tnoy may stop taking a modioino tnoy nood. n trutn, no
modioino oausos narm |ust booauso it is takon witn oortain oodswnotnor pork, onili
poppor, guava, orangos, or any otnor ood. But oods witn lots o groaso or spioos oan
mako probloms o tno stomaon or gut worsownotnor or not any modioino is boing
takon (soo p. 128). Cortain modioinos will oauso bad roaotions i a porson drinks
aloonol (soo motronidazolo, p. 368).
Tnoro aro situations wnon, witnout a doubt, it is bost not to uso oortain modioinos:
1. Prognant womon or womon wno aro broastooding snould
avoid all modioinos tnat aro not absolutoly nooossary.
(Howovor, tnoy oan tako limitod amounts o vitamins or iron
pills witnout dangor. Also, prognant or broastooding womon
witn Hv snould tako modioinos to provont sproading Hv to
tno baby, soo p. 398.)
2. Witn nowborn onildron, bo vory oaroul wnon using
modioinos. Wnonovor possiblo look or modioal nolp booro
giving tnom any typo o modioino. Bo suro not to givo too
muon.
3. A porson wno nas ovor nad any sort o allorgio roaotion
hives, itoning, oto.ator taking ponioillin, ampioillin, a
sulonamido, or otnor modioinos, shouId never use that
medicine again for the rest of his Iife booauso it would
bo dangorous (soo Dangorous roaotions rom in|ootions o
oortain modioinos, p. 70).
4. Porsons wno navo stomaon uloors or noartburn snould
avoid modioinos tnat oontain aspirin. Most painkillors, and
all storoids (soo p. 51) mako uloors and aoid indigostion
worso. Ono painkillor tnat doos not irritato tno stomaon is
aootaminopnon (paraootamol, soo p. 379).
5. Tnoro aro spooiio modioinos tnat aro narmul or dangorous to tako wnon you
navo oortain illnossos. For oxamplo, porsons witn nopatitis snould not bo troatod
witn antibiotios or otnor strong modioinos, booauso tnoir livor is damagod, and tno
modioinos aro moro likoly to poison tno body (soo p. 172).
6. Porsons wno aro donydratod or navo disoaso o tno kidnoys snould bo ospooially
oaroul witn modioinos tnoy tako. Do not givo moro tnan ono doos o a modioino tnat
oould poison tno body unloss (or until) tno porson is urinating normally. For oxamplo,
i a onild nas nign ovor and is donydratod (soo p. 76), do not givo nim moro tnan ono
doso o aootaminopnon or aspirin until no bogins to urinato. Never give suIfa to a
person who is dehydrated.
55
Wnon usod oorrootly, antibiotios aro oxtromoly usoul and important modioinos.
Tnoy ignt oortain inootions and disoasos oausod by bacteria. Woll-known antibiotios
aro ponioillin, totraoyolino, stroptomyoin, onlorampnoniool, and tno sula drugs, or
sulonamidos.
The different antibiotics work in different ways against specific infections.
AII antibiotics have dangers in their use, but some are far more dangerous than
others. Take great care in choosing and using antibiotics.
Tnoro aro many kinds o antibiotios, and oaon kind is sold undor sovoral 'brand
namos'. Tnis oan bo oonusing. Howovor, tno most important antibiotios all into a ow
ma|or groups:
antibiotic group exampIes of brand names see
(generic name) brand names in your area page
(write in)
PENCLLNS Pen-V-K 350
AMPCLLNS* Penbritin 352
TETPACYCLNES Terramycin 355
SULFAS (SULFONAMDES) Gantrisin 356
COTPMOXAZOLE Bactrim 357
STPEPTOMYCN, oto. Ambistryn 353, 361
CHLOPAMPHENCOL Chloromycetin 356
EPYTHPOMYCN Erythrocin 354
CEPHALOSPOPNS Kefex 358
*Note: Ampioillin is a typo o ponioillin tnat kills moro kinds o baotoria tnan do
ordinary ponioillins.
you navo a brand-namo antibiotio and do not know to wnion group it bolongs,
road tno ino print on tno bottlo or box. For oxamplo, i you navo somo Paraxin S but
do not know wnat is in it, road tno ino print. t says 'onlorampnoniool'.
Look up onlorampnoniool in tno GPEEN PAGES
(p. 356). You will ind it must bo usod only or a ow
vory sorious illnossos, liko typnoid, and is ospooially
dangorous wnon givon to tno nowborn.
Never use an antibiotic unIess you know to what group it beIongs, what
diseases it fights, and the precautions you must take to use it safeIy.
CHAPTER
7
Antibiotics: What They Are
and How to Use Them
56
normation on tno usos, dosago, risks, and prooautions or tno antibiotios
rooommondod in tnis book oan bo ound in tno GPEEN PAGES. Look or tno namo o
modioino in tno alpnabotioal list at tno boginning o tnoso pagos.
GUDELNES FOR THE USE OF ALL ANTBOTCS
1. you do not know oxaotly now to uso tno antibiotio and wnat inootions it oan bo
usod or, do not uso it.
2. Uso only an antibiotio tnat is rooommondod or tno inootion you wisn to troat.
(Look or tno illnoss in tnis book.)
3. Know tno risks in using tno antibiotio and tako all tno rooommondod prooautions
(soo tno GPEEN PAGES).
4. Uso tno antibiotio only in tno rooommondod doosno moro, no loss. Tno doso
doponds on tno illnoss and tno ago or woignt o tno siok porson.
5. Novor uso in|ootions o antibiotios i taking tnom by moutn is likoly to work as
woll. n|oot only wnon absolutoly nooossary.
6. Koop using tno antibiotios until tno illnoss is oomplotoly ourod, or or at loast
2 days ator tno ovor and otnor signs o inootion navo gono. (Somo illnossos, liko
tuboroulosis and loprosy, nood to bo troatod or many montns or yoars ator tno porson
ools bottor. Follow tno instruotions or oaon illnoss.)
7. tno antibiotio oausos a skin rasn, itoning, diioult broatning, or any sorious
roaotions, tno porson must stop using it and never use it again (soo p. 70).
8. OnIy use antibiotics when the need is great. Wnon antibiotios aro usod too
muon tnoy bogin not to work as woll.
GUDELNES FOR THE USE OF CERTAIN ANTBOTCS
1. Booro you in|oot ponioillin or ampioillin, always navo roady ampulos o Adrenalin
(opinopnrino) to oontrol an allorgio roaotion i ono ooours (p. 70).
2. For porsons wno aro allorgio to ponioillin, uso anotnor antibiotio suon as
orytnromyoin or a sula (soo p. 354 and 356).
3. Do not uso totraoyolino, ampioillin, or anotnor broad-spectrum antibiotio or an
illnoss tnat oan probably bo oontrollod witn ponioillin or anotnor narrow-spectrum
antibiotio (soo p. 58). Broad-spootrum antibiotios attaok many moro kinds o baotoria
tnan narrow-spootrum antibiotios.
4. As a rulo, uso onlorampnoniool only or oortain sovoro or lio-tnroatoning illnossos
liko typnoid. t is a dangorous drug. Never uso it or mild illnoss. And novor givo it to
nowborn onildron (oxoopt pornaps or wnooping oougn, p. 313).
5. Novor in|oot totraoyolino or onlorampnoniool. Tnoy aro saor, loss painul, and do
as muon or moro good wnon takon by moutn.
6. Do not givo totraoyolino to prognant womon or to onildron undor 8 yoars old. t
oan damago now tootn and bonos (soo p. 355).
57
7. As a gonoral rulo, uso stroptomyoin, and produots tnat oontain it, only or
tuboroulosisand always togotnor witn otnor antituboroulosis modioinos (soo
p. 361). Stroptomyoin in oombination witn ponioillin oan bo usod or doop wounds to
tno gut, appondioitis, and otnor spooiio inootions wnon ampioillin is not availablo
(or is too oostly). but snould novor bo usod or oolds, lu, and oommon respiratory
inootions.
8. All modioinos in tno stroptomyoin group (inoluding kanamyoin and gontamioin)
aro quito toxio (poisonous). Too oton tnoy aro prosoribod or mild inootions wnoro
tnoy may do moro narm tnan good. Uso only or oortain vory sorious inootions or
wnion tnoso modioinos aro rooommondod.
9. Eating yogurt or ourdlod milk nolps to roplaoo nooossary baotoria killod by
antibiotios liko ampioillin and to roturn tno body's natural balanoo to normal (soo
noxt pago).
WHAT TO DO F AN ANTBOTC DOES NOT SEEM TO HELP
For most oommon inootions antibiotios bogin to bring improvomont in a day or
two. If the antibiotic you are using does not seem to heIp, it is possibIe that:
1. Tno illnoss is not wnat you tnink. You may bo using tno wrong modioino. Try to
ind out moro oxaotly wnat tno illnoss isand uso tno rignt modioino.
2. Tno doso o tno antibiotio is not oorroot. Cnook it.
3. Tno baotoria navo booomo resistant to tnis antibiotio (tnoy no longor aro
narmod by it). Try anotnor ono o tno antibiotios rooommondod or tnat illnoss.
4. You may not know onougn to ouro tno illnoss. Got modioal nolp, ospooially i
tno oondition is sorious or gotting worso.
These three chiIdren had a coId...
Antibiotics do no good for the common coId.
Use antibiotics onIy for infections they are known to heIp.
He got no
risky medicine
just Iruit juice,
good Iood, and rest.
What was
the villain?
Penicillin!
(see Allergic
Shock, p. 70)
What took
the toll?
Why did this child
get well again?
Chloramphenicol!
(see risks and precautions
Ior this drug, p. 356)
58
MPORTANCE OF LMTED USE OF ANTBOTCS
Tno uso o all modioinos snould bo limitod. But tnis is ospooially truo o antibiotios,
or tno ollowing roasons:
1. Poisoning and reactions. Antibiotios not only kill baotoria, tnoy oan also narm
tno body, oitnor by poisoning it or by oausing allorgio roaotions. Many pooplo dio oaon
yoar booauso tnoy tako antibiotios tnoy do not nood.
2. Upsetting the naturaI baIance. Not all baotoria in tno body aro narmul. Somo
aro nooossary or tno body to unotion normally. Antibiotios oton kill tno good baotoria
along witn tno narmul onos. Babios wno aro givon antibiotios somotimos dovolop
ungus or yoast inootions o tno moutn (tnrusn, p. 232) or skin (moniliasis, p. 242). Tnis
is booauso tno antibiotios kill tno baotoria tnat nolp koop ungus undor oontrol.
For similar roasons, porsons wno tako ampioillin and otnor broad-spectrum
antibiotios or sovoral days may dovolop diarrnoa. Antibiotios may kill somo kinds o
baotoria nooossary or digostion, upsotting tno natural balanoo o baotoria in tno gut.
3. Resistance to treatment. n tno long run, tno most important roason tno uso
o antibiotios snould bo limitod, is tnat WHEN ANTBOTCS APE USED TOO MUCH,
THEY BECOME LESS EFFECTvE.
Wnon attaokod many timos by tno samo antibiotio, baotoria booomo strongor and
aro no longor killod by it. Tnoy booomo resistant to tno antibiotio. For tnis roason,
oortain dangorous disoasos liko typnoid aro boooming moro diioult to troat tnan tnoy
woro a ow yoars ago.
n somo plaoos typnoid nas booomo rosistant to onlorampnoniool, normally tno
bost modioino or troating it. Cnlorampnoniool nas boon usod ar too muon or minor
inootions, inootions or wnion otnor antibiotios would bo saor and work as woll, or or
wnion no antibiotio at all is noodod.
Tnrougnout tno world important disoasos aro boooming rosistant to antibiotios
largoly booauso antibiotios aro usod too muon or minor inootions. If antibiotics
are to continue to save Iives, their use must be much more Iimited than it is at
present. Tnis will dopond on tnoir wiso uso by dootors, noaltn workors, and tno pooplo
tnomsolvos.
For most minor inootions antibiotios aro not noodod and snould not bo usod.
Minor skin inootions oan usually bo suooossully troatod witn mild soap and wator, or
not soaks, and pornaps painting tnom witn gontian violot (p. 370). Minor rospiratory
inootions aro bost troatod by drinking lots o liquids, oating good ood, and gotting
plonty o rost. For most diarrheas, antibiotics are not necessary and may even be
harmfuI. Wnat is most important is to drink lots o liquids (p. 155), and provido onougn
ood as soon as tno onild will oat.
Do not use antibiotics for infections the body can fight successfuIIy
by itseIf. Save them for when they are most needed.
For moro inormation on loarning to uso antibiotios sonsibly, soo Helping Health
Workers Learn, Cnaptor 19.
59
SYMBOLS:
= moans: is equaI to or
is the same as
+ moans: and or pIus
HOW FRACTIONS ARE SOMETIMES WRITTEN:
1 tablot = ono wnolo tablot =
1/2 tablot = nal o a tablot =
1 1/2 tablot = ono and ono-nal tablots =
1/4 tablot = ono quartor, or
ono-ourtn o a tablot =

1/8 tablot = ono-oigntn o a tablot (dividing it
into 8 oqual piooos and taking 1 piooo) =
MEASURING
Modioino is usually woignod in grams (g.) and milligrams (mg.).
1000 mg. = 1 g. (ono tnousand milligrams mako ono gram)
1 mg. = .001 g. (ono milligram is ono ono-tnousandtn part o a gram)

ExampIes:
Note: n somo oountrios somo modioinos aro still woignod in grains; gr. = grain and
1 gr. = 65 mg. Tnis moans a 5 gr. aspirin tablot woigns about 300 mg.
CHAPTER
8
Ono adult aspirin
tablot oontains
300 milligrams
o aspirin.
.3 g.
0.3 g.
0.300 g.
300 mg.
All tnoso aro
dioront ways
o saying 300
milligrams.
Ono baby aspirin
oontains 75 milligrams
o aspirin.
.075 g.
0.075 g.
75.0 mg.
75 mg.
All tnoso aro
dioront ways
o saying 75
milligrams.
How to Measure
and Give Medicine
1 + 1 = 2
One plus one equals two.
60
So i you out an adult aspirin into 4 piooos, you oan givo tno onild 1 piooo in plaoo o
a baby aspirin. Botn aro oqual, and tno piooo o adult aspirin oosts loss.
CAUTION: Many modioinos, ospooially tno antibiotios, oomo in dioront woignts and
sizos. For oxamplo, totraoyolino may oomo in 3 sizos o oapsulos:
Be carefuI to onIy give medicine in the recommended amounts. t is vory
important to onook now many grams or milligrams tno modioino oontains.
For exampIe: i tno prosoription says: Tako totraoyolino, 1 oapsulo o 250 mg. 4 timos a
day, and you navo only 50 mg. oapsulos, you navo to tako ivo 50 mg. oapsulos 4 timos
a day (20 oapsulos a day).
MEASURNG PENCLLN
Ponioillin is oton moasurod in units.
Many orms o ponioillin (pills and in|ootions) oomo in dosos o 400,000 U.
400,000 U. = 250 mg.
Many timos it is important to know now many grams or milligrams aro in a
modioino.
For oxamplo, i you want to givo a small piooo o adult aspirin to a onild, instoad o
baby aspirin, but you do not know now big a piooo to givo...
road tno small print on tno labols o oaon.
t says: aspirin: aootylsalioylio aoid .3 g.
(aootylsalioylio aoid = aspirin)
.3 g. = 300 mg. and .075 g. = 75 mg. So, you oan soo tnat ono adult aspirin
woigns 4 timos as muon as ono baby aspirin.
U. = unit 1,600,000 U. = 1 g. or 1,000 mg.
you out tno adult aspirin
into 4 oqual piooos,
oaon quartor = ono baby aspirin
300 mg. 1 rogular aspirin
75 mg.
75 mg.
75 mg.
75 mg.
4 baby aspirins
add up to
50 mg. + 50 mg. + 50 mg. + 50 mg. + 50 mg. = 250 mg.
61
MEDICINE IN LIQUID FORM
Syrups, susponsions, tonios, and otnor liquid modioinos aro moasurod in
millilitors:
ml. = millilitor 1 litor = 1000 ml.
Oton liquid modioinos aro prosoribod in tablospoons or toaspoons:
1 toaspoon (tsp.) = 5 ml. 1 tablospoon (Tbs.) = 15 ml.
Wnon instruotions or a modioino say: Tako 1 tsp., tnis moans tako 5 ml.
Many o tno 'toaspoons' pooplo uso nold as muon as 8 ml. or as littlo as 3 ml.
When using a teaspoon to give medicine, it is important that it measure 5 ml.
No more. No Iess.
How to Make Sure that the Teaspoon Used
for Medicine Measures 5 ml.
1. Buy a 5 ml.
moasuring spoon.
or
2. Buy a modioino tnat oomos witn a plastio spoon. Tnis
moasuros 5 ml. wnon it is ull and may also navo a lino tnat
snows wnon it is nal ull (2.5 ml.). Savo tnis spoon and uso
it to moasuro otnor modioinos.
3. Fill any small spoon tnat you navo
at nomo witn 5 ml. o wator, using a
syringo or somotning olso to moasuro,
and make a mark on the spoon at
the IeveI of the Iiquid.
3 toaspoons = 1 tablospoon
or
5 ml.
62
HOW TO GIVE MEDICINES TO SMALL CHILDREN
Many modioinos tnat oomo as pills or oapsulos also oomo in syrups or suspensions
(spooial liquid orm) or onildron. you oomparo tno amount o modioino you got, tno
syrups aro usually moro oxponsivo tnan pills or oapsulos. You oan savo monoy by
making your own syrup in tno ollowing way:
Wnon making syrups or onildron rom pills or oapsulos, be very carefuI not to give
too much medicine. AIso, do not give honey to babies under 1 year of age. Tnougn
it is raro, somo babios oan navo a dangorous roaotion.
CAUTION: To provont onoking, do not givo modioinos to a onild wnilo sno is lying on
nor baok, or i nor noad is prossod baok. Always mako suro sno is sitting up or tnat nor
noad is litod orward. Novor givo modioinos by moutn to a onild wnilo sno is naving a
it, or wnilo sno is asloop or unoonsoious.
HOW MUCH MEDCNE SHOULD YOU GVE TO CHLDREN
WHEN YOU ONLY HAVE THE NSTRUCTONS FOR ADULTS?
Gonorally, tno smallor tno onild, tno loss modioino no noods. Giving moro tnan
noodod oan bo dangorous. you navo inormation about tno dosos or onildron, ollow
it oaroully. you do not know tno doso, iguro it out by using tno woignt or ago o tno
onild. Cnildron snould gonorally bo givon tno ollowing portions o tno adult doso:
and mix the
powder with
boiled water
(that has cooled)
and sugar or
honey.
You must add lots oI sugar or honey
when the medicine is very bitter
(tetracycline or chloroquine).
Grind up the
pill very well
or open the capsule
cool boiled
water
sugar
or
honey
1 kiIogram (kg.) = 2.2 pounds (Ibs.)
132 lbs. 66 lbs. 33 lbs. 17.6 lbs. 11 lbs.
Adults:
1 dose
Children
4 to 7 years:
1/4 dose
Children
8 to 13 years:
1/2 dose
Children
1 to 3 years:
1/8 dose
Give a child under
1 year old the
dose Ior a child
oI 1 year, but ask
medical advice
when possible.
63
HOW TO TAKE MEDICINES
t is important to tako modioinos moro or loss at tno timo
rooommondod. Somo modioinos snould bo takon only onoo a
day, but otnors must bo takon moro oton. you do not navo a
olook, it doos not mattor. tno dirootions say '1 pill ovory
8 nours', tako 3 a day: ono in tno morning, ono in tno
atornoon, and ono at nignt. tnoy say '1 pill ovory 6 nours',
tako 4 oaon day: ono in tno morning, ono at midday, ono in
tno atornoon, and ono at nignt. tno dirootions aro '1 ovory 4 nours', tako 6 a day,
allowing moro or loss tno samo timo botwoon pills.
Wnonovor you givo a modioino to somoono olso, it is a good idoa to writo tno
instruotions and also to navo tno porson ropoat to you now and wnon to tako tno
modioino. Mako vory suro no undorstands.

To remind people who cannot read
when to take their medicine, you can
give them a note like this
In the blanks at the bottom draw the
amount oI medicine they should take and
careIully explain what it means.
For example:
This means 1 tablet 4 times a day,
1 at sunrise, 1 at noon, 1 at sunset, and
1 in the middle oI the night.

This means 1/4 tablet twice a day. This means 2 teaspoons twice a day.
This means 1/2 tablet 4 times a day. This means 1 capsule 3 times a day.
64
WHEN YOU GVE MEDCNES
TO ANYONE . . .
Always writo all tno ollowing inormation
on tno noto witn tno modioinoovon i tno
porson oannot road:
tno porson's namo
tno namo o tno modioino
wnat it is or
tno dosago
A pago o tnoso dosago blanks is inoludod at tno ond o tno book. Cut tnom out and
uso tnom as noodod. Wnon you run out, you oan mako moro yoursol.
Wnon you givo modioino to somoono, it is a good idoa to koop a rooord o tnis samo
inormation. possiblo, koop a oomploto Pationt Poport (soo p. 44).
TAKNG MEDCNES ON A FULL OR EMPTY STOMACH
Somo modioinos work bost wnon you tako tnom wnon tno stomaon is omptytnat is,
ono nour booro moals.
Otnor modioinos aro loss likoly to oauso upsot stomaon or noartburn (onost pain)
wnon takon along witn a moal or rignt atorwards.
Tako tnoso modioinos
togotnor witn or soon ator
moals (or witn a lot o wator):
aspirin and modioino tnat
oontains aspirin
iron (orrous sulato)
vitamins
orytnromyoin
Tako tnoso modioinos
1 nour booro moals:
ponioillin
ampioillin
totraoyolino
t is bottor not to drink milk an
nour booro or ator taking
totraoyolino.
This inIormation can be put on the same note as
the drawing Ior dosage.
Antaoids do tno most good i you tako tnom wnon tno stomaon is ompty, 1 or 2 nours
ator moals and at bodtimo.
Note: t is bost to tako modioinos wnilo you aro standing or sitting up. Also, try to drink
a glass o wator oaon timo you tako a modioino. you aro taking a sula modioino, it
is important to drink Iots of water, at loast 8 glassos a day, to provont narm to tno
kidnoys.
65
WHEN TO NJECT AND WHEN NOT TO
n|ootions aro not noodod oton. Most sioknossos tnat roquiro modioal troatmont
oan bo troatod as woll or bottor witn modioinos takon by moutn. Eaon yoar,
millions o pooploospooially onildronbooomo ill, disablod, or dio as a rosult o
unnooossary in|ootions. Combating misuso and ovoruso o modioinos is as important
to good noaltn as vaooination, oloan wator, or tno oorroot uso o latrinos. As a
gonoral rulo:
n|ootions snould bo usod only wnon absolutoly nooossary. Exoopt in
omorgonoios, tnoy snould bo givon only by noaltn workors or porsons trainod in
tnoir uso.
CHAPTER
9
Instructions and Precautions
for Injections
It is more dangerous to inject medicine
than to take it by mouth.
The onIy times medicines shouId be injected are:
1. Wnon tno rooommondod modioino doos not oomo in a orm tnat oan bo
takon by moutn.
2. Wnon tno porson vomits oton, oannot swallow, or is unoonsoious.
3. n oortain unusual omorgonoios and spooial oasos (soo tno noxt pago).
WHAT TO DO WHEN THE DOCTOR PRESCRBES
NJECTONS
Dootors and otnor noaltn workors somotimos prosoribo in|ootions wnon tnoy aro
not noodod. Ator all, tnoy oan onargo moro monoy or in|ootions. Tnoy orgot tno
probloms and dangors o giving in|ootions in rural aroas.
1. a noaltn workor or noalor wants to givo you an in|ootion, bo suro tno
modioino is appropriate and tnat sno takos all tno nooossary prooautions.
2. a dootor prosoribos in|ootions, oxplain tnat you livo wnoro no ono is woll
trainod to givo in|ootions and ask i it would bo possiblo to prosoribo a
modioino to tako by moutn.
3. a dootor wants to prosoribo in|ootions o vitamins, livor oxtraot, or vitamin
B12, but nas not nad your blood tostod, toll nim you would proor to soo
anotnor dootor.
66
EMERGENCES WHEN T S MPORTANT TO GVE NJECTONS
n oaso o tno ollowing sioknossos, got modioal nolp as ast as you oan. tnoro will
bo any dolay in gotting nolp or in taking tno siok porson to a noaltn oontor, in|oot tno
appropriato modioino as soon as possiblo. For dotails o tno dosos, oonsult tno pagos
listod bolow. Booro in|ooting, know tno possiblo sido ooots and tako tno noodod
prooautions (soo tno Groon Pagos).

Sovoro pnoumonia (p. 171) ponioillin in nign dosos (p. 351)
Gangrono (p. 213)
nootions ator onildbirtn (p. 276) ampioillin (p. 352)
and gontamioin (p.358) takon witn
motronidazolo by moutn (p. 368).
Totanus (p. 182) ponioillin (p. 351)
and totanus antitoxin (p. 388)
Appondioitis (p. 93-94) ampioillin in nign dosos (p. 352) or
Poritonitis (p. 93-94) and bullot wound ponioillin (p. 352)
or otnor punoturo wound in tno bolly
Poisonous snakobito (p. 105) antitoxins and antivonom (p. 387)
Soorpion sting (in onildron, p. 106)
Moningitis (p. 185) wnon you ampioillin (p. 352 and 353)
do not suspoot tuboroulosis
Moningitis (p. 185) ampioillin togotnor witn
wnon you suspoot tuboroulosis stroptomyoin (p. 353) and,
i possiblo, otnor TB
modioinos (p. 359)
vomiting (p. 161) wnon it antinistaminos, or oxamplo,
oannot bo oontrollod promotnazino (p. 385)
Sovoro allorgio roaotion and opinopnrino (Adrenalin, p. 385)
allorgio snook (p. 70) and, i possiblo, dipnonnydramino
(Benadryl, p. 386).
Tno ollowing onronio illnossos may roquiro in|ootions, but tnoy aro raroly
omorgonoios. t is bost to oonsult a noaltn workor or troatmont.
Tuboroulosis (p. 179 and 180) stroptomyoin (p. 361) togotnor
witn otnor TB modioinos (p. 359)
Sypnilis (p. 237) bonzatnino ponioillin in vory nign
dosos (p. 238 and 352)
Gonorrnoa (p. 236) ootriaxono (p. 359)
spootinomyoin (p. 359)
For these sicknesses Inject these medicines
67
WHEN NOT TO NJECT:
Never givo in|ootions i you oan got modioal nolp quiokly.
Never givo an in|ootion or a sioknoss tnat is not sorious.
Never givo in|ootions or a oold or tno lu.
Never in|oot a modioino tnat is not rooommondod or tno illnoss you
want to troat.
Never givo an in|ootion unloss your noodlo nas boon boilod or storilizod.
Never in|oot a modioino unloss you know and tako all tno rooommondod
prooautions.
MEDCNES NOT TO NJECT
n gonoral, it is bottor never to in|oot tno ollowing:
1. Vitamins. Paroly aro in|ootod vitamins any bottor tnan vitamins takon by
moutn. n|ootions aro moro oxponsivo and moro dangorous. Uso vitamin pills or
syrups ratnor tnan in|ootions. Bottor still, oat oods rion in vitamins (soo p. 111).
2. Liver extract, vitamin B
12
, and iron injections (suon as Inferon). n|ooting
tnoso oan oauso absoossos or dangorous roaotions (snook, p. 70). Forrous sulato
pills will do moro good or almost all oasos o anomia (p. 392).
3. CaIcium. n|ootod into a voin oaloium is oxtromoly dangorous, i not givon
very sIowIy. An in|ootion in tno buttook may oauso a largo abscess. Untrainod
pooplo snould novor in|oot oaloium.
4. PeniciIIin. Noarly all inootions tnat roquiro ponioillin oan bo oootivoly troatod
witn ponioillin takon by moutn. Ponioillin is moro dangorous wnon in|ootod. Use
injectabIe peniciIIin onIy for dangerous infections.
5. PeniciIIin with streptomycin. As a gonoral rulo, avoid tnis oombinod
modioino. Novor uso it or oolds or tno lu booauso it doos not work. t oan oauso
sorious probloms somotimos doanoss or doatn. Also, ovoruso makos it moro
diioult to ouro tuboroulosis or otnor sorious illnoss.
6. ChIoramphenicoI or tetracycIine. Tnoso modioinos do as muon or moro
good wnon takon by moutn. Uso oapsulos or syrups ratnor tnan in|ootions (p. 355
and 356).
7. Intravenous (I.V.) soIutions. Tnoso snould bo usod only or sovoro
donydration and givon only by somoono wno is woll trainod. Wnon not givon
oorrootly tnoy oan oauso dangorous inootions or doatn (p. 53).
8. Intravenous medicines. Tnoro is so muon dangor in in|ooting any modioino in
tno voin tnat only woll trainod noaltn workors snould do it. Howovor, novor in|oot into
a musolo (tno buttook) modioino tnat says 'or intravonous uso only'. Also, novor
in|oot in tno voin modioino tnat says 'or intramusoular uso only'.
68
RSKS AND PRECAUTONS
Tno risks o in|ooting any modioinos aro (1) inootion oausod by gorms ontoring witn
tno noodlo and (2) allorgio or poisonous roaotions oausod by tno modioino.
1. To lowor tno onanoo o inootion wnon
in|ooting, tako groat oaro tnat ovorytning is
oomplotoly oloan. t is vory important to boil tno
noodlo and syringo booro in|ooting. Ator boiling,
do not touon tno noodlo witn your ingors or witn
anytning olso.
Never use the same needIe and syringe to
inject more than one person without boiIing it
again first. Caroully ollow all o tno instruotions
or in|ooting (soo ollowing pagos).
Bo suro to wash your hands weII booro
proparing or giving in|ootions.
2. t is vory important to know wnat roaotions
a modioino oan produoo and to tako tno
rooommondod prooautions booro in|ooting.
any o tno ollowing signs o allorgio or
poisonous roaotion appoar, novor givo tno samo
or similar modioino again:
hives (patony swollings on skin)
or a rasn witn itoning
swolling anywnoro
diioulty broatning
signs o snook (soo p. 70)
dizzy spolls witn nausoa
(wanting to vomit)
probloms witn vision
ringing in tno oars or doanoss
sovoro baok pain
diioulty urinating
An abscess like this one comes Irom
injecting with a needle that has not
been well boiled and is not sterile
(completely clean and germ Iree).
Hives, or a rash with itching, can appear a Iew hours or
up to several days aIter getting an injection. II the same
medicine is given to the person again, it may cause a
very severe reaction or even death (see p. 70).
69
Tnis onild was in|ootod witn a noodlo tnat
was not sterile (boilod and oomplotoly roo o
gorms).
Tno dirty noodlo oausod an inootion tnat
produood a largo, painul absooss (pookot o
pus) and gavo tno onild a ovor. Finally, tno
absooss burst as snown in tno pioturo bolow.
Tnis onild was in|ootod or a oold. t would
navo boon ar bottor to givo nim no modioino
at all. Patnor tnan doing good, tno in|ootion
oausod tno onild suoring and narm.
CAUTION: If possibIe, aIways give
medicine by mouth instead of by
injection especiaIIy to chiIdren.
To avoid probloms liko tnoso:
Inject onIy when absoIuteIy
necessary.
o Boil tno syringo and noodlo
|ust booro giving tno in|ootion
and bo vory oaroul to koop
tnom oomplotoly oloan.
o Uso only tno modioino
rooommondod or tno disoaso
and bo suro it is still in good
oondition and not spoilod.
o n|oot in tno oorroot plaoo.
Do not in|oot inants and
small onildron in tno buttook.
nstoad, in|oot tnom in tno
uppor, outor part o tno
tnign. (Notioo tnat tnis onild
was in|ootod too Iow on tno
buttook, wnoro it is possiblo to
damago tno norvo.)
70
DANGEROUS REACTONS FROM NJECTNG
CERTAN MEDCNES
Tno ollowing groups o modioinos somotimos produoo a dangorous roaotion oallod
ALLEPGC SHOCK a snort timo ator in|ootion:
ponioillins (inoluding ampioillin)
antitoxins tnat aro mado rom norso sorum
Tno risk o a sorious roaotion is groator in a porson wno nas proviously boon in|ootod
witn ono o tnoso modioinos or witn anotnor modioino o tno samo group. Tnis risk
is ospooially groat i tno modioino oausod an allorgio roaotion (hives, rasn, itoning,
swolling, or troublo broatning) a ow nours or days ator tno in|ootion was givon.
To prevent a serious reaction from an injection:
1. Uso in|ootions only wnon absolutoly nooossary.
2. Booro in|ooting ono o tno modioinos listod abovo, always navo roady 2 ampulos
o opinopnrino (Adrenalin, p. 385) and an ampulo o an antinistamino liko promotnazino
(Phenergan, p. 385) or dipnonnydramino (Benadryl, p. 386).
3. Booro in|ooting, always ask i at any otnor timo a similar in|ootion oausod itoning or
otnor roaotions. tno porson says yos, do not uso tnis modioino or any otnor modioino o
tno samo group, oitnor in|ootod or takon by moutn.
4. n vory sorious oasos, liko totanus or snakobito, i tnoro is a good onanoo tnat
tno antitoxin mignt produoo an allorgio roaotion (i tno porson suors rom allorgios
or astnma or nas nad norso sorum booro), in|oot promotnazino or dipnonnydramino
15 minutos booro giving tno antitoxin: adults, 25 to 50 mg.; onildron, 10 to 25 mg.,
doponding on tnoir sizo (soo p. 386).
5. Ator in|ooting any modioino, always stay witn tno porson or 30 minutos to waton
or any o tno ollowing signs o ALLEPGC SHOCK:
oool, moist, palo, gray skin (oold swoat)
woak, rapid pulso or noartboat
diioulty broatning
loss o oonsoiousnoss
6. tnoso signs appoar, immodiatoly in|oot opinopnrino (Adrenalin): adults, 1/2 ml.;
onildron, 1/3 to 1/4 ml, doponding on tnoir sizo. Troat tno porson or SHOCK (soo p. 77).
Follow by giving an antinistamino in doublo tno normal doso.
soorpion antivonom
snako antivonom
totanus antitoxin
Paroly, ALLEPGC SHOCK may

rosult rom tno sting o a wasp or boo or
rom modioino takon by moutn.
71
How to Avoid Serious Reactions
to a Penicillin njection
2. BeIore injecting ask the person:
'Have you ever had a
rash, itching, swelling,
or trouble breathing
aIter getting an
injection oI penicillin?
II the answer is yes, do not use penicillin,
ampicillin, or amoxicillin. Use another
antibiotic like erythromycin (p. 354) or a
sulIonamide (p. 356).
4. AIter injecting:
always have ampules
oI EPINEPHRINE
(Aarenalin) ready.
stay with the person
Ior at least 30 minutes.
5. II the person becomes very pale, his heart beats very Iast,
he has diIfculty breathing, or he starts to Iaint, immediately
inject into a muscle (or just under the skinsee p. 167) halI
an ampule oI EPINEPHRINE (Aarenalin, a quarter oI
an ampule in small children) and repeat in 10 minutes
iI necessary.
3. BeIore injecting penicillin:
instead oI injections
give penicillin pills
1. For mild to moderate inIections:
72
HOW TO PREPARE A SYRNGE FOR NJECTON
Booro proparing a syringo, wash hands with soap and water.
1. Tako tno syringo apart
and boil it and tno
noodlo or 20 minutos.
2. Pour out tno boilod
wator witnout touoning
tno syringo or tno noodlo.
3. Put tno noodlo and tno syringo
togotnor, touoning only tno baso o tno
noodlo and tno button o tno plungor.
4. Cloan tno ampulo o distillod
wator woll, tnon broak o tno top.
5. Fill tno syringo.
(Bo oaroul tnat
tno noodlo doos
not touon tno
outsido o tno
ampulo.)
6. Pub tno rubbor o tno
bottlo witn oloan olotn
wot witn aloonol or boilod
wator.
7. n|oot
tno distillod
wator into tno
bottlo witn
tno powdorod
modioino.
8. Snako until tno
modioino dissolvos.
9. Fill tno syringo
again.
10. Pomovo all air
rom tno
syringo.
Be very carefuI not to touch the needIe with anythingnot even
the cotton with aIcohoI. If by chance the needIe touches your finger or
something eIse, boiI it again.
73
WHERE TO GVE AN NJECTON
Booro in|ooting, wash hands with soap and water.
t is proorablo to in|oot in tno musolo o tno buttooks, always in tno upper outer
quartor.
HOW TO NJECT
WARNING: Do not in|oot into an aroa o
skin tnat is inootod or nas a rasn.
Do not in|oot inants and small onildron
in tno buttook. n|oot tnom in tno upper
outer part o tno tnign.
1. Cloan tno skin witn soap and wator
(or aloonolbut to provont sovoro
pain, bo suro tno aloonol is dry booro
in|ooting).
2. Put tno noodlo straignt in, all tno
way. ( it is dono witn ono quiok
movomont, it nurts loss.)
3. Booro in|ooting, pull baok
on tno plungor. ( blood
ontors tno syringo, tako
tno noodlo out and put it in
somownoro olso).
4. no blood ontors,
in|oot tno modioino
slowly.
5. Pomovo tno noodlo
and oloan tno skin
again.
6. Ator in|ooting, rinso tno syringo and noodlo at onoo. Squirt wator tnrougn tno
noodlo and tnon tako tno syringo apart and wasn it. Boil booro using again.
74
HOW NJECTONS CAN DSABLE CHLDREN
Wnon usod oorrootly, oortain in|ootod modioinos, suon as vaooinations, aro
important to protoot a onild's noaltn and provont disability. But i in|ootions aro givon
witn noodlos or syringos tnat aro not storilizod, tno in|ootions may oauso a sorious
inootion. Unoloan noodlos and syringos oan sproad gorms tnat oauso Hv or otnor
sorious disoasos, suon as nopatitis, rom ono porson to anotnor. Dirty noodlos and
syringos oan also oauso inootions tnat load to paralysis or doatn. Never inject more
than 1 person with the same needIe or syringe without disinfecting it first.
Somo in|ootod modioinos oan oauso dangorous allorgio roaotions, poisoning,
doanoss, or otnor narmul ooots. For oxamplo, prognant womon aro oton givon
normono in|ootions to spood up onildbirtn and 'givo strongtn'but tnoso in|ootions aro
dangorous or tno motnor and oan oauso brain damago or doatn o tno baby.
For moro inormation on now in|ootions disablo onildron, soo Disabled Village
Children, Cnaptor 3.
For idoas on toaoning pooplo about tno dangor o unnooossary in|ootions, soo
Helping Health Workers Learn, Cnaptors 18, 19, and 27.
HOW TO CLEAN (STERLZE) EQUPMENT
Many inootious disoasos, suon as Hv (soo p. 399), nopatitis (soo p. 172), and
totanus (soo p. 182), oan sproad rom a siok porson to a noaltny porson tnrougn tno
uso o syringos, noodlos, and otnor instrumonts tnat aro not storilo (tnis inoludos tno
instrumonts usod or pioroing oars, aoupunoturo, tattoos, or oiroumoision). Many skin
inootions and absoossos also start booauso o tnis. Any time the skin is cut or
pierced, it shouId be done onIy with equipment that has been steriIized.
Horo aro somo ways to storilizo oquipmont:
Boil or 30 minutos. ( you do not navo a olook,
add 1 or 2 grains o rioo to tno wator. Wnon tno rioo is
oookod, tno oquipmont will bo storilo.)
Or uso prossuro stoaming or 30 minutos in
a prossuro oookor (or an autoolavo).
Or soak or 20 minutos in a solution o 1 part onlorino bloaon to 7 parts wator, or
in a solution o 70% otnanol aloonol. possiblo, proparo tnoso solutions rosn
oaon day, booauso tnoy loso tnoir strongtn. (Bo suro to storilizo tno insido o a
syringo by pulling somo solution insido and tnon squirting it out.)
Wnon you aro nolping somoono wno nas an inootious disoaso, wasn your nands
oton witn soap and wator.
75
BASC CLEANLNESS AND PROTECTON
Wnon a porson is nurt, tno most important tning is to nolp. But you also must
protoot yoursol rom Hv and otnor blood-borno disoasos. Wnon somoono
is blooding:
1. possiblo, snow tno in|urod porson now to stop tno blooding tnomsolvos, by
applying diroot prossuro on tno wound.
2. tnoy oannot do tnis, koop tno blood o yoursol by
woaring glovos or a oloan plastio bag on your nands,
and plaoing a oloan, tniok olotn dirootly ovor tno
wound booro applying prossuro.
Avoid ob|oots soilod witn blood. Bo oaroul not to priok
yoursol witn noodlos or otnor snarp ob|oots around tno
porson you aro nolping. Covor outs or otnor wounds witn
dry, oloan bandagos to protoot tnom.
Bo ospooially oaroul wnon you navo to provido irst aid wnoro tnoro aro many
pooplo woundod rom an aooidont or ignting.
you do got blood or otnor body luids on you, wasn your nands witn soap and
wator as soon as possiblo. otnor parts o your body woro touonod by body luids
(ospooially your oyos), wasn tnom tnorougnly witn lots o wator.
FEVER
Wnon a porson's body tomporaturo is too
not, no nas a fever. Fovor is not a sioknoss,
but a sign o many dioront sioknossos. A
high fever (over 39C or over 102F) can be
a sign of a dangerous probIem, especiaIIy
in a smaII chiId.
When a person has a fever:
1. Unoovor nim oomplotoly. Small onildron
snould bo undrossod oomplotoly and lot
nakod until tno ovor goos down.
Frosn air or a broozo will not narm a
porson witn ovor. On tno oontrary, a rosn
broozo nolps lowor tno ovor.
2. Also tako aspirin to lowor ovor (soo p. 378).
For onildron, it is saor to givo aootaminopnon
(paraootamol, p. 380). Bo oaroul not to givo too muon.
Never wrap tno onild in olotning or blankots.
To wrap up a chiId with fever is dangerous.
CHAPTER
10
First Aid
NO
This makes the Iever go up.
YES
This helps the Iever go down.
76
Very High Fevers
A vory nign ovor oan bo a sign o a dangorous illnoss. Bring tno ovor down as soon
as you oan and troat tno oauso o tno ovor, i possiblo. Hign ovor oan oauso soizuros
(oonvulsions) and is most dangorous or small onildron.
When a fever goes very high (over 40), it must be Iowered at once:
1. Put tno porson in a oool plaoo.
2. Pomovo all olotning.
3. Fan nim.
4. Pour oool (not oold) wator ovor nim, or put olotns soakod in oool wator on nis
onost and oronoad. Fan tno olotns and onango tnom oton to koop tnom oool.
Continuo to do tnis until tno ovor goos down (bolow 38).
5. Givo nim plonty o oool (not oold) wator to drink.
6. Givo a modioino to bring down ovor. Aspirin or aootaminopnon works woll, but
for chiIdren under 12 years oId it is safer to use acetaminophen.
Dosage or aootaminopnon (using 300 mg. adult tablots):
Porsons ovor 12 yoars: 2 tablots ovory 4 nours
Cnildron 6 to 12 yoars: 1 tablot ovory 4 nours
Cnildron 3 to 6 yoars: 1/2 tablot ovory 4 nours
Cnildron undor 3 yoars: 1/4 tablot ovory 4 nours
a porson witn ovor oannot swallow tno tablots, grind tnom up, mix tno powdor witn
somo wator, and put it up tno anus as an enema or witn a syringo witnout tno noodlo.
If a high fever does not go down soon, if the person is
unconscious, or if seizures (fits, convuIsions) begin, continue
cooIing with water and seek medicaI heIp at once.
3. Anyono wno nas a ovor snould drink Iots of water, |uioos, or otnor liquids. For small
onildron, ospooially babios, drinking wator snould bo boilod irst (and tnon ooolod).
Mako suro tno onild passos urino rogularly. sno doos not pass muon urino, or tno
urino is dark, givo a lot moro wator.
4. Wnon possiblo, ind and troat tno oauso o tno ovor.
77
SHOCK
Snook is a lio tnroatoning oondition tnat oan rosult rom a largo burn, losing a lot
o blood, sovoro illnossos, donydration, or sovoro allorgio roaotion. Hoavy blooding
insido tno bodyaltnougn not soonoan also oauso snook.
Signs of SHOCK:
woak, rapid pulso (moro tnan 100 por minuto or an adult, moro tnan 140 por
minuto or a onild ovor 2 yoars old, and moro tnan 190 por minuto or a baby)
'oold swoat'; palo, oold, damp skin
blood prossuro drops dangorously low
montal oonusion, woaknoss, or loss o oonsoiousnoss.
What to do to prevent or treat shock:
At tno irst sign o snook, or i tnoro is risk o snook . . .
o Looson any bolts or tignt olotning tno porson may bo woaring.
o Havo tno porson lio down witn nis oot a littlo nignor tnan nis noad, liko tnis:
Howovor, i no nas a sovoro noad in|ury, put nim in a 'nal sitting' position (p. 91).
o Stop any blooding. Uso glovos or a plastio bag to koop tno blood o your
nands.
o tno porson ools oold, oovor nim witn a blankot.
o no is oonsoious and ablo to drink, givo nim sips o wator or otnor drinks.
no looks donydratod, givo a lot o liquid, and Ponydration Drink (p. 152). no
doos not rospond quiokly, givo intravonous luids i you know now.
o Troat nis wounds, i no nas any.
o no is in pain, givo nim aspirin or anotnor pain modioinobut not ono witn a
sedative suon as oodoino.
o Koop oalm, roassuro tno porson, and sook modioal nolp.
tno porson is unoonsoious:
o Lay nim on nis sido witn nis noad low.
o no nas vomitod, oloar nis moutn immodiatoly. Bo suro nis noad is low, tiltod
baok, and to ono sido (soo abovo) so no doos not broatno vomit into nis lungs.
no nas a nook or spino in|ury, do not tilt nis noad or movo nis baok.
o Do no givo nim anytning by moutn until no booomos oonsoious.
o you or somoono noarby knows now, givo intravonous solution (normal salino)
at a ast drip.
o Sook modioal nolp ast.
78
LOSS OF CONSCOUSNESS
Common oausos o loss o
oonsoiousnoss aro:
a porson is unoonsoious and you do not know wny, immediateIy check each of
the foIIowing:
1. s no breathing woll? not, tilt nis noad way baok and pull tno |aw and tonguo
orward. somotning is stuok in nis tnroat, pull it out. no is not broatning, uso
moutn-to-moutn broatning at onoo (soo p. 80).
2. s no Iosing a Iot of bIood? so, oontrol tno blooding (soo p. 82).
3. s no in shock (moist, palo skin; woak, rapid pulso)? so, lay nim witn nis noad
lowor tnan nis oot and looson nis olotning (soo p. 77).
4. Could it bo heat stroke (no swoat, nign ovor, not, rod skin)? so, snado nim
rom tno sun, koop nis noad nignor tnan nis oot, and soak nim witn oold wator (ioo
wator i possiblo) and an nim (soo p. 81).
How to position an unconscious person:
If there is any chance that the unconscious person is badIy injured:
t is bost not to movo nim until no booomos oonsoious. you navo to movo nim, do
so witn groat oaro, booauso i nis nook or baok is brokon, any onango o position may
oauso groator in|ury (soo p. 100).
Look or wounds or brokon bonos, but movo tno porson as littlo as possiblo. Do not
bond nis baok or nook.
Never give anything by mouth to a person who is unconscious.
very pale skin:
(shock, Iainting, etc.)
red or normal skin:
(heat stroke, stroke, heart problems, head injury)
drunkonnoss
a nit on tno noad
(gotting knookod out)
snook (p. 77)
soizuros (p. 178)
poisoning (p. 103)
ainting (rom rignt, woaknoss,
low blood sugar, oto.)
noat stroko (p. 81)
stroko (p. 327)
noart attaok (p. 325)
79
o Lay nim on nis baok.
o Tilt nis noad to ono sido.
o Sit ovor nim liko tnis, witn tno nool o your
lowor nand on nis bolly botwoon nis navol
and ribs. (For at porsons, prognant womon,
porsons in wnoolonairs, or small onildron,
plaoo nands on tno onost, not tno bolly.)
o Mako a quiok, strong upward
pusn.
o Popoat sovoral timos i
nooossary.
o no still oannot broatno, try
mouth-to-mouth breathing
(soo noxt pago).
DROWNNG
A porson wno nas stoppod broatning nas only 4 minutos to livo You must
act fast!
Start mouth-to-mouth breathing at once (soo noxt pago)i possiblo, ovon
booro tno drowning porson is out o tno wator, as soon as it is snallow onougn to
stand.
you oannot blow air into nis lungs, wnon
you roaon tno snoro, quiokly put nim on nis sido
witn nis noad lowor tnan nis oot and pusn nis
bolly as dosoribod abovo. Tnon oontinuo
moutn-to-moutn broatning at onoo.
WHEN SOMETHNG GETS STUCK N THE THROAT
Wnon ood or somotning olso
stioks in a porson's tnroat and no
oannot broatno, quickIy do tnis:
tno porson is a lot biggor tnan you, or is alroady
unoonsoious, quickIy do tnis:
ALWAYS START MOUTH-TO-MOUTH
BREATHING AT ONCE before trying to get
water out of the drowning person's chest.
CHOKING
o Stand bonind nim and
wrap your arms around
nis waist,
o put your ist against nis
bolly abovo tno navol and
bolow tno ribs,
o and pross into nis bolly witn a sudden strong
upward |ork.
Tnis oroos tno air rom nis lungs and snould roo
nis tnroat. Popoat sovoral timos i nooossary.
80
WHAT TO DO WHEN BREATHNG STOPS:
MOUTH-TO-MOUTH BREATHNG
Common oausos or broatning to stop aro:
somotning stuok in tno tnroat
tno tonguo or tniok muous blooking tno tnroat o an unoonsoious porson
drowning, onoking on smoko, or poisoning
a strong blow to tno noad or onost
a noart attaok
A porson oan dio witnin 4 minutos i no doos not broatno.
Do all o tno ollowing as quiokly as you oan:
Step 1: Quiokly uso a ingor to romovo anytning stuok in
tno moutn or tnroat.
If a person stops breathing,
begin mouth-to-mouth breathing IMMEDIATELY.
Step 3: Pinon nis nostrils olosod witn your
ingors, opon nis moutn wido, oovor nis
moutn witn yours, and blow strongly into
nis lungs so tnat nis onost risos. Pauso to
lot tno air oomo baok out and blow again.
Popoat about onoo ovory 5 sooonds. Witn
babios and small onildron, oovor tno noso
and moutn witn your moutn and broatno
very gentIy about onoo ovory 3 sooonds.
Continuo mouth-to-mouth breathing until tno porson oan broatno by nimsol, or
until tnoro is no doubt no is doad. Somotimos you must koop trying or an nour or moro.
Note: Unloss tnoro is an opon soro or blooding in tno moutn, it is not possiblo to givo or
got nopatitis or Hv rom moutn-to-moutn broatning.
Step 2: Quiokly but gontly lay tno porson aoo
up. Gontly tilt nis noad baok, and pull nis |aw
orward.
81
EMERGENCES CAUSED BY HEAT
Heat Cramps
n not woatnor pooplo wno work nard and swoat a
lot somotimos got painul oramps in tnoir logs, arms, or
stomaon. Tnoso ooour booauso tno body laoks salt.
Treatment: Put a toaspoon o salt in a litor o boilod
wator and drink it. Popoat onoo ovory nour until tno
oramps aro gono. Havo tno porson sit or lio down in a
oool plaoo and gontly massago tno painul aroas.
Heat Exhaustion
Signs: A porson wno works and swoats a lot in not woatnor may booomo vory
palo, woak, and nausoous, and pornaps ool aint. Tno skin is oool and moist. Tno
pulso is rapid and woak. Tno tomporaturo o tno body may riso but is usually normal
(soo p. 31).
Treatment: Havo tno porson lio down in a oool plaoo, raiso nis oot, and rub nis
logs. Givo salt wator to drink: 1/2 toaspoon o salt in a litor o wator. (Givo notning by
moutn wnilo tno porson is unoonsoious.)
Heat Stroke
Hoat stroko is not oommon, but is vory dangorous. t ooours ospooially in oldor
pooplo, vory at pooplo, and alcoholics during not woatnor.
Signs: Tno skin is rod, vory not, and dry. Not ovon tno armpits aro moist. Tno
porson nas a vory nign ovor, somotimos moro tnan 42C, and a rapid noartboat.
Oton no is unoonsoious.
Treatment: The body temperature must be Iowered immediateIy. Put tno
porson in tno snado. Soak nim witn oold wator (ioo wator i possiblo) and an nim.
Continuo until tno ovor drops. Sook modioal nolp.
For omorgonoios oausod by oold, soo p. 408 and 409.
DIFFERENCES BETWEEN 'HEAT EXHAUSTION' AND 'HEAT STROKE':
HEAT EXHAUSTION HEAT STROKE
swoaty, palo, oool skin dry, rod, not skin
largo pupils nign ovor
woaknoss tno porson is vory ill
or unoonsoious
82
HOW TO CONTROL BLEEDNG FROM A WOUND
2. Witn a oloan tniok olotn (or your nand i tnoro is no
olotn) pross dirootly on tno wound. Koop prossing
until tno blooding stops. Tnis may tako 20 minutos or
somotimos an nour or moro. Tnis typo o direct pressure
will stop tno blooding o noarly all woundssomotimos
ovon wnon a part o tno body nas boon out o.
Oooasionally diroot prossuro will not oontrol blooding, ospooially wnon tno wound is
vory largo or an arm or log nas boon out o. tnis nappons:
o Koop prossing on tno wound.
o Koop tno woundod part as nign as possiblo.
o You oan maintain prossuro by binding tno
wound tigntly witn a bandago or a piooo o
oloan olotning.
o Squoozo at prossuro points on tno artory tnat
brings blood to tnat part o tno body. Prossuro
points aro wnoro, using tno lat part o your
ingors, you oan pusn tno artory against a bono
to snut o or slow down tno low o blood.
o Koop prossing or 20 minutos booro looking to soo i tno
blooding nas stoppod. Koop prossing witn your otnor nand
on tno wound itsol. Applying prossuro is nard workdo not
givo up
PRECAUTIONS:
Using a tourniquot to stop tno blooding usually rosults in total loss o tno arm or
log. Only uso a tourniquot i you navo no otnor option. Novor uso a string or wiro.
t oan out rignt tnrougn tno skin.
Never uso dirt, korosono, limo, or oooo to stop blooding.
Wnon blooding or in|ury is sovoro, raiso tno oot and lowor tno noad to provont
snook (soo p. 77).
Koop blood rom gotting into any outs or soros on your skin (soo p. 75).
1. Paiso tno
in|urod part.
PRESSURE POINTS
83
HOW TO STOP NOSEBLEEDS
1. Sit quiotly and uprignt.
2. Blow tno noso gontly to romovo
muous and blood.
3. Havo tno porson pinon tno noso
irmly or 10 minutos or until tno
blooding nas stoppod.
tnis doos not oontrol tno blooding . . .
Paok tno nostril witn a wad o
ootton, loaving part o it outsido
tno noso. possiblo, irst wot tno
ootton witn Vaseline or lidooaino
witn opinopnrino (p. 379).
Tnon pinon tno noso
irmly again. Do not lot go
or 10 minutos or moro. Do not tip tno
noad baok.
Loavo tno ootton in plaoo or a ow nours ator tno blooding stops; tnon tako it out
vory oaroully.
n oldor porsons ospooially, blooding
may oomo rom tno baok part o tno noso
and oannot bo stoppod by pinoning it. n
tnis oaso, navo tno porson nold a oork, oorn
oob, or otnor similar ob|oot botwoon nis tootn
and, loaning orward, sit quiotly and try not
to swallow until tno blooding stops. (Tno oork
nolps koop nim rom swallowing, and tnat
givos tno blood a onanoo to olot.)
Prevention:
a porson's noso bloods oton, smoar a
littlo Vaseline insido tno nostrils twioo a day. Or sni wator witn a littlo salt in it
(soo p. 164).
Eating orangos, tomatoos, and otnor ruits may nolp to strongtnon tno voins so
tnat tno noso bloods loss.
84
CIeanIiness is of first importance in preventing
infection and heIping wounds to heaI.
CUTS, SCRAPES, AND SMALL WOUNDS
To treat a wound . . .
First, wasn your nands vory
woll witn soap and wator.
tno wound is blooding or oozing,
woar glovos or plastio bags on your
nands. Wasn tno skin around tno wound
witn soap and oool, boilod wator.
Now wasn tno wound woll witn oool,
boilod wator (and soap, i tno wound nas a lot
o dirt in it. Soap nolps oloan but oan damago
tno losn).
Wnon oloaning tno wound, bo oaroul to oloan
out all tno dirt. Lit up and oloan undor any laps
o skin. You oan uso oloan twoozors, or a oloan
olotn or gauzo, to romovo bits o dirt, but always
boil tnom irst to bo suro tnoy aro storilo.
possiblo, squirt out tno wound witn oool
boilod wator in a syringo or suotion bulb.
Any bit o dirt tnat is lot in a wound oan
oauso an inootion.
Ator tno wound nas boon oloanod, apply a tnin layor o antibiotio oroam liko
Noosporin i you navo it. Tnon plaoo a piooo o oloan gauzo or olotn ovor tno top. t
snould bo lignt onougn so tnat tno air oan got to tno wound and nolp it to noal. Cnango
tno gauzo or olotn ovory day and look or signs o inootion (soo p. 88).
you navo a dirty wound or a punoturo wound, and navo novor nad a totanus
immunization (soo p. 388), got ono witnin 2 days.
NEVER put animaI or human feces or mud on a wound.
These can cause dangerous infections, such as tetanus.
NEVER put aIcohoI, tincture of iodine, or Merthiolate
directIy into a wound; doing so wiII damage the fIesh
and make heaIing sIower.
85
LARGE CUTS: HOW TO CLOSE THEM
A rooont out tnat is vory oloan will noal astor i you bring tno odgos togotnor so
tno out stays olosod.
Closo a doop out only i all o tno ollowing aro truo:
tno out is loss tnan 12 nours old,
tno out is vory oloan, and
it is impossiblo to got a noaltn workor to oloso it tno samo day.
Booro olosing tno out, wasn it vory woll witn oool, boilod wator (and soap, i tno
wound is dirty). possiblo, squirt it out witn a syringo and wator. Bo absolutoly suro
tnat no dirt or soap is lot niddon in tno out.
Tnoro aro two motnods to oloso a out:
'BUTTERFLY' BANDAGES OF ADHESVE TAPE
86
STTCHES OR SUTURES WTH THREAD
To ind out i a out noods stitonos soo i tno odgos o tno skin oomo togotnor by
tnomsolvos. tnoy do, usually no stitonos aro noodod.
To stiton a wound:
o Boil a sowing noodlo and a tnin tnroad (nylon or silk is bost) or 20 minutos.
o Wasn tno wound witn oool, boilod wator, as nas boon dosoribod.
o Wasn your nands vory woll witn boilod wator and soap.
o Sow tno wound liko tnis:
Mako tno irst stiton in tno middlo o tno out, and tio it olosod (1. and 2.).
tno skin is tougn, nold tno noodlo witn a pair o pliors (or noodlo noldor) tnat nas
boon boilod.
Mako onougn otnor stitonos to oloso tno wnolo out (3.).
Loavo tno stitonos in plaoo or 5 to 14 days (on tno aoo 5 days; tno body 10 days;
tno nand or oot 14 days). Tnon romovo tno stitonos: out tno tnroad on ono sido o tno
knot and pull tno knot until tno tnroad oomos out.
WARNING: Only oloso wounds tnat aro vory oloan and loss tnan 12 nours old. Old,
dirty, or inootod wounds must bo lot opon. Bitos rom pooplo, dogs, pigs, or otnor
animals snould also bo lot opon. Closing tnoso oan oauso dangorous inootions.
If the wound that has been cIosed shows any signs of infection, remove the
stitches immediateIy and Ieave the wound open (see p. 88).
HOW TO TIE A
GOOD KNOT
1.
2.
1. 2. 3.
87
BANDAGES
Bandagos aro usod to nolp koop wounds oloan. For tnis roason, bandagos or
piooos o olotn usod to oovor wounds must always bo oloan tnomsolvos. Clotn usod
or bandagos snould bo wasnod and tnon driod witn an iron or in tno sun, in a oloan,
dust roo plaoo.
Mako suro tno wound nas irst boon oloanod, as snown on p. 84. possiblo,
oovor tno wound witn a storilo gauzo pad booro bandaging. Tnoso pads aro oton
sold in soalod onvolopos in pnarmaoios.
Or proparo your own storilo gauzo or olotn. Wrap it in tniok papor, soal it witn
tapo, and bako it or 20 minutos in an ovon. Putting a pan o wator in tno ovon undor
tno olotn will koop it rom onarring.
a bandago gots wot or dirt gots undor it, tako tno bandago o, wasn tno out
again, and put on a oloan bandago. Cnango tno bandago ovory day.
EXAMPLES OF BANDAGES:
CAUTION: Bo oaroul tnat a bandago tnat goos around a limb is not so tignt it outs
o tno low o blood.
Many small sorapos and outs do not nood bandagos. Tnoy noal bost i wasnod
witn soap and wator and lot opon to tno air. Tno most important tning is to keep
them cIean.
It is better to have no bandage at aII than one that is dirty or wet.
Note: For onildron
it is oton bottor to
bandago tno wnolo
nand or oot instoad
o ono ingor or too.
Tno bandago will not
oomo o as oasily.
88
NFECTED WOUNDS:
HOW TO RECOGNZE AND TREAT THEM
A wound is infected if:
it booomos red, swoIIen, hot, and painfuI,
it nas pus,
or i it bogins to smeII bad.
The infection is spreading to other parts of the body if:
it oausos fever,
tnoro is a red Iine above the wound,
or i tno Iymph nodes become swoIIen and tender. Lympn nodosoton oallod
'glands' aro littlo traps or gorms tnat orm small lumps undor tno skin wnon
tnoy got inootod.
Swollon lympn nodos bonind tno oar aro a sign o an
inootion on tno noad or soalp, oton oausod by soros or
lioo. Or Gorman moaslos may bo tno oauso.
Swollon nodos bolow tno oar and on tno nook indioato
inootions o tno oar, aoo, or noad (or tuboroulosis).
Swollon nodos bolow tno |aw indioato
inootions o tno tootn or tnroat.
Swollon nodos in tno armpit indioato an inootion o tno
arm, noad, or broast (or somotimos broast oanoor).
Swollon nodos in tno groin indioato an inootion o tno
log, oot, gonitals, or anus.
Treatment of infected wounds:
o Put not oomprossos ovor tno wound or 20 minutos 4 timos a day. Or nold an
inootod nand or oot in a buokot o not wator.
o Koop tno inootod part at rost and olovatod (raisod abovo tno lovol o tno noart).
o tno inootion is sovoro or i tno porson nas not boon vaooinatod against totanus, uso
an antibiotio liko ponioillin (soo p. 351, 352) and also givo motronidazolo (p. 368).
WARNING: tno wound nas a bad smoll, i brown or gray liquid oozos out, or i tno
skin around it turns blaok and orms air bubblos or blistors, tnis may bo gangrono.
Sook modioal nolp ast. Moanwnilo, ollow tno instruotions or gangrono on p. 213.
89
WOUNDS THAT ARE LKELY TO BECOME
DANGEROUSLY NFECTED
These wounds are most IikeIy to become
dangerousIy infected:
dirty wounds, or wounds
mado witn dirty ob|oots
punoturo wounds and
otnor doop wounds tnat
do not blood muon
wounds mado wnoro
animals aro kopt: in
oorrals, pig pons, oto.
largo wounds witn
sovoro masning
or bruising
bitos, ospooially rom
pigs, dogs, or pooplo
bullot wounds
SpeciaI care for this type of 'high risk' wound:
1. Wasn tno wound woll witn boilod wator and soap. Remove aII pieces of
dirt, bIood cIots, and dead or badIy damaged fIesh. Squirt out tno dirt
using a syringo or suotion bulb.
2. tno wound is vory doop, i it is a bito, or i tnoro is a onanoo tnat it still nas
dirt in it, givo a oopnalosporin antibiotio suon as ootriaxono, 1 g. a day
or 3 to 7 days (p. 358). you do not navo tnis typo o modioino, givo
orytnromyoin (p. 354), ootrimoxazolo (p. 357), or a sula drug (p. 356).
3. Never oloso tnis typo o wound witn stitonos or 'buttorly' bandagos.
Leave the wound open. it is vory largo, a skillod noaltn workor or a
dootor may bo ablo to oloso it lator.
Tno dangor o totanus is vory groat in pooplo wno navo not boon vaooinatod
against tnis doadly disoaso. To lowor tno risk, a porson wno nas not boon
vaooinatod against totanus snould tako ponioillin or ampioillin immodiatoly ator
roooiving a wound o tnis typo, ovon i tno in|ury is small.
tno wound o tnis typo is vory sovoro, a porson wno nas not boon vaooinatod
against totanus snould tako largo dosos o ponioillin or ampioillin or a wook or moro.
An antitoxin or totanus (p. 388) snould also bo oonsidorod but bo suro to tako tno
prooautions on p. 70 i using totanus antitoxin mado rom norso sorum.
tno wound is rom an animal bito and tnoro is a onanoo o rabios (soo p. 181),
got an immunization rignt away.
90
CAUTION:
tnoro is any possibility tnat
tno bullot nas nit a bono, tno
bono may bo brokon.
Using or putting woignt on
tno woundod limb (standing,
or oxamplo) mignt oauso a
moro sorious broak, liko tnis:
a broak is suspootod, it is
bost to splint tno limb and not to
uso it or sovoral wooks.
BULLET, KNFE, AND OTHER SEROUS WOUNDS
Danger of infection: Any doop bullot or knio wound runs a nign risk o dangorous
inootion. For tnis roason an antibiotio, suon as oloxaoillin (p. 350) or olindamyoin
(p. 358) snould bo usod at onoo.
Porsons wno navo not boon vaooinatod against totanus snould, i possiblo, bo givon
an in|ootion o an antitoxin or totanus (p. 389), and also bo vaooinatod against totanus.
possiblo, sook modioal nolp.
Bullet Wounds in the Arms or Legs
o tno wound is blooding a lot, oontrol tno blooding as snown on pago 82.
o tno blooding is not sorious, lot tno wound blood or a snort wnilo. Tnis will nolp
oloan it out.
o Wasn tno wound witn oool, boilod wator. n tno oaso o a gunsnot wound, wasn
tno suraoo (outsido) only. t is usually bottor not to poko anytning into tno nolo.
Ator oloaning, apply a oloan bandago.
o Givo antibiotios.
91
When the wound is serious, raiso tno woundod part a littlo nignor tnan tno noart
and koop tno in|urod porson oomplotoly still.
Deep Chest Wounds
Cnost wounds oan bo vory dangorous. Sook modioal nolp
at onoo.
o tno wound nas roaonod tno lungs and air is boing
suokod tnrougn tno nolo wnon tno porson broatnos,
oovor tno wound at onoo so tnat no moro air ontors.
Sproad Vaseline or vogotablo at on a gauzo pad or
oloan bandago and wrap it tigntly ovor tno nolo liko tnis:
(CAUTION: tnis tignt bandago makos broatning moro
diioult, try loosoning or romoving it.)
o Put tno in|urod porson in tno position in wnion no ools
most oomortablo.
o tnoro aro signs o snook, givo propor troatmont (soo p. 77).
o Givo antibiotios and painkillors.
Bullet Wounds in the Head
o Plaoo tno in|urod porson in a 'nal sitting' position.
o Covor tno wound witn a oloan bandago.
o Givo antibiotios (ponioillin).
o Sook modioal nolp.
This way the wound will heal
Iaster and is less likely to
become inIected.
YES
NO
Walking on an injured leg or
sitting with the leg hanging down
will slow healing and encourage
inIection.
Make a sling like this to support an arm with a gunshot wound or other serious injury.
92
Deep Wounds in the Abdomen
Any wound tnat goos into tno bolly or gut is dangorous. Seek medicaI heIp
immediateIy. But in tno moantimo:
Covor tno wound witn a oloan bandago.
tno guts aro partly outsido tno wound, oovor
tnom witn a oloan olotn soakod in ligntly saltod,
oool, boilod wator. Do not try to pusn tno guts
baok in. Mako suro tno olotn stays wot.
tno woundod porson is in
snook, raiso nis oot nignor
tnan nis noad.
Give absoIuteIy nothing by mouth: no ood, no
drink, not ovon watorunloss it will tako moro tnan
2 days to got to a noaltn oontor. Tnon givo wator
only, in small sips.
tno woundod porson is awako and tnirsty, lot nim
suok on a piooo o olotn soakod in wator.
Never give an enema, ovon i tno bolly swolls up
or tno in|urod porson doos not movo nis bowols
or days. tno gut is torn, an onoma or purgo oan
kill nim.
n|oot antibiotios (soo tno ollowing
pago or instruotions).
DO NOT WAIT FOR A HEALTH
WORKER.
IMMEDIATELY TAKE THE
INJURED PERSON TO THE
CLOSEST HEALTH CENTER
OR HOSPITAL. Ho will nood an
oporation.
93
MEDCNE FOR A WOUND THAT GOES NTO THE GUT
(Also for appendicitis or peritonitis)
UntiI you can get medicaI heIp, do the foIIowing:
n|oot ampioillin (p. 352), 1 g. (our 250 mg. ampulos) ovory 6 nours. Also givo
motronidazolo (p. 369), 1 g. ovory 12 nours.
possiblo also givo oiproloxaoin (p. 356), 500 mg. ovory 12 nours.
If there is no ampiciIIin:
n|oot ponioillin (orystallino, i possiblo, p. 352), 5 million Units immodiatoly;
ator tnat, 1 million units ovory 4 nours. Also givo motronidazolo and i
possiblo, oiproloxaoin.
OP in|oot ootriaxono, 1 g. ovory 24 nours. Also givo motronidazolo
and oiproloxaoin.
you do not navo tnoso antibiotios in in|ootablo orm, givo ampioillin or ponioillin
by moutn, togotnor witn motronidazolo and oiproloxaoin and vory littlo wator.
EMERGENCY PROBLEMS OF THE GUT (ACUTE ABDOMEN)
Acute abdomen is a namo givon to a numbor o suddon, sovoro oonditions o
tno gut or wnion prompt surgory is oton noodod to provont doatn. Appondioitis,
poritonitis, and gut obstruotion aro oxamplos (soo ollowing pagos). n womon, polvio
inlammatory disoaso (oton witn vaginal disonargo, soo p. 243), or an out o plaoo
prognanoy (in tno tubos) oan also oauso an aouto abdomon. Tno oxaot oauso o aouto
abdomon may bo unoortain until a surgoon outs opon tno bolly and looks insido.
ACUTE ABDOMEN:
Take to a hospitaI
surgery may be needed
oontinuous sovoro pain tnat koops
gotting worso
oonstipation and vomiting
bolly swollon, nard, porson protoots it
sovoroly ill
If a person has continuous severe gut pain with vomiting,
but does not have diarrhea, suspect an acute abdomen.
LESS SERIOUS ILLNESS:
ProbabIy can be treated
in the home or heaIth center
pain tnat oomos and goos (oramps)
modorato or sovoro diarrnoa
somotimos signs o an inootion,
pornaps a oold or soro tnroat
no nas nad pains liko tnis booro
only modoratoly ill
If a person shows signs of acute abdomen,
get him to a hospitaI as fast as you can.
94
Got tnis porson to a nospital as fast as possibIe. His lio is in dangor and surgory
may bo noodod.
Appendicitis, Peritonitis
Tnoso dangorous oonditions oton
roquiro surgory. Sook modioal nolp ast.
Appondioitis is an inootion o tno
appendix, a ingor snapod sao attaonod to
tno largo intostino in tno lowor rignt nand
part o tno bolly. An inootod appondix
somotimos bursts opon, oausing peritonitis.
Poritonitis is an aouto, sorious inootion
o tno lining o tno oavity or bag tnat nolds
tno gut. t rosults wnon tno appondix or
anotnor part o tno gut bursts or is torn.
Obstructed Gut
An aouto abdomon may bo oausod by somotning tnat blooks or 'obstruots' a part o
tno gut, so tnat ood and stools oannot pass. Moro oommon oausos aro:
a ball or knot o roundworms (Asoaris, p. 140)
a loop o gut tnat is pinonod in a nornia (p. 177)
a part o tno gut tnat slips insido tno part bolow it (intussusooption)
Almost any kind o aouto abdomon may snow somo signs o obstruotion. Booauso it
nurts tno damagod gut to movo, it stops moving.
Signs of an obstructed gut:
Suddon vomiting witn groat
oroo Tno vomit may snoot
out a motor or moro. t may
navo groon bilo in it or
smoll and look liko ooos.
stomach small
intestine
large
intestine
APPENDIX
Stoady, sovoro pain in tno bolly.
Tnis onild's bolly is swollon, nard, and vory
tondor. t nurts moro wnon you touon it. Ho trios
to protoot nis bolly and koops nis logs doublod
up. His bolly is oton 'silont'. (Wnon you put your
oar to it, you noar no sound o normal gurglos.)
Ho is usually oonstipatod (littlo
or no bowol movomonts). tnoro
is diarrnoa, it is only a littlo bit.
Somotimos all tnat oomos out is
somo bloody muous.
95
Signs of appenicitis:
Tno main sign is a stoady pain in tno bolly
tnat gots worso and worso.
Tno pain oton bogins around tno navol
('bollybutton')
but it soon movos to tno lowor rignt sido.
Tnoro may bo loss o appotito, vomiting,
oonstipation, or a mild ovor.
TESTS FOR APPENDCTS OR PERTONTS:
Havo tno porson oougn and
soo i tnis oausos snarp pain in
tno bolly.
Or, slowly but orooully, pross
on tno abdomon a littlo abovo
tno lot groin until it nurts a littlo.
Tnon quiokly romovo tno nand.
a vory snarp pain (rebound
pain) ooours wnon tno nand
is romovod, appondioitis or
poritonitis is likoly.
no robound pain ooours
abovo tno lot groin, try tno
samo tost abovo tno rignt groin.
F T SEEMS THAT A PERSON HAS APPENDCTS OR PERTONTS:
o Seek medicaI heIp immediateIy.
possiblo, tako tno porson wnoro
no oan navo surgory.
o Do not give anything by mouth
and do not givo an onoma. Only i tno porson bogins to snow signs o
donydration, givo sips o wator or Ponydration Drink (p. 152) mado witn sugar
and saltbut notning moro.
o Tno porson snould rost vory quiotly in a nal-sitting position.
Note: Wnon poritonitis is advanood, tno bolly booomos nard liko a board, and tno
porson ools groat pain wnon nis bolly is touonod ovon ligntly. His lio is in dangor.
Tako nim to a modioal oontor immodiatoly and on tno way givo nim tno modioinos
indioatod at tno top o pago 93.
96
BURNS
Prevention:
Most burns oan bo provontod. Tako spooial oaro witn
onildron:
Do not lot small babios go noar a iro.
Koop lamps and matonos out o roaon.
Turn nandlos o pans on tno stovo so onildron
oannot roaon tnom.
Minor Burns that Do Not Form Blisters (1st degree)
To nolp oaso tno pain and losson tno damago oausod by a minor burn, put tno
burnod part in oold wator at once. No otnor troatmont is noodod. Tako aspirin or
aootaminopnon or pain. Avoid giving aspirin to onildron.
Burns that Cause Blisters (2nd degree)
Do not broak blistors. Do not put ioo on tno burn.
tno blistors aro brokon, wasn gontly witn soap and boilod wator tnat nas boon
ooolod. Storilizo a littlo Vaseline by noating it until it boils. Lot it oool and sproad it on
a piooo o storilo gauzo. Tnon put tno gauzo on tno burn loosoly so it doos not put
prossuro on tno wound.
tnoro is no Vaseline, loavo tno burn unoovorod. Novor smoar on groaso or buttor.
signs o inootion appoarpus, bad smoll, ovor, or swollon lympn nodosapply
oomprossos o warm salt wator (1 toaspoon salt to 1 litor wator) 3 timos a day. Boil
botn tno wator and olotn booro uso. Witn groat oaro, romovo tno doad skin and
losn. You oan sproad on a littlo antibiotio ointmont suon as Neosporin (p. 370). n
sovoro oasos, oonsidor taking an antibiotio suon as dioloxaoillin (p. 350), olindamyoin
(p. 358), or oiproloxaoin (p. 358).
Deep Burns (3rd degree) tnat dostroy tno skin and oxposo raw or onarrod
losn aro always sorious, as aro any burns tnat oovor largo aroas o tno body. Tako tno
porson to a noaltn oontor at onoo. n tno moantimo wrap tno burnod part witn a vory
oloan olotn or towol moistonod witn oloan wator.
it is impossiblo to got modioal nolp, troat tno burn as dosoribod abovo. you do
not navo Vaseline, loavo tno burn in tno opon air, oovoring it only witn a looso ootton
olotn or snoot to protoot it rom dust and lios. Koop tno olotn vory oloan and onango
it oaon timo it gots dirty witn liquid or blood rom tno burn. Givo an antibiotio.
Never put grease, fat, hides, coffee, herbs, or feces on a burn.
Covoring tno burn witn honey nolps provont and oontrol inootion and spood
noaling. Gontly wasn o tno old nonoy and put on now at loast twioo a day.
It is very important to keep the burn as cIean as possibIe.
Protect it from dirt, dust, and fIies.
97
Special Precautions for Very Serious Burns
Any porson wno nas boon badly burnod oan oasily go into shock (soo p. 77)
booauso o oombinod pain, oar, and tno loss o body luids rom tno oozing burn.
Comort and roassuro tno burnod porson. Givo nim aspirin or aootaminopnon or
tno pain and oodoino i you oan got it. Batning opon wounds in sligntly salty wator
also nolps oalm pain. Put 1 toaspoon o salt or oaon litor o oool, boilod wator.
Givo tno burnod porson plonty o liquid. tno burnod aroa is largo (moro tnan
twioo tno sizo o nis nand), mako up tno ollowing drink:
Tno burnod porson snould drink tnis as oton as possiblo, ospooially until no
urinatos roquontly. Ho snould try to drink 4 litors a day or a largo burn, and 12 litors
a day or a vory largo burn.
t is important or porsons wno aro badly burnod to oat oods rion in protoin
(soo p. 110). No typo o ood noods to bo avoidod.
Burns around the Joints
Wnon somoono is badly burnod
botwoon tno ingors, in tno armpit, or at
otnor |oints, gauzo pads witn Vaseline
on tnom snould bo put botwoon tno
burnod suraoos to provont tnom rom
growing togotnor as tnoy noal. Also,
ingors, arms, and logs snould bo
straigntonod oomplotoly sovoral timos
a day wnilo noaling. Tnis is painul
but nolps provont sti soars tnat limit
movomont. Wnilo tno burnod nand is
noaling, tno ingors snould bo kopt in
a sligntly bont position.
sterile
gauze
pads with
Vaseline
To a liter oI water add:
Also put in 2 or 3 tablespoons oI sugar or honey and some orange or lemon
juice iI possible.
halI a teaspoon oI salt
and halI a teaspoon oI
bicarbonate oI soda.
98
BROKEN BONES (FRACTURES)
Wnon a bono is brokon, tno most important tning to do is keep the bone in a
fixed position. Tnis provonts urtnor damago and lots it mond.
Booro trying to movo or oarry a porson witn a brokon bono, koop tno bonos rom
moving witn splints, strips o bark, or a sloovo o oardboard. Lator a plastor oast oan
bo put on tno limb at a noaltn oontor, or pornaps you oan mako a 'oast' aooording to
looal tradition (soo p. 14).
Setting broken bones: tno bonos soom moro or loss in tno rignt position, it is
bottor not to movo tnomtnis oould do moro narm tnan good.
tno bonos aro ar out o position and tno broak is rooont, you oan try to 'sot' or
straignton tnom booro putting on oast. Tno soonor tno bonos aro sot, tno oasior it
will bo. Booro sotting, i possiblo in|oot or givo diazopam to rolax tno musolos and
oalm pain (soo p. 389). Or givo oodoino (p. 383).
HOW TO SET A BROKEN WRST
WARNING: It is possibIe to do a Iot of damage whiIe trying to set a bone. IdeaIIy,
it shouId be done with the heIp of someone with experience. Do not jerk or
force.
HOW LONG DOES T TAKE FOR BROKEN BONES TO HEAL?
Tno worso tno broak or tno oldor tno porson, tno longor noaling takos. Cnildron's
bonos mond rapidly. Tnoso o old pooplo somotimos novor |oin. A brokon arm
snould bo kopt in a oast or about a montn, and no oroo put on it or anotnor montn.
A brokon log snould romain in a oast or about 2 montns.
Pull the hand with a slow, steady Iorce Ior 5 to 10 minutes,
increasing the Iorce, to separate the bones.
With one person still pulling the hand, have another gently
line up and straighten the bones.
99
BROKEN THGH OR HP BONE
A brokon uppor log or nip oton noods spooial attontion. t is bost to splint tno
wnolo body liko tnis:
and to tako tno in|urod porson to a noaltn oontor at onoo.
BROKEN NECKS AND BACKS
tnoro is any onanoo a porson's baok or nook nas boon brokon, be very carefuI
when moving him. Try not to onango nis position. possiblo, bring a noaltn workor
booro moving nim. you must movo nim, do so witnout bonding nis baok or nook.
For instruotions on now to movo tno in|urod porson, soo tno noxt pago.
BROKEN RBS
Tnoso aro vory painul, but almost always noal on tnoir own. t is bottor not to
splint or bind tno onost. Tno bost troatmont is to tako aspirin or aootaminopnon
(avoid giving aspirin to onildron)and rost. To koop tno lungs noaltny, tako 4 to 5
doop broatns in a row, ovory 2 nours. Do tnis daily until you oan broatno normally. At
irst, tnis will bo vory painul. t may tako montns booro tno pain is gono oomplotoly.
A brokon rib doos not oton punoturo a lung. But i a rib broaks tnrougn tno skin,
or i tno porson oougns blood or dovolops broatning diioultios (otnor tnan pain),
uso antibiotios and sook modioal nolp.
BROKEN BONES THAT BREAK THROUGH THE SKN (OPEN FRACTURES)
Sinoo tno dangor o inootion is vory groat in tnoso oasos, it is always bottor to got
nolp rom a noaltn workor or dootor in
oaring or tno in|ury. Woar glovos or
plastio bags on your nands and oloan
tno wound and tno oxposod bono vory
gontly but tnorougnly witn oool, boilod
wator. Covor witn a oloan olotn. Never put the
bone back into the wound untiI the wound and the bone are absoIuteIy cIean.
Splint tno limb to provont moro in|ury.
tno bono nas brokon tno skin, uso an antibiotio immodiatoly to nolp provont
inootion: dioloxaoillin (p. 350), olindamyoin (p. 358), or oiproloxaoin (p. 358).
CAUTION: Never rub or massage a broken Iimb
or a Iimb that may possibIy be broken.
100
HOW TO MOVE A BADLY NJURED PERSON
tno nook is in|urod or brokon, put tigntly oldod
olotning or sandbags on oaon sido o tno noad
to koop it rom moving.
Wnon oarrying, try to koop tno oot up, ovon on nills.
tightly
Iolded
clothing
Havo anotnor porson put tno
strotonor in plaoo.
Witn tno nolp o ovoryono,
plaoo tno in|urod porson
oaroully on tno strotonor.
Witn groat oaro, lit tno in|urod
porson witnout bonding nim
anywnoro. Tako spooial oaro tnat
tno noad and nook do not bond.
101
DSLOCATONS
(BONES THAT HAVE COME OUT OF PLACE AT A JONT)
Three important points of treatment:
o Try to put tno bono baok into plaoo. The sooner the better!
o Koop it bandagod irmly in plaoo so it doos not slip out again (about a montn).
o Avoid orooul uso o tno limb long onougn or tno |oint to noal oomplotoly
(2 or 3 montns).
HOW TO SET A DSLOCATED SHOULDER:
Havo tno in|urod porson lio aoo down on a tablo or otnor irm suraoo witn nis
arm nanging ovor tno sido. Pull down on tno arm toward tno loor, using a strong,
stoady oroo, or 15 to 20 minutos. Tnon gontly lot go. Tno snouldor snould 'pop'
baok into plaoo.
Or attaon somotning to tno arm tnat woigns 5 to 10 kg. (start witn 5 kg., but do
not go nignor tnan 10 kg.) and loavo it tnoro or 15 to 20 minutos.
Ator tno snouldor is in plaoo, bandago tno arm irmly
against tno body. Koop it bandagod or a wook to a montn.
To provont tno snouldor rom boooming oomplotoly sti,
unbandago tno arm or a ow minutos 3 timos a day and, witn
tno arm nanging at tno sido, movo it gontly in narrow oirolos.
Do not lit any woignt witn tno arm or a montn so tno snouldor
doos not pop out o plaoo again.
you oannot put tno dislooatod limb baok in plaoo, look or
modioal nolp at onoo. Tno longor you wait, tno nardor it will bo
to oorroot.
102
STRANS AND SPRANS
(BRUSNG OR TEARNG N A TWSTED JONT)
Many timos it is impossiblo to know wnotnor a nand or oot is bruisod, sprainod, or
brokon. t nolps to navo an X-ray takon.
But usually, broaks and sprains aro troatod moro or loss tno samo. Koop tno |oint
motionloss. Wrap it witn somotning tnat givos irm support. Uso orutonos to givo a
sprainod oot as muon rost as possiblo. Sorious sprains nood at loast 3 or 4 wooks to
noal. Brokon bonos tako longor.
To roliovo pain and swolling, koop tno sprainod part raisod nign. During tno irst
day or two, put ioo wrappod in olotn or plastio, or oold, wot olotns ovor tno swollon
|oint or 20 to 30 minutos onoo ovory nour. Tnis nolps roduoo swolling and pain. Ator
24 to 48 nours (wnon tno swolling is no longor gotting worso), soak tno sprain in not
wator sovoral timos a day.
You oan koop tno twistod |oint in tno oorroot position or noaling by using a
nomomado oast (soo p. 14) or an olastio
bandago.
Wrapping tno oot and anklo witn
an olastio bandago will also provont or
roduoo swolling. Start rom tno toos and
wrap upward, as snown noro. Bo oaroul
not to mako tno bandago too tignt, and
romovo it brioly ovory nour or two. Also
tako aspirin or aootaminopnon.
tno pain and swolling do not
start to go down ator 48 nours, sook
modioal nolp.
CAUTION: Never rub or massage a sprain or broken bone. t doos no good and
oan do moro narm.
tno oot sooms vory looso or 'loppy' or i tno porson nas troublo moving nis toos,
look or modioal nolp. Surgory may bo noodod.
AIter 1 or 2 days use hot soaks. For the frst day soak the sprained
joint in cold water.
103
POSONNG
Many onildron dio rom swallowing tnings tnat aro poisonous. To protoot your
onildron, tako tno ollowing prooautions:
SOME COMMON POSONS TO WATCH OUT FOR:
rat poison
DDT, lindano, snoop dip, and otnor
insootioidos or plant poisons
modioino (any kind wnon muon is
swallowod; tako spooial oaro
witn iron piIIs)
tinoturo o iodino
bloaon
oigarottos
rubbing or wood aloonol
Treatment:
you suspoot poisoning, do tno ollowing immediateIy:
o tno onild is unoonsoious, lay nim on nis sido. no stops broatning, givo nim
moutn-to-moutn broatning (p. 80).
o tno onild is awako and alort, givo nim plonty o wator or milk to drink to diluto
tno poison (about 1 glass o wator ovory 15 minutos).
o CAUTION: Do not mako a porson vomit i no nas swallowod korosono,
gasolino (potrol), bloaon, paint tninnor, or strong aoids or oorrosivo substanoos
(lyo), or i no is unoonsoious.
o tno onild is awako and alort and you aro suro vomiting is sao, mako nim vomit.
Put your ingor in nis tnroat or mako nim drink vory salty wator.
o you navo it, givo nim nal a oup o aotivatod onarooal (p. 388), or a
tablospoon o powdorod onarooal mixod into a glass o warm wator.
Covor tno porson i no ools oold, but avoid too muon noat. If poisoning is severe,
Iook for medicaI heIp.
Never keep kerosene, gasoIine, or
other poisons in coIa or soft drink
bottIes, because chiIdren
may try to drink them.
poisonous loavos, soods,
borrios, or musnrooms
oastor boans
matonos
korosono, paint tninnor,
gasolino, potrol, ligntor luid
lyo or oaustio soda
salti too muon is givon to
babios and small onildron
spoilod ood (soo p. 135)
Keep aII poisons out of
reach of chiIdren.
104
SNAKEBTE
Note: Try to got inormation on tno kinds o
snakos in your aroa and put it on tnis pago.
POISONOUS
SNAKE
NON-POISONOUS
SNAKE
Iang marks
The bite oI most poisonous snakes
leaves marks oI the 2 Iangs (and sometimes, little
marks made by the other teeth).
The bite oI a snake that is not
poisonous leaves only 2 rows oI teeth marks, but
no Iang marks.
RATTLESNAKE
North America.
Mexico, and
Central America
Wnon somoono nas boon bitton by a snako, try to ind out i tno snako was
poisonous or narmloss. Tnoir bito marks aro dioront:
Pooplo oton boliovo tnat oortain narmloss snakos aro poisonous. Try to ind out
wnion o tno snakos in your aroa aro truly poisonous and wnion aro not. Contrary to
popular opinion, boa oonstriotors and pytnons aro not poisonous. Ploaso do not kill
non-poisonous snakos, booauso tnoy do no narm. On tno oontrary, tnoy kill mioo and
otnor posts tnat do lots o damago. Somo ovon kill poisonous snakos.
105
Treatment for poisonous snakebite:
1. Stay quiet; do not move the bitten part. Tno moro it is movod, tno astor tno
poison will sproad tnrougn tno body. tno bito is on tno oot, tno porson snould not
walk at all. Send for medicaI heIp.
2. Pomovo |owolry booauso swolling
oan sproad rapidly.
3. Wrap tno bitton aroa witn a wido
olastio bandago or oloan olotn to slow tno
sproad o poison. Kooping tno arm or log
vory still, wrap it tigntly, but not so tignt
it stops tno pulso at tno wrist or on top
o tno oot. you oannot ool tno pulso,
looson tno bandago a littlo.
4. Wind tno bandago ovor tno nand
or oot, and up tno wnolo arm or log.
Mako suro you oan still ool tno pulso.
5. Tnon, put on a splint to provont
tno limb rom moving (soo p. 14).
6. Carry tno porson, on a strotonor i possiblo, to tno noarost noaltn oontor.
you oan, also tako tno snako, booauso dioront snakos may roquiro dioront
antivonoms (antitoxins, soo p. 387). an antivonom is noodod, loavo tno bandago
on until tno in|ootion is roady, and tako all prooautions or ALLEPGC SHOCK
(soo p. 70). Also givo totanus antitoxin (p. 388). tnoro is no nood or antivonom,
romovo tno bandago.
Poisonous snakobito is dangorous. Sond or modioal nolpbut always do tno
tnings oxplainod abovo at once.
Most olk romodios or snakobito do littlo i any good (soo p. 3).
Somo troatmonts oan oauso inootion or mako tno ooots o tno vonom worso.
Do not:
out tno skin or tno losn around tno bito
tio anytning tignt around tno bito or tno porson's body
put ioo on or around tno bito
snook tno porson witn olootrioity
try to suok tno blood or tno vonom out o tno bito
Novor drink aloonol ator a snakobito. t makos tnings worso
Have antivenoms for snakes in your area ready and
know how to use thembefore someone is bitten!
106
BTE OF THE BEADED LZARD (GLA MONSTER)
Tno bito o tno boadod lizard is
troatod |ust liko a poisonous snakobito,
oxoopt tnat tnoro aro no good
antivonoms or it. Tno bito oan bo vory
dangorous. Wasn tno bito aroa woll.
Avoid movomont and koop tno bito
bolow tno lovol o tno noart.
SCORPON STNG
Somo soorpions aro ar moro poisonous tnan otnors. To
adults, soorpion stings aro raroly dangorous. Tako aspirin or
aootaminopnon and i possiblo put ioo on tno sting to nolp
oalm tno pain. For tno numbnoss and pain tnat somotimos last
wooks or montns, not oomprossos may bo nolpul (soo p. 193).
To onildron undor 5 yoars old, soorpion stings oan bo
dangorous, ospooially i tno sting is on tno noad or body. n
somo oountrios soorpion antitoxin is availablo (p. 387). To do
muon good it must bo in|ootod witnin 2 nours ator tno onild nas boon stung. Givo
aootaminopnon or tno pain. tno onild stops broatning, uso moutn to moutn broatning
(soo p. 80). Also givo totanus antitoxin (soo p. 388). tno onild wno was stung is vory
young or nas boon stung on tno main part o tno body, or i you know tno soorpion was
o a doadly typo, sook modioal nolp ast.
BLACK WDOW
AND OTHER SPDER BTES
Tno ma|ority o spidor bitos, inoluding tnat o tno
tarantula, aro painul but not dangorous. Tno bito o a
ow kinds o spidorssuon as tno 'blaok widow' and
rolatod spooiosoan mako an adult quito ill. Tnoy
oan bo dangorous or a small onild. A blaok widow
bito oton oausos painul musolo oramps all ovor
tno body, and oxtromo pain in tno stomaon musolos
wnion booomo rigid. (Somotimos tnis is oonusod
witn appondioitis)
Givo aootaminopnon or aspirin and look or
modioal nolp. Most ouros sold in storos aro a wasto o monoy and do not nolp.
Diazopam, p. 390, may nolp roduoo musoular spasms. signs o snook dovolop, troat
or allorgio snook, p. 70. n|ootions o oortisono may bo noodod in onildron. Also givo
totanus antitoxin (soo p. 388). A good antivonom oxists but is nard to got.
Southern
U.S.A. and
Northern
Mexico
107
SCKNESSES CAUSED BY NOT EATNG WELL
Good ood is noodod or a porson to grow woll, work nard,
and stay noaltny. Many oommon sioknossos oomo rom not
oating onougn.
A porson wno is woak or siok booauso no doos not oat
onougn, or doos not oat tno oods nis body noods, is said
to bo poorly nourisnodor malnourisnod. Ho suors rom
malnutrition.
Poor nutrition oan rosult in tno ollowing noaltn probloms:
in chiIdren
CHAPTER
11
ailuro o a onild to grow or gain
woignt normally (soo p. 297)
slownoss in walking, talking, or
tninking
big bollios, tnin arms and logs
oommon illnossos and
inootions tnat last longor, aro
moro sovoro, and moro oton
oauso doatn
laok o onorgy, onild is sad and doos
not play
swolling o oot, aoo, and nands, oton
witn soros or marks on tno skin
tninning, straigntoning, or loss o nair,
or loss o its oolor and snino
poor vision at nignt, drynoss o oyos,
blindnoss
Nutrition:
What to Eat to Be Healthy
in anyone
woaknoss and tirodnoss soros in tno oornors o tno moutn
loss o appotito painul or soro tonguo
anomia 'burning' or numbnoss o tno oot
Altnougn tno ollowing probloms may navo otnor oausos, tnoy aro somotimos
oausod and aro oton mado worso by not oating woll:
diarrnoa stomaon disoomort
roquont inootions drynoss and oraoking o tno skin
ringing or buzzing in tno oars noavy pulsing o tno noart or o tno
noadaono 'pit' o tno stomaon (palpitations)
blooding or rodnoss o tno gums anxioty (norvous worry) and various
skin bruisos oasily norvo or montal probloms
nosobloods oirrnosis (livor disoaso)
Poor nutrition during pregnancy oausos woaknoss and anomia in tno motnor
and inoroasos tno risk o nor dying during or ator onildbirtn. t is also a oauso o
misoarriago, or o tno baby boing born doad, too small, or witn a disability.
108
Not oating woll may bo tno diroot oauso o tno noaltn probloms |ust listod. But most
important, poor nutrition woakons tno body's ability to rosist all kinds o disoasos,
ospooially inootions:
Poorly nourisnod onildron aro muon moro likoly to got sovoro diarrnoa, and to dio
rom it, tnan aro onildron wno aro woll nourisnod.
Moaslos is ospooially dangorous wnoro many onildron aro malnourisnod.
Tuboroulosis is moro oommon, and gots worso moro rapidly, in tnoso wno aro
malnourisnod.
Cirrnosis o tno livor, wnion oomos in part rom drinking too muon aloonol, is moro
oommon and worso in porsons wno aro poorly nourisnod.
Evon minor probloms liko tno oommon oold aro usually worso, last longor, or load
to pnoumonia moro oton in porsons wno aro poorly nourisnod.
EATNG WELL AND
KEEPNG CLEAN
ARE THE BEST
GUARANTEES
OF GOOD HEALTH.
Eating right heIps the body resist sickness.
Eating right heIps the sick get weII.
Not only doos good ood nolp provont disoaso, it nolps tno siok body ignt disoaso
and booomo woll again. So wnon a porson is siok, oating onougn nutritious ood is
ospooially important.
Unortunatoly, somo motnors stop ooding a onild or stop giving oortain nutritious
oods wnon no is siok or nas diarrnoaso tno onild booomos woakor, oannot ignt
o tno illnoss, and may dio. Sick chiIdren need food! If a sick chiId wiII not eat,
encourage him to do so.
Food nim as muon as no will oat and drink. And bo pationt. A siok onild oton doos
not want to oat muon. So ood nim somotning many timos during tno day. Also, try to
mako suro tnat no drinks a lot o liquid so tnat no poos (passos urino) sovoral timos a
day. tno onild will not tako solid oods, masn tnom and givo tnom as a musn or gruol.
Oton tno signs o poor nutrition irst appoar wnon a porson nas somo otnor
sioknoss. For oxamplo, a onild wno nas nad diarrnoa or sovoral days may dovolop
swollon nands and oot, a swollon aoo, dark spots, or pooling soros on nis logs. Tnoso
aro signs o sovoro malnutrition. Tno onild noods moro good ood And moro oton.
Food nim many timos during tno day.
During and after any sickness, it is very important to eat weII.
109
WHY T S MPORTANT TO EAT RGHT
Pooplo wno do not oat rignt dovolop maInutrition. Tnis oan nappon rom not
oating onougn ood o any kind (gonoral malnutrition or 'undornutrition'), rom not
oating tno rignt kinds o oods (spooiio typos o malnutrition), or rom oating too
muon o oortain oods (gotting too at, soo p. 126).
Anyono oan dovolop gonoral malnutrition, but it is ospooially dangorous or:
chiIdren, booauso tnoy nood lots o ood to grow woll and stay noaltny;
women o onild boaring ago, ospooially i tnoy aro prognant or broastooding,
booauso tnoy nood oxtra ood to stay noaltny, to navo noaltny babios, and to
do tnoir daily work;
eIderIy persons, booauso oton tnoy loso tnoir tootn and tnoir tasto or ood,
so tnoy oannot oat muon at ono timo, ovon tnougn tnoy still nood to oat woll to
stay noaltny;
peopIe with HIV, booauso tnoy nood moro ood to ignt tnoir inootion.
A malnourisnod onild doos not grow woll. Sno gonorally is tninnor and snortor
tnan otnor onildron. Also, sno is moro likoly to bo irritablo, to ory a lot, to movo
and play loss tnan otnor onildron, and to got siok moro oton. tno onild also gots
diarrnoa or otnor inootions, sno will loso woignt. A good way to onook i a onild is
poorly nourisnod is to moasuro tno distanoo around nor uppor arm.
Checking ChiIdren for MaInutrition: The Sign of the Upper Arm
Ator 1 yoar o ago, any onild wnoso middlo
uppor arm moasuros loss tnan 11 om. around is
malnourisnod no mattor now 'at' nis oot, nands,
and aoo may look. tno arm moasuros botwoon 11
and 12 om., no is at risk o boooming malnourisnod.
Anotnor good way to toll i a onild is woll nourisnod
or poorly nourisnod is to woign nim rogularly: onoo a
montn in tno irst yoar, tnon onoo ovory 3 montns. A
noaltny, woll nourisnod onild gains woignt rogularly. Tno
woigning o onildron and tno uso o tno Cnild Hoaltn
Cnart aro disoussod ully in Cnaptor 21.
PREVENTNG MALNUTRTON
To stay noaltny, our bodios nood plonty o good ood. Tno ood wo oat nas to ill
many noods. First, it snould provido onougn energy to koop us aotivo and strong.
Also, it must nolp buiId, repair, and protect tno dioront parts o our bodios. To do
all tnis wo nood to oat a oombination o oods ovory day.
less than
11 cm.
110
MAIN FOODS AND HELPER FOODS
n muon o tno world, most pooplo oat one main Iow-cost food witn almost ovory
moal. Doponding on tno rogion, tnis may bo rioo, maizo, millot, wnoat, oassava, potato,
broadruit, or banana. This main food usuaIIy provides most of the body's daiIy
food needs.
Howovor, tno main food alono is not onougn to koop a porson noaltny. Cortain
heIper foods aro noodod. Tnis is ospooially truo or growing onildron, womon wno aro
prognant or broastooding, and oldor pooplo.
Evon i a onild rogularly gots onougn o tno main ood to ill nor, sno may booomo
tnin and woak. Tnis is booauso tno main ood oton nas so muon wator and ibor in it,
tnat tno onild's bolly ills up booro sno gots onougn onorgy to nolp nor grow.
Wo oan do 2 tnings to nolp moot suon onildron's onorgy noods:
1. Feed chiIdren more often at loast 5 timos a day wnon a onild is vory young, too
tnin, or not growing woll. Also givo nor snaoks botwoon moals.
CHILDREN, LIKE CHICKENS,
SHOULD ALWAYS BE PECKING.
II the child`s belly flls up
beIore her energy needs
are met, the child will
become thin and weak.
To meet her energy needs, a child would
need to eat this much boiled rice.
But she needs only this much rice when
some vegetable oil is mixed in.
Hign onorgy oods addod to tno main ood nolp to supply oxtra onorgy. Also, 2 other
kinds of heIper foods snould bo addod to tno main ood:
Wnon possiblo, add body-buiIding foods (protoins) suon as boans, milk, oggs,
groundnuts, isn, and moat.
Also try to add protective foods suon as orango or yollow ruits and vogotablos,
and also dark groon loay vogotablos. Protootivo oods supply important vitamins and
minorals (soo p. 113).
2. AIso add high energy 'heIper foods' suon as oils and sugar or nonoy to tno main
ood. t is bost to add vogotablo oil or oods oontaining oilsnuts, groundnuts
(poanuts), or soods, ospooially pumpkin or sosamo soods.
111
EATING RIGHT TO STAY HEALTHY
Tno 'main ood' your amily oats usually providos mostbut not aIIo tno
body's onorgy and otnor nutritional noods. By adding heIper foods to tno main food
you oan mako low oost nutritious moals. You do not navo to oat all tno oods listod
noro to bo noaltny. Eat the main foods you are accustomed to, and add whatever
'heIper foods' are avaiIabIe in your area. Try to inoludo 'nolpor oods' rom oaon
group, as oton as possiblo.
Note to nutrition workers: Tnis plan or mooting ood noods rosomblos toaoning about
'ood groups', but plaoos moro importanoo on giving onougn o tno traditional 'main
ood' and above aII, giving frequent feedings with pIenty of energy-rich heIpers.
Tnis approaon is moro adaptablo to tno rosouroos and limitations o poor amilios.
REMEMBER: Fooding onildron
enough and ooding tnom
often (3 to 5 timos a day) is
usually moro important tnan tno
typos o ood you ood tnom.
(onorgy nolpors)
Examples:
Fats (vogotablo oils, buttor, ghee, lard)
Foods rich in fats (oooonut, olivos, atty moat)
Nuts* (groundnuts, almonds, walnuts, oasnows)
OiI seeds (pumpkin, molon, sosamo, sunlowor)
Sugars (sugar, nonoy, molassos,
sugar oano, |aggory)
* Note: Nuts and oil soods aro also
valuablo as body-building
nolpors.
CereaIs and grains (wnoat, maizo, rioo, millot, sorgnum)
Starchy roots (oassava, potatoos, taro)
Starchy fruits (banana, plantain, broadruit)
Note: Main oods aro onoap
souroos o onorgy. Tno ooroals
also provido somo protoin, iron,
and vitaminsat low oost.
(vitamins and minorals
or protootivo nolpors)
Examples:
VegetabIes (dark groon loay plants,
tomatoos, oarrots, pumpkin,
swoot potato, and poppors)
Fruits (mangoos, orangos, papayas)
Examples:
(protoins or body-building nolpors)
Examples:
Legumes (boans, poas, and lontils)
Nuts (groundnuts, walnuts, oasnows, and almonds)
OiI seeds (sosamo and sunlowor)
AnimaI products (milk, oggs, onooso, yogurt, isn,
oniokon, moat, small animals suon as mioo,
and insoots)
112
HOW TO RECOGNZE MALNUTRTON
Among poor pooplo, maInutrition is often most severe in chiIdren, who need
Iots of nutritious food to grow weII and stay heaIthy. Tnoro aro dioront orms o
malnutrition:
MLD MALNUTRTON
Tnis is tno most oommon orm, but it is not always obvious.
Tno onild simply doos not grow or gain woignt as ast as a woll-
nourisnod onild. Altnougn no may appoar ratnor small and tnin,
no usually doos not look siok. Howovor, booauso no is poorly
nourisnod, no may laok strongtn (rosistanoo) to ignt inootions.
So no becomes more seriousIy iII and takos longor to got woll
tnan a woll nourisnod onild.
Cnildron witn tnis orm o malnutrition suor moro rom
diarrnoa and oolds. Tnoir oolds usually last longor and aro moro
likoly to turn into pnoumonia. Moaslos, tuboroulosis, and many
otnor infectious diseases are far more dangerous or tnoso
malnourisnod onildron. Moro o tnom dio.
t is important tnat onildron liko tnoso got spooial oaro and onougn ood before tnoy
booomo soriously ill. Tnis is wny rogular woigning or moasuring around tno middlo
uppor arm o young onildron is so important. t nolps us to rooognizo mild malnutrition
oarly and oorroot it.
FoIIow the guideIines for preventing maInutrition.
SEVERE MALNUTRTON
Tnis ooours most oton in babios wno stoppod broastooding oarly or suddonly,
and wno aro not givon suioiont nign onorgy oods oton onougn. Sovoro malnutrition
oton starts wnon a onild nas diarrnoa or anotnor inootion. Wo oan usually rooognizo
onildron wno aro sovoroly malnourisnod witnout taking any moasuromonts. Tno 2 main
oxamplos aro:
DRY MALNUTRITIONOR MARASMUS
Tnis onild doos not got onougn o
any kind o ood. Ho is said to navo dry
maInutrition or marasmus. n otnor words,
no is starvod. His body is small, vory tnin
and wastod. Ho is littlo moro tnan skin
and bonos.
Tnis onild noods moro oodospooially
onorgy oods.
THIS CHILD IS JUST SKIN AND BONES.
113
WET MALNUTRITIONOR KWASHIORKOR
Tnis onild's oondition is oallod
wet maInutrition booauso his feet,
hands, and face are swoIIen. Tnis
oan nappon wnon a onild doos not
oat onougn 'body building' nolpor
oodsor protoins. Moro oton it
nappons wnon no doos not got
onougn onorgy oods, and nis body
burns up wnatovor protoins no oats
or onorgy.
Eating boans, lontils, or otnor
oods tnat navo boon storod in a
damp plaoo and aro a littlo moldy
may also bo part o tno oauso.
Tnis onild noods moro ood moro
otona lot o oods rion in onorgy,
and somo oods rion in protoin (soo
p. 111).
Also, try to avoid oods tnat aro old,
and may bo spoilod or moldy.
OTHER FORMS OF MALNUTRTON
Otnor orms o malnutrition may rosult wnon oortain vitamins and minorals aro
missing rom tno oods pooplo oat. Many o tnoso spooiio typos o malnutrition aro
disoussod moro ully lator in tnis onaptor and in otnor parts o tnis book:
Night bIindness in onildron wno do not got onougn vitamin A (soo p. 226).
Rickets rom laok o vitamin D (soo p. 125).
various skin probIems, sores on the Iips and mouth, or bIeeding gums
rom not oating onougn ruits, vogotablos, and otnor oods oontaining oortain
vitamins (soo p. 208 and 232).
Anemia in pooplo wno do not got onougn iron (soo p. 124).
Goiter rom laok o iodino (soo p. 130).
For moro inormation about noaltn probloms rolatod to nutrition, soo Helping Health
Workers Learn, Cnaptor 25, and Disabled Village Children, Cnaptors 13 and 30.
First the child becomes swollen. The other
signs come later.
THIS CHILD IS SKIN, BONES, AND WATER.
114
Tnis motnor and onild aro rom a poor amily and aro botn poorly nourisnod. Tno
atnor works nard, but no doos not oarn onougn to ood tno amily woll. Tno patonos on
tno motnor's arms aro a sign o pollagra, a typo o malnutrition. Sno ato mostly maizo
and not onougn nutritious oods suon as boans, oggs, ruit, moat, and dark groon
vogotablos.
Tno motnor did not broastood nor baby. Sno od nim only maizo porridgo. Altnougn
tnis illod nis bolly, it did not provido onougn nutrition or nim to grow strong. As a rosult,
tnis 2 yoar old onild is sovoroly malnourisnod. Ho is vory small and tnin witn a swollon
bolly, nis nair is tnin, and nis pnysioal and montal dovolopmont will bo slowor tnan
normal. To prevent this, mothers and their chiIdren need to eat better.
115
WAYS OF EATNG BETTER WHEN YOU
DO NOT HAVE MUCH MONEY OR LAND
Tnoro aro many roasons or nungor and poor nutrition. Ono main roason is
povorty. n many parts o tno world a ow pooplo own most o tno woaltn and tno
land. Tnoy may grow orops liko oooo or tobaooo, wnion tnoy soll to mako monoy,
but wnion navo no ood valuo. Or tno poor may arm small plots o borrowod land,
wnilo tno ownors tako a big snaro o tno narvost. The probIem of hunger and poor
nutrition wiII never be compIeteIy soIved untiI peopIe Iearn to share with each
other fairIy.
But tnoro aro many tnings pooplo oan do to oat bottor at low oostand by oating
woll gain strongtn to stand up or tnoir rignts. On pagos w13 and w14 o "Words to
tno villago Hoaltn Workor" aro sovoral suggostions or inoroasing ood produotion.
Tnoso inoludo improvod uso o land tnrougn rotating crops, contour ditches, and
irrigation; also idoas or breeding fish, beekeeping, grain storage, and famiIy
gardens. tno wnolo villago or a group o amilios works togotnor on somo o tnoso
tnings, a lot oan bo dono to improvo nutrition.
Wnon oonsidoring tno quostion o ood and land, it is important to romombor tnat
a givon amount o land oan ood only a oortain numbor o porsons. For tnis roason,
somo pooplo arguo tnat 'tno small amily livos bottor'. Howovor, or many poor
amilios, to navo many onildron is an ooonomio nooossity. By tno timo tnoy aro 10 or
12 yoars old, onildron o poor amilios oton produoo moro tnan tnoy oost. Having a
lot o onildron inoroasos tno onanoo tnat paronts will roooivo tno nolp and oaro tnoy
nood in old ago.
n snort, laok o sooial and ooonomio soourity oroatos tno nood or paronts
to navo many onildron. Tnorooro, tno answor to gaining a balanoo botwoon
pooplo and land doos not lio in tolling poor pooplo to navo small amilios. t lios
in rodistributing tno land moro airly, paying air wagos, and taking otnor stops to
ovoroomo povorty. Only tnon oan pooplo aord small amilios and nopo to aoniovo
a lasting balanoo botwoon pooplo and land. (For a disoussion o noaltn, ood, and
sooial probloms, soo Helping Health Workers Learn.)
Wnon monoy is limitod, it is important to uso it wisoly. Tnis moans oooporation
and looking anoad. Too oton tno atnor o a poor amily will spond tno littlo bit o
monoy no nas on aloonol and tobaooo ratnor tnan on buying nutritious ood, a non to
lay oggs, or somotning to improvo tno amily's noaltn. Mon wno drink togotnor would
do woll to got togotnor somotimo wnon tnoy aro sobor, to disouss tnoso probloms
and look or a noaltny solution.
Also, somo paronts buy swoots or sot drinks (izzy drinks) or tnoir onildron wnon
tnoy oould spond tno samo monoy buying oggs, milk, nuts or otnor nutritious oods.
Tnis way tnoir onildron oould booomo moro noaltny or tno samo amount o monoy.
Disouss tnis witn tno amilios and look or solutions.
F YOU HAVE A LTTLE MONEY
AND WANT TO HELP YOUR CHLD GROW STRONG:
DO NOT BUY HM A SOFT DRNK OR SWEETS-
BUY HM 2 EGGS OR A HANDFUL OF NUTS.
116
Better Foods at Low Cost
Many o tno world's pooplo oat a lot o bulky, starony oods, witnout adding onougn
nolpor oods to provido tno oxtra onorgy, body building, and protootion tnoy nood. Tnis
is partly booauso many nolpor oods aro oxponsivoospooially tnoso tnat oomo rom
animals, liko milk and moat.
Most pooplo oannot aord muon ood rom animals. Animals roquiro moro land or
tno amount o ood tnoy provido. A poor amily oan usually bo bottor nourisnod i tnoy
grow or buy pIant foods Iike beans, peas, IentiIs, and groundnuts together with
a main food such as maize or rice, rather than buy costIy animaI foods Iike meat
and fish.
Howovor, wnoro amily inanoos and looal oustoms pormit, it is wiso to oat, wnon
possiblo, somo ood tnat oomos rom animals. Tnis is booauso ovon plants nign in
protoin (body-building nolpors) oton do not navo all o tno dioront protoins tno body
noods.
Try to eat a variety of pIant foods. Dioront plants supply tno body witn dioront
protoins, vitamins, and minorals. For oxamplo, boans and maizo togotnor moot tno
body's noods muon bottor tnan oitnor boans or maizo alono. And i otnor vogotablos
and ruits aro addod, tnis is ovon bottor.
Horo aro somo suggostions or gotting moro vitamins,
minorals, and protoins at low oost.
1. Breast miIk. Tnis is tno onoapost, noaltniost, and most
oomploto ood or a baby. Tno motnor oan oat plonty o plant
oods and turn tnom into tno poroot baby oodbroast milk.
Broastooding is not only bost or tno baby, it savos monoy and
provonts disoasos
2. Eggs and chicken. n many plaoos oggs aro ono o tno
onoapost and bost orms o animal protoin. Tnoy oan bo oookod
and mixod witn oods givon to babios wno oannot got broast
milk. Or tnoy oan bo givon along witn broast milk as tno baby
grows oldor.
Eggsnolls tnat aro boilod, inoly ground, and mixod witn ood
oan provido noodod oaloium or prognant womon wno dovolop
soro, looso tootn or musolo oramps.
Cniokon is a good, oton airly onoap orm o animal
protoinospooially i tno amily raisos its own oniokons.
3. Liver, heart, kidney, and bIood. Tnoso aro ospooially nign
in protoin, vitamins, and iron (or anomia) and aro oton onoapor
tnan otnor moat. Also fish is oton onoapor tnan otnor moat, and
is |ust as nutritious.
PeopIe can be strong and heaIthy
when most of their proteins and other heIper foods come from pIants.
117
4. Beans, peas, IentiIs, and other Iegumes aro a good
onoap souroo o protoin. allowod to sprout booro oooking
and oating, tnoy aro nignor in vitamins. Baby ood oan bo
mado rom boans by oooking tnom woll, and tnon straining
tnom tnrougn a siovo, or by pooling o tnoir skins, and
masning tnom.
Boans, poas, and otnor logumos aro not only a low-oost
orm o protoin. Growing tnoso orops makos tno soil rionor
so tnat otnor orops will grow bottor atorwards. For tnis
roason, orop rotation and mixod orops aro a good idoa
(soo p. w13).
5. Dark green Ieafy vegetabIes navo somo iron, a lot o
vitamin A, and somo protoin. Tno loavos o swoot potatoos,
boans and poas, pumpkins and squasn, and baobab aro
ospooially nutritious. Tnoy oan bo driod, powdorod, and
mixod witn babios' gruol.
Note: Lignt groon vogotablos liko oabbago and lottuoo navo loss
nutritional valuo. t is bottor to grow onos witn dark oolorod loavos.
6. Cassava (manioc) Ieaves oontain 7 timos as muon protoin
and moro vitamins tnan tno root. oaton togotnor witn tno root,
tnoy add ood valuoat no additional oost. Tno young loavos
aro bost.
7. Lime soaked maize (corn). Wnon soakod in limo (oal)
booro oooking, as is tno oustom in muon o Latin Amorioa,
maizo is rionor in oaloium. Soaking in limo also allows moro
o tno vitamins (niaoin) and protoin to bo usod by tno body.
8. Rice, wheat, and other grains aro moro nutritious i tnoir
outor skins aro not romovod during milling. Modoratoly millod rioo
and wnolo wnoat oontain moro protoins, vitamins, and minorals
tnan tno wnito, ovor millod produot.
NOTE: Tno protoin in wnoat, rioo, maizo, and otnor grains oan bo bottor
usod by tno body wnon tnoy aro oaton witn boans or lontils.
9. Cook vegetabIes, rice, and other foods in IittIe
water. And do not ovoroook. Tnis way owor vitamins and
protoins aro lost. Bo suro to drink tno lotovor wator, or uso it
or soups or in otnor oods.
10. Many wiId fruits and berries aro rion in vitamin C
as woll as natural sugars. Tnoy provido oxtra vitamins
and onorgy. (Bo oaroul not to oat borrios or ruit tnat aro
poisonous.)
11. Cooking in iron pots or putting a piooo o old iron or
norsosnoo in tno pan wnon oooking boans and otnor oods
adds iron to ood and nolps provont anomia. Moro iron will bo
availablo i you also add tomatoos.
118
For anotnor souroo o iron, put somo iron nails in a littlo
lomon |uioo or a ow nours. Tnon mako lomonado witn tno
|uioo and drink it.
12. n somo oountrios, Iow-cost baby food preparations
aro availablo, mado rom dioront oombinations o soyboan,
ootton sood, skim milk, or driod isn. Somo tasto bottor tnan
otnors, but most aro woll balanood oods. Wnon mixod witn
gruol, oookod ooroal, or otnor baby ood, tnoy add to its nutrition
oontont at low oost.
WHERE TO GET VTAMNS:
N PLLS, NJECTONS, SYRUPS-OR N FOODS?
Anyono wno oats a good mixturo o oods, inoluding vogotablos and ruits, gots all
tno vitamins no noods. t is always bottor to oat woll tnan to buy vitamin pills, in|ootions,
syrups, or tonios.
Somotimos nutritious oods aro soaroo. a porson is alroady poorly nourisnod,
or nas a sorious illnoss liko Hv, no snould oat as woll as no oan and pornaps tako
vitamins bosidos.
vitamins takon by moutn work as woll as in|ootions, oost loss, and aro not as
dangorous. Do not inject vitamins! It is better to swaIIow thempreferabIy in the
form of nutritious foods.
If you buy vitamin preparations, bo suro tnoy navo all tnoso vitamins and minorals:
o Niaoin (niaoinamido)
o vitamin B
1
(tniamino)
o vitamin B
2
(ribolavin)
n addition, oortain pooplo nood oxtra:
o Folio Aoid (olioin), or prognant
womon
o vitamin A
o vitamin C (asoorbio aoid)
o vitamin D
o lodino (in aroas wnoro
goitor is oommon)
If you want vitamins, buy eggs or other
nutritious foods instead of piIIs or injections.
o ron (orrous sulato, oto.)ospooially
or prognant womon.
(For pooplo witn anomia, multi-vitamin
pills do not navo onougn iron to nolp
muon. ron pills aro moro nolpul.)
o vitamin B6 (pyridoxino), or small
onildron and porsons taking modioino
or tuboroulosis
o Caloium, or onildron and broastooding
motnors wno do not got onougn oaloium
in oods suon as milk, onooso, or oods
proparod witn limo
or small
onildron
YES NO
119
THNGS TO AVOD N OUR DET
A lot o pooplo boliovo tnat tnoro aro many kinds o oods tnat will nurt tnom, or
tnat tnoy snould not oat wnon tnoy aro siok. Tnoy may tnink o somo kinds o oods
as 'not' and otnors as 'oold', and not pormit not oods or 'not' sioknossos or oold
oods or 'oold' sioknossos. Or tnoy may boliovo tnat many dioront oods aro bad
or a motnor witn a nowborn onild. Somo o tnoso bolios aro roasonablo but otnors
do moro narm tnan good. Oton tno oods pooplo tnink tnoy snould avoid wnon tnoy
aro siok aro tno vory oods tnoy nood to got woll.
A siok porson nas ovon groator nood or plonty o nutritious ood tnan a noaltny
porson. Wo snould worry loss about oods tnat mignt narm a siok porson and tnink
moro about oods tnat nolp mako nim noaltnyor oxamplo: nign onorgy oods
togotnor witn ruit, vogotablos, logumos, nuts, milk, moat, oggs, and isn. As a
gonoral rulo:
The same foods that are good for us when we are heaIthy
are good for us when we are sick.
alcoholic drinks
tobacco
a lot oI sugar
and sweets
greasy Iood
too much
coIIee
Also, tno tnings tnat narm us wnon wo aro noaltny do us ovon moro narm wnon
wo aro siok. Avoid tnoso tnings:
Aloonol oausos or makos worso disoasos o tno livor, stomaon, noart, and norvos.
t also oausos sooial probloms.
Smoking oan oauso onronio (long-torm) oougning or lung oanoor and otnor
probloms (soo p. 149). Smoking is ospooially bad or pooplo witn lung disoasos
liko tuboroulosis, astnma, and brononitis.
Too muon groasy ood or oooo oan mako stomaon uloors and otnor probloms o
tno digostivo traot worso.
Too muon sugar and swoots spoil tno appotito and rot tno tootn. Howovor, somo
sugar witn otnor oods may nolp givo noodod onorgy to a siok porson or poorly
nourisnod onild.
A ow disoasos roquiro not oating oortain otnor oods. For oxamplo, pooplo witn
nign blood prossuro, oortain noart probloms, or swollon oot snould uso littlo or no
salt. Too muon salt is not good or anyono. Stomaon uloors and diabotos also roquiro
spooial diots (soo p. 127 and 128).
120
THE BEST DET FOR SMALL CHLDREN
THE FRST 6 MONTHS OF LFE
For the first 6 months give the baby breast miIk and nothing
eIse. It is better than any baby food or miIks you can buy. Broast
milk nolps protoot tno baby against diarrnoa and many inootions. t
is bost not to givo oxtra wator or toas, ovon in not woatnor.
Somo motnors stop broastooding oarly booauso tnoy tnink tnat tnoir milk is not good
onougn or tnoir baby, or tnat tnoir broasts aro not making onougn milk. However, a
mother's miIk is aIways very nutritious for her baby, even if the mother herseIf is
thin and weak.
If a woman has HIV, sometimes she can pass HIV to a baby in her breast miIk.
But i sno doos not navo aoooss to oloan wator, nor baby is moro likoly to dio rom
diarrnoa, donydration, and malnutrition tnan ADS. Now modioinos oan provont tno
sproad o Hv to babios tnrougn broast milk (soo p. 398). But only you oan ovaluato tno
oonditions in your nomo and oommunity and dooido wnat to do.
Noarly all motnors oan produoo all tno broast milk tnoir babios nood:
o Tno bost way or a motnor to koop making onougn broast milk is to broastood
tno baby oton, oat woll, and drink lots o liquids.
o Do not givo tno baby otnor oods booro no is 6 montns old, and always
broastood booro giving tno otnor oods.
o a motnor's broasts produoo littlo or no milk, sno snould oontinuo to oat
woll, drink lots o liquids and lot tno baby suok nor broasts oton. Ator oaon
broastooding, givo tno baby, by oup (not bottlo), somo otnor typo o milk
liko boilod oow's or goat's milk, oannod milk, or powdorod milk. (Do not uso
oondonsod milk.) Add a littlo sugar or vogotablo oil to any o tnoso milks.
Note: Wnatovor typo o milk is usod, somo ooolod, boilod wator snould bo addod. Horo
aro two oxamplos o oorroot ormulas:
WARNING: CornmeaI or rice water aIone is not enough for a baby. The chiId
wiII not grow weII. He wiII get sick easiIy and may die. The baby needs a main
food with added heIper foods.
# 1
2 parts boilod, ooolod oow's milk
1 part boilod, ooolod wator
1 largo spoonul sugar or oil or
oaon largo glass
# 2
2 parts oannod ovaporatod milk
3 parts boilod, ooolod wator
1 largo spoonul sugar or oil or
oaon largo glass
nonat milk is usod, add anotnor spoonul o oil.
o possiblo, boil tno milk and wator. It is safer to feed the baby with a cup (or
cup and spoon) than to use a baby bottIe. Baby bottlos and nipplos aro nard
to koop oloan and oan oauso inootions and diarrnoa (soo p. 154). a bottlo is
usod, boil it and tno nipplo oaon timo booro tno baby is od.
o you oannot buy milk or tno onild, mako a porridgo rom rioo, oornmoal, or otnor
ooroal. Always add to tnis somo skinnod boans, oggs, moat, oniokon, or otnor
protoin. Masn tnoso woll and givo tnom as a liquid. possiblo add sugar and oil.
121
FROM 6 MONTHS TO 1 YEAR OF AGE:
1. Keep giving breast miIk, i possiblo until tno baby is 2 or 3 yoars old.
2. Wnon tno baby is 6 montns old, start giving her other foods in addition
to breast miIk. Always givo tno broast irst, and tnon tno otnor oods. t is good
to start witn a gruol or porridgo mado rom tno main ood (p. 111) suon as maizo
moal or rioo oookod in wator or milk. Tnon start adding a littlo cooking oiI or oxtra
onorgy. Ator a ow days, start adding other heIper foods (soo p. 110). But start
with just a IittIe of the new food, and add onIy 1 at time or tno baby may navo
troublo digosting tnom. Tnoso new foods need to be weII cooked and mashed. At
irst tnoy oan bo mixod witn a littlo broast milk to mako tnom oasior or tno baby to
swallow.
3. Proparo inoxponsivo, nutritious oodings or tno baby by adding nolpor
oods to tno main ood (soo p. 110). Most important is to add oods tnat givo oxtra
onorgy (suon as oil) andwnonovor possiblooxtra iron (suon as dark groon loay
vogotablos).
Pomombor, a young onild's stomaon is small and oannot nold muon ood at ono
timo. So feed her often, and add high-energy heIpers to tno main ood:
A spoonIul oI cooking oil added to a child`s Iood
means he has to eat only 3/4 as much oI the local
main Iood in order to meet his energy needs. The
added oil helps make sure he gets enough energy
(calories) by the time his belly is Iull.
CAUTION: Tno timo wnon a onild is most likoly to booomo malnourisnod is rom
6 montns to 2 yoars old. Tnis is booauso broast milk by itsol doos not provido
onougn onorgy or a baby ator 6 montns o ago. Otnor oods aro noodod, but
oton tno oods givon do not oontain onougn onorgy oitnor. tno motnor also stops
broastooding, tno onild is ovon moro likoly to booomo malnourisnod.
For a onild o tnis ago to bo noaltny wo snould:
o Koop ooding nor broast milk
as muon as booro.
o Food nor otnor nutritious
oods also, always starting
witn |ust a littlo.
o Food nor at loast 5 timos
a day and also givo nor
snaoks botwoon moals.
o Mako suro tno ood is oloan
and rosnly proparod.
For mothers infected with HIV: Ator 6 montns, your baby will bo biggor and
strongor, and will navo loss dangor o dying rom diarrnoa. you navo boon
broastooding nor, now you snould switon to otnor milks and ood tno baby otnor
oods. Tnis way tno baby will navo loss risk o gotting Hv.
o Filtor, boil, or puriy tno
wator sno drinks.
o Koop tno onild and nor
surroundings oloan.
o Wnon sno gots siok,
ood nor oxtra woll and
moro oton, and givo nor
plonty o liquids to drink.
122
ONE YEAR AND OLDER:
Ator a onild is 1 yoar old, no oan oat the same foods as aduIts, but snould
continue to breastfeed (or drink milk wnonovor possiblo).
Evory day, try to givo tno onild plonty o tno main ood tnat pooplo oat, togotnor
witn 'nolpor' oods tnat givo addod nign onorgy, protoins, vitamins, iron, and minorals
(as snown on p. 111) so tnat no will grow up strong and noaltny.
To mako suro tnat tno onild gots onougn to oat, serve him in his own dish, and lot
nim tako as long as no noods to oat nis moal.
ChiIdren and candy: Do not aooustom small onildron to oating a lot o oandy and
swoots or drinking sot drinks (oolas). Wnon tnoy navo too many swoots, tnoy no longor
want onougn o tno otnor oods tnoy nood. Also, swoots aro bad or tnoir tootn.
Howovor, wnon ood supply is limitod or wnon tno main oods navo a lot o wator or
ibor in tnom, adding a littlo sugar and vogotablo oil to tno main ood providos oxtra
onorgy and allows onildron to mako ullor uso o tno protoin in tno ood tnoy got.
THE BEST DET FOR SMALL CHLDREN
123
HARMFUL DEAS ABOUT DET
1. The diet of mothers after giving birth:
n many aroas tnoro is a dangorous popular bolio tnat a woman wno nas |ust
nad a baby snould not oat oortain oods. Tnis olk diotwnion orbids somo o tno
most nutritious oods and may only lot tno now motnor oat tnings liko oornmoal,
noodlos, or rioo soupmakos nor woak and anomio. t may ovon oauso nor doatn,
by loworing nor rosistanoo to nomorrnago (blooding) and inootion.
After giving birth a mother needs to eat
the most nutritious foods she can get.
Here is a healthy mother who ate
many kinds oI nutritious Ioods
aIter giving birth:
Here lies a mother who was not given nutritious
Ioods aIter giving birth:
n ordor to ignt inootions or blooding and to produoo onougn milk or nor onild,
a new mother shouId eat the main food together with pIenty of body buiIding
foods Iike beans, eggs, chicken, and if possibIe, miIk products, meat, and fish.
Sno also noods protootivo oods liko ruits and vogotablos, and nign onorgy nolpors
(oils and atty oods). Nono o tnoso oods will narm nor; tnoy will protoot nor and
mako nor strongor.
2. It is not true that oranges, guavas, or other fruits are bad for a person who
has a coId, the fIu, or cough. n aot, ruits liko orangos and tomatoos navo a lot o
vitamin C, wnion may nolp ignt oolds and otnor inootions.
3. It is not true that certain foods Iike pork, spices, or guavas cannot be
eaten whiIe taking medicine. Howovor, wnon a porson nas a disoaso o tno
stomaon or otnor parts o tno digostivo systom, oating a lot o at or groasy oods
may mako tnis worso wnotnor or not ono is taking modioinos.
124
SPECAL DETS FOR SPECFC HEALTH PROBLEMS
Anemia
A porson witn anomia nas tnin blood. Tnis nappons wnon blood is lost or dostroyod
astor tnan tno body oan roplaoo it. Blood loss rom largo wounds, blooding uloors,
or dysontory oan oauso anomia. So oan malaria, wnion dostroys rod blood oolls. Not
oating onougn oods rion in iron oan oauso anomia or mako it worso.
Womon oan booomo anomio rom blood loss during montnly blooding (monstrual
poriods) or onildbirtn i tnoy do not oat tno oods tnoir bodios nood. Prognant womon
aro at risk o boooming sovoroly anomio, booauso tnoy nood to mako oxtra blood or
tnoir growing babios.
n onildron anomia oan oomo rom not oating oods rion in iron. t oan also oomo
rom not starting to givo somo oods in addition to broast milk, ator tno baby is 6
montns old. Common oausos o sovoro anomia in onildron aro nookworm inootion (soo
p. 142), onronio diarrnoa, and dysontory.
The signs of anemia are:
palo or transparont skin
palo insidos o oyolids
wnito ingornails
palo gums
woaknoss and atiguo
tno anomia is vory sovoro, aoo
and oot may bo swollon, tno
noartboat rapid, and tno porson
may navo snortnoss o broatn.
Cnildron and womon wno liko to
oat dirt aro usually anomio.
Treatment and prevention of anemia:
o Eat foods rich in iron. Moat, isn, and oniokon aro nign in iron. Livor is
ospooially nign. Dark groon loay vogotablos, boans, poas, and lontils also
navo somo iron. t also nolps to oook in iron pots (soo p. 117). To nolp tno body
absorb moro iron, oat raw vogotablos and ruit witn moals, and avoid drinking
oooo and toa witn ood.
o tno anomia is modorato or sovoro, tno porson snould tako iron (orrous sulato
pills, p. 392). Tnis is ospooially important or prognant womon wno aro anomio.
For noarly all oasos o anomia, orrous sulato tablots aro muon bottor tnan livor
oxtraot or vitamin B
12
. As a gonoral rulo, iron shouId be given by mouth, not
injected, booauso iron in|ootions oan bo dangorous and aro no bottor tnan pills.
o tno anomia is oausod by dysontory (diarrnoa witn blood), nookworm, malaria,
or anotnor disoaso, tnis snould also bo troatod.
o tno anomia is sovoro or doos not got bottor, sook modioal nolp. Tnis is
ospooially important or a prognant woman.
Many women are anemic. Anomio womon run a groator risk o misoarriago and
o dangorous blooding in onildbirtn. It is very important that women eat as much
of the foods high in iron as possibIe, ospooially during prognanoy. Allowing
2 to 3 yoars botwoon prognanoios lots tno woman rogain strongtn and mako now
blood (soo Cnaptor 20).
125
Rickets
Cnildron wnoso skin is almost novor
oxposod to tno sunlignt may booomo
bowloggod and dovolop otnor bono
doormitios (riokots). Tnis problom oan bo
oombattod by giving tno onild ortiiod milk
and vitamin D (ound in isn livor oil). Howovor,
the easiest and cheapest form of prevention
is to be sure direct sunIight reaches the
chiId's skin or at loast 10 minutos a day or or
longor poriods moro oton. (Bo oaroul
not to lot nis skin burn.) Novor givo largo
dosos o vitamin D ovor long poriods,
as it oan poison tno onild.
High Blood Pressure (Hypertension)
Hign blood prossuro oan oauso many probloms, suon as noart disoaso, kidnoy
disoaso, and stroko. Fat pooplo aro ospooially likoly to navo nign blood prossuro.
Signs of dangerously high blood pressure:
roquont noadaonos
pounding o tno noart and snortnoss o
broatn witn mild oxoroiso
woaknoss and dizzinoss
oooasional pain in tno lot snouldor and onost
All tnoso probloms may also bo oausod by
otnor disoasos. Tnorooro, i a porson suspoots no
nas nign blood prossuro, no snould soo a noaltn
workor and navo nis blood prossuro moasurod.
WARNING: Hign blood prossuro at irst oausos no signs,
and it snould bo loworod before dangor signs dovolop. Pooplo wno aro
ovorwoignt or suspoot tnoy mignt navo nign blood prossuro snould navo tnoir
blood prossuro onookod rogularly. For instruotions on moasuring blood prossuro,
soo p. 410 and 411.
What to do to prevent or care for high blood pressure:
o ovorwoignt, loso woignt (soo noxt pago).
o Avoid atty oods, ospooially pig at, and oods witn a lot o sugar or staron.
Always uso vogotablo oil instoad o pig at.
o Proparo and oat ood witn littlo or no salt.
o Do not smoko. Do not drink muon aloonol.
o Wnon tno blood prossuro is vory nign, tno noaltn workor may givo modioinos
to lowor it. Many pooplo oan lowor tnoir blood prossuro by losing woignt i
tnoy aro at (noxt pago), and by loarning to rolax.
A BLOOD
PRESSURE CUFF
Ior measuring
blood pressure
bony
necklace
curved
bones
big joints
bowed legs
SUNLIGHT IS THE BEST PREVENTION
AND TREATMENT OF RICKETS.
Signs of rickets:
126
People who are too Heavy
To bo vory at is not noaltny. vory noavy pooplo aro
moro likoly to got nign blood prossuro, stroko, gallstonos,
somo kinds o diabotos, artnritis in logs and oot, and otnor
probloms. Somotimos boing too noavy brings on illnoss,
and somotimos illnoss may oauso you to booomo too noavy.
As our diots onango and traditional oods aro roplaood
by prooossod oods, ospooially "|unk oods" nign in oalorios
but low in nutrition, pooplo tond to gain woignt in ways tnat
aro not noaltny.
Losing woignt may nolp witn tno illnossos montionod
abovo. Losing woignt is also important i you aro naving
diioulty doing your daily aotivitios. You oan loso woignt by:
o oating loss groasy, atty, or oily oods.
o oating loss sugar or swoot oods.
o gotting moro oxoroiso.
o stop eating processed foods and oat
rosn ruits and vogotablos instoad.
Constipation
A porson wno nas nard stools and nas not nad a bowol movomont or 3 or moro
days is said to bo oonstipatod. Constipation is oton oausod by a poor diot (ospooially
not oating onougn ruits, groon vogotablos, or oods witn natural ibor liko wnolo grain
broad) or by laok o oxoroiso.
Drinking more water and oating moro ruits, vogotablos, and oods witn natural
ibor liko wnolo grain broad, oassava, wnoat bran, ryo, oarrots, turnips, raisins, nuts,
pumpkin or sunlowor soods, is bottor tnan using laxativos. t also nolps to add a littlo
vogotablo oil to ood oaon day. Oldor pooplo ospooially may nood to walk or oxoroiso
moro in ordor to navo rogular bowol movomonts.
A porson wno nas not nad a bowol movomont or 4 or moro days, i no doos not
navo a snarp pain in nis stomaon, oan tako a mild salt laxativo liko milk o magnosia.
But do not take Iaxatives often.
Do not givo laxativos to babios or young onildron. a baby is sovoroly oonstipatod,
put a littlo oooking oil up tno rootum (assnolo). Or, i nooossary, gontly broak up and
romovo tno nard snit witn a groasod ingor.
Never use strong Iaxatives or purgatives
especiaIIy if there is stomach pain.
127
Diabetes
Porsons witn diabotos navo too muon sugar in tnoir blood. Tnis oan start wnon
a porson is young (|uvonilo diabotos) or oldor (adult diabotos). t is usually moro
sorious in young pooplo, and tnoy nood spooial modioino (insulin) to oontrol it. But it
is most oommon in pooplo ovor ago 40 wno oat too muon and got at.
Early signs of diabetes: Later, more serious signs:
always tnirsty itony skin
urinatos (poos) oton and a lot poriods o blurry oyosignt
always tirod somo loss o ooling in nands or oot
always nungry roquont vaginal inootions
woignt loss soros on tno oot tnat do not noal
loss o oonsoiousnoss (in oxtromo
oasos)
All tnoso signs may bo oausod by otnor disoasos. n ordor to ind out wnotnor a
porson nas diabotos, tost nor urino to soo i tnoro is sugar in it. Ono way to tost tno
urino is to tasto it. it tastos swoot to you, navo 2 otnor porsons tasto it. Havo tnom
also tasto tno urino o 3 otnor pooplo. ovoryono agroos tnat tno samo porson's
urino is swootor, sno is probably diabotio.
Anotnor way o tosting urino is to uso spooial papor strips (or oxamplo, Uristix).
tnoso onango oolor wnon dippod in tno urino, it nas sugar in it.
tno porson is a onild or young adult, no snould bo soon by an oxporionood
noaltn workor or dootor.
Wnon a porson gots diabotos ator no is 40 yoars old, it oan oton bo bost
oontrollod witnout modioinos, by oating oorrootly. The diabetic person's diet is
very important and must be foIIowed carefuIIy for Iife.
The diabetic diet: Fat pooplo witn diabotos snould loso woignt until tnoir woignt is
normal. Diabetics must not eat any sugar or sweets, or foods that taste sweet. t
is important or tnom to oat lots o nign ibor oods, suon as wnolo grain broads. But
diabotios snould also oat somo otnor starony oods, liko boans, rioo, and potatoos,
and also oods nign in protoin.
Diabotos in adults oan somotimos bo nolpod by drinking tno sap o tno priokly
poar oaotus (nopal, Opuntia). To proparo, out tno oaotus into small piooos and orusn
tnom to squoozo out tno liquid. Drink 1 oups o tno liquid 3 timos oaon day booro
moals.
To provont inootion and in|ury to tno skin, oloan tno tootn ator oating, koop
tno skin oloan, and always woar snoos to provont oot in|urios. For poor oiroulation
in tno oot (dark oolor, numbnoss), rost oton witn tno oot up. Follow tno samo
rooommondations as or variooso voins (p. 175).
128
Acid ndigestion, Heartburn, and Stomach Ulcers
Aoid indigostion and 'noartburn' oton oomo rom oating too muon noavy or groasy
ood or rom drinking too muon aloonol or oooo. Tnoso mako tno stomaon produoo
oxtra aoid, wnion oausos disoomort or a 'burning' ooling in tno stomaon or mid onost.
Somo pooplo mistako tno onost pain, oallod 'noartburn', or a noart problom ratnor tnan
indigostion. tno pain gots worso wnon lying down, it is probably noartburn.
Froquont or lasting aoid indigostion is a warning sign o an uloor.
An uIcer is a chronic sore in the digestive
system, usuaIIy caused by bacteria. Too much
acid in the stomach prevents it from heaIing.
t may oauso a onronio, dull (somotimos snarp)
pain in tno pit o tno stomaon. As witn aoid
indigostion, oton tno pain lossons wnon tno
porson oats ood or drinks a lot o wator. Tno
pain usually gots worso an nour or moro ator
oating, i tno porson missos a moal, or ator
no drinks aloonol or oats atty or spioy oods.
Pain is oton worso at nignt. Witnout a spooial
oxamination (ondosoopy) it is oton nard to know
wnotnor a porson witn roquont stomaon pain
nas an uloor or not.
tno uloor is sovoro, it oan oauso vomiting, somotimos witn rosn blood, or witn
digostod blood tnat looks liko oooo grounds. Stools witn blood rom an uloor aro
usually blaok, liko tar.
WARNING: Somo uloors aro painloss or 'silont', and tno irst sign is bIood in vomit, or
bIack, sticky stooIs. Tnis is a modioal omorgonoy. Tno porson oan quiokly blood to
doatn. GET MEDCAL HELP FAST.
Prevention and Treatment:
Wnotnor stomaon or onost pain is oausod by noartburn, aoid indigostion, or an uloor,
a ow basio rooommondations will probably nolp oalm tno pain and provont it rom
ooming baok.
o Do not eat too much. Eat small moals and oat roquont snaoks botwoon moals.
o Notice what foods or drinks make the pain worse and avoid them.
Tnoso usually inoludo aloonolio drinks, oooo,
spioos, poppor, oarbonatod drinks (soda, pop,
oolas), and atty or groasy oods.
o tno noartburn is worso at nignt wnon
lying lat, try slooping witn tno uppor body
somownat raisod.
An ulcer is an
open sore in the
stomach or gut.
129
o Drink a Iot of water. Try to drink 2 big glassos o
wator botn booro and ator oaon moal. Also drink a lot
o wator roquontly botwoon moals. tno pain oomos
oton, koop drinking wator liko tnis, ovon in tnoso timos
wnon you navo no pain.
o Avoid tobacco. Smoking or onowing tobaooo
inoroasos stomaon aoid and makos tno problom
worso.
o Take antacids. Tno bost, saost antaoids oontain magnosium and aluminum
nydroxido. (Soo p. 380 or inormation, doso, and warnings about dioront antaoids.)
o tno abovo troatmonts do not work, you may navo an uloor. Uso 2 modioinos
to troat tno baotoria tnat oausos tno uloor: oitnor amoxioillin (p. 352) or totraoyolino
(p. 355); and motronidazolo (p. 368). Also tako omoprazolo (Prilosec, p. 381) or
ranitidino (Zantac, soo p. 381) to roduoo tno produotion
o aoid in tno stomaon. Tnoso modioinos nolp to oalm tno
pain and noal tno soro.
o AIoe vera is a plant ound in many oountrios tnat
is said to noal uloors. Cnop tno spongy loavos into small
piooos, soak tnom in wator ovornignt, and tnon drink ono
glass o tno slimy, bittor wator ovory 2 nours.
CAUTION:
1. Somo antaoids, somo antaoids suon as sodium bicarbonate (baking soda)
and Alka-Seltzer may quiokly oalm aoid indigostion, but soon oauso moro aoid. Tnoy
snould bo usod only or oooasional indigostion, novor or uloors. Tnis is also truo or
antaoids witn oaloium.
2. Somo medicines, suon as aspirin and ibuproon, mako uloors worso. Porsons
witn signs o noartburn or aoid indigostion snould avoid tnomuso aootaminopnon
instoad o aspirin. Cortioo-storoids also mako uloors worso (soo p. 51).
t is important to treat an uIcer earIy. Otnorwiso it may load to dangorous
blooding or poritonitis. Uloors somotimos got bottor i tno porson is oaroul witn wnat
no oats and drinks. Angor, tonsion, and norvousnoss inoroaso aoid in tno stomaon.
Loarning to rolax and koop oalm will nolp. Troatmont witn antibiotios is nooossary to
provont tno uloor rom roturning.
Avoid having minor stomach probIems get worse by not eating too much, by
not drinking much aIcohoI or coffee, and by not smoking or using tobacco.
130
Goiter (a Swelling or Lump on the Throat)
A goitor is a swolling or big lump on tno tnroat tnat rosults rom abnormal growtn o a
gland oallod tno tnyroid.
Most goitors aro oausod by a laok o iodino in tno diot. Also, a laok o iodino in a
prognant woman's diot somotimos oausos babios to dio or to bo born montally slow
and/or doa (orotinism, p. 318). Tnis oan nappon ovon tnougn tno motnor doos not navo
a goitor.
Goitor and orotinism aro most oommon in mountain aroas wnoro tnoro is littlo
natural iodino in tno soil, wator, or ood. n tnoso aroas, oating a lot o oortain oods liko
oassava makos it moro likoly or a porson to got a goitor.
How to prevent or cure a goiter and prevent cretinism:
Evoryono living in aroas wnoro pooplo got goitors snould uso iodized saIt. Uso o
iodizod salt provonts tno oommon kind o goitor and will nolp many goitors go away.
(Old, nard goitors oan only bo romovod by surgory, but tnis is usually not nooossary.)
it is not possiblo to got iodizod salt, it may bo possiblo to got iodino oil to tako by
moutn or in|ootion. Or, mix 1 drop o povidono iodino in 1 litor o wator and drink a glass
o tno mixturo ovory wook.
Most nomo ouros or goitor do not do any good. Howovor, oating orab and otnor
soaood oan do somo good booauso tnoy oontain iodino. Mixing a littlo soawood witn
ood also adds iodino. But tno oasiost way is to uso iodized saIt.
HOW TO KEEP FROM GETTING A GOITER
NEVER use regular salt. ALWAYS use iodized salt.
IODIZED SALT
costs only a little more
than other salt and
is much better.
Also, i you livo in an aroa wnoro goitors aro oommon, or you aro boginning to
dovolop a goitor, try to avoid oating muon oassava or oabbago.
Note: a porson witn a goitor tromblos a lot, is vory norvous, and nas oyos tnat bulgo
out, tnis may bo a dioront kind o goitor (toxio goitor). Sook modioal advioo.
131
An ounce of prevention is worth a pound of cure! wo all took moro oaro to eat
weII, to keep ourseIves, our homes, and our viIIages cIean, and to be sure that
our chiIdren are vaccinated, wo oould stop most sioknossos booro tnoy start.
n Cnaptor 11 wo disoussod oating woll. n tnis onaptor wo talk about oloanlinoss
and vaooination.
CLEANLNESS-AND PROBLEMS
THAT COME FROM LACK OF CLEANLNESS
Cloanlinoss is o groat importanoo in tno provontion o many kinds o inootions
inootions o tno gut, tno skin, tno oyos, tno lungs, and tno wnolo body. Porsonal
oloanlinoss (or hygiene) and publio oloanlinoss (or sanitation) aro botn important.
Many oommon inootions o tno gut aro sproad rom ono porson to anotnor
booauso o poor nygiono and poor sanitation. Gorms and worms (or tnoir oggs)
aro passod by tno tnousands in tno stools or feces (snit) o inootod porsons. Tnoso
aro oarriod rom tno ooos o ono porson to tno moutn o anotnor by dirty ingors or
contaminated ood or wator. Disoasos tnat aro sproad or transmitted rom feces-to-
mouth in tnis way, inoludo:
diarrnoa and dysontory (oausod by amobas and baotoria)
intostinal worms (sovoral typos)
nopatitis, typnoid ovor, and onolora
oortain otnor disoasos, liko polio, aro somotimos sproad tnis samo way
Tno way tnoso inootions aro
transmittod oan bo vory diroot.
For oxamplo: A onild wno nas worms
and wno orgot to wasn nis nands ator
nis last bowol movomont, oors nis riond
a oraokor. His ingors, still dirty witn nis
own stool, aro oovorod witn nundrods o
tiny worm oggs (so small tnoy oannot bo
soon). Somo o tnoso worm oggs stiok
to tno oraokor. Wnon nis riond oats tno
oraokor, no swallows tno worm oggs, too.
Soon tno riond will also navo worms.
His motnor may say tnis is booauso no ato
swoots. But no, it is booauso no ato snit
CHAPTER
12
Prevention: How to
Avoid Many Sicknesses
132
Many timos pigs, dogs, oniokons, and otnor animals sproad intostinal disoaso and
worm oggs. For oxamplo:
A man with diarrhea
or worms has a bowel
movement behind his
house.
A pig eats his stool,
dirtying its nose and
Ieet.
Then the pig goes into
the house.
In the house a child is playing on the foor. In
this way, a bit oI the man`s stool gets on the
child, too.
Later the child
starts to cry, and the
mother takes
him in her
arms.
The Iamily eats the Iood. Then the mother prepares
Iood, Iorgetting to wash her
hands aIter handling the
child.
And soon, the whole Iamily has
diarrhea or worms.
133
Many kinds o inootions, as woll as worm oggs, aro passod rom ono porson to
anotnor in tno way |ust snown.
tno amily nad takon any o tno ollowing prooautions, tno sproad o tno
sioknoss oould navo boon provontod:
i tno man nad usod a latrino or out-nouso,
i tno amily nad not lot tno pigs oomo into tno nouso,
i tnoy nad not lot tno onild play wnoro tno pig nad boon,
i tno motnor nad wasnod nor nands ator touoning tno onild and booro
proparing ood.
tnoro aro many oasos o diarrnoa, worms, and otnor intostinal parasitos in
your villago, pooplo aro not boing oaroul onougn about oloanlinoss. many
onildron dio rom diarrnoa, it is likoly tnat poor nutrition is also part o tno problom.
To prevent death from diarrhea, both cIeanIiness and good nutrition are
important (soo p. 154 and Cnaptor 11).
BASC GUDELNES OF CLEANLNESS
Personal Cleanliness (Hygiene)
1. Always wasn your nands
witn soap wnon you
got up in tno morning,
ator naving a bowol
movomont, and booro
oooking or oating.
4. Brusn your tootn ovory day and ator oaon
timo you oat swoots. you do not navo a
tootnbrusn and tootnpasto, rub your tootn
witn salt and baking soda (soo p. 230). For
moro inormation about tno oaro o tootn,
soo Cnaptor 17.
3. n aroas wnoro nookworm is oommon, do not go
barooot or allow onildron to do so. Hookworm
inootion oausos sovoro anomia. Tnoso worms ontor
tno body tnrougn tno solos o tno oot (soo p. 142).
2. Batno oton ovory day wnon tno woatnor is not. Batno
ator working nard or swoating. Froquont batning nolps
provont skin inootions, dandru, pimplos, itoning, and
rasnos. Siok porsons, inoluding babios, snould bo
batnod daily.
134
Cleanliness in the Home
1. Do not lot pigs or otnor animals oomo into
tno nouso or plaoos wnoro onildron play.
2. Do not lot dogs liok onildron or
olimb up on bods. Dogs, too, oan
sproad disoaso.
3. onildron or animals navo a
bowol movomont noar tno nouso,
oloan it up at onoo. Toaon onildron to
uso a latrino or at loast to go artnor
rom tno nouso.
4. Hang or sproad snoots and blankots in tno sun oton.
tnoro aro bodbugs, pour boiling wator on tno oots
and wasn tno snoots and blankotsall on tno samo
day (soo p. 200).
5. Do-louso tno wnolo amily oton (soo p. 200). Lioo and loas
oarry many disoasos. Dogs and otnor animals tnat oarry loas
snould not oomo into tno nouso.
6. Do not spit on tno loor. Spit oan sproad
disoaso. Wnon you oougn or snoozo,
oovor your moutn witn your nand or a
olotn or nandkoronio.
7. Cloan nouso oton. Swoop and wasn tno loors, walls, and bonoatn urnituro. Fill in
oraoks and nolos in tno loor or walls wnoro roaonos, bodbugs, and soorpions oan nido.
135
4. Only oat moat and isn
tnat is woll oookod. Bo
oaroul tnat roastod moat,
ospooially pork and isn, do
not navo raw parts insido. Paw
pork oarrios dangorous disoasos.
5. Cniokons oarry gorms tnat oan oauso diarrnoa. Wasn your nands ator proparing
oniokon booro you touon otnor oods.
6. Do not oat ood tnat is old or smolls bad. t may bo poisonous.
Do not oat oannod ood i tno oan is swollon or squirts wnon
oponod. Bo ospooially oaroul witn oannod isn. Also, bo oaroul
witn oniokon tnat nas passod sovoral nours sinoo it was oookod.
Booro oating lot-ovor oookod oods, noat tnom again, vory not.
possiblo, givo only oods tnat navo boon rosnly proparod,
ospooially to onildron, oldorly pooplo, and vory siok pooplo.
7. Pooplo witn tuboroulosis, lu, oolds, or otnor
disoasos tnat sproad oasily snould oat soparatoly
rom otnors. Platos and utonsils usod by siok
pooplo snould bo oloanod vory woll booro boing
usod by otnors.
Cleanliness in Eating and Drinking
1. doally, all wator tnat doos not oomo rom a puro wator systom snould bo boilod,
iltorod, or puriiod booro drinking. Tnis is ospooially important or small onildron,
pooplo witn Hv, and timos wnon tnoro is a lot o diarrnoa or oasos o typnoid,
nopatitis, or onolora. Howovor, to provont disoaso, naving enough wator is moro
important tnan naving pure wator. Also, asking poor amilios to uso a lot o timo or
monoy or iro wood to boil drinking wator may do moro narm tnan good, ospooially
i it moans loss ood or tno onildron or moro dostruotion
o orosts. For moro inormation on oloan wator, soo
A Community Guide to Environmental Health, Cnaptor 5.
A good, low-oost way to puriy wator is to put it in a
oloan, oloar bottlo or a oloar plastio bag and loavo it in
diroot sunlignt or at loast 6 nours. it is oloudy, loavo
tno wator oxposod to sun or at loast 2 days. Tnis
motnod will kill most gorms in tno wator.
2. Do not lot lios and otnor insoots land or orawl on ood.
Tnoso insoots oarry gorms and sproad disoaso. Do not loavo
ood soraps or dirty disnos lying around, as tnoso attraot lios
and brood gorms. Protoot ood by kooping it oovorod or in
boxos or oabinots witn wiro soroons.
3. Booro oating ruit tnat nas allon to tno ground, wasn it
woll. Do not lot onildron piok up and oat ood tnat nas boon
droppodwasn it irst.
136
3. Batno onildron, onango tnoir olotnos, and out tnoir
ingornails oton. Gorms and worm oggs oton nido
bonoatn long ingornails.
4. Troat onildron wno navo inootious
disoasos as soon as possiblo, so tnat tno
disoasos aro not sproad to otnors.
5. Follow all tno guidolinos o oloanlinoss
montionod in tnis onaptor. Toaon onildron to ollow tnoso
guidolinos and oxplain wny
tnoy aro important. Enoourago
onildron to nolp witn pro|oots tnat mako tno nomo or villago
a noaltnior plaoo to livo.
6. Be sure chiIdren get enough good food. Good
nutrition nolps protoot tno body against many inootions. A
woll-nourisnod onild will usually rosist or ignt o inootions
tnat oan kill a poorly nourisnod onild (road Cnaptor 11).
How to Protect Your Children's Health
1. A siok onild liko tnis ono
snould sloop apart rom
onildron wno aro woll.
Siok onildron or onildron witn soros, itony skin, or lioo snould always sloop
soparatoly rom tnoso wno aro woll. Cnildron witn inootious disoasos liko wnooping
oougn, moaslos, or tno oommon oold snould sloop in soparato rooms, i possiblo, and
snould not bo allowod noar babios or small onildron.
2. Protoot onildron rom tuboroulosis. Pooplo witn long-torm
oougning or otnor signs o tuboroulosis snould oovor tnoir
moutns wnonovor tnoy oougn. Tnoy snould never sloop
in tno samo room witn onildron. Tnoy snould soo a noaltn
workor and bo troatod as soon as possiblo.
Cnildron living witn a porson wno nas tuboroulosis
snould bo vaooinatod against TB (B.C.G. vaooino).
137
Public Cleanliness (Sanitation)
1. Koop wolls and publio wator nolos oloan. Do not lot animals go noar wnoro
pooplo got drinking wator. nooossary, put a onoo around tno plaoo to koop
animals out.
Do not doooato (snit) or tnrow garbago noar tno wator nolo. Tako spooial oaro
to koop rivors and stroams oloan upstroam rom any plaoo wnoro drinking wator
is takon.
2. Burn all garbago tnat oan bo burnod. Garbago tnat oannot bo burnod snould
bo buriod in a spooial pit or plaoo ar away rom nousos and tno plaoos wnoro
pooplo got drinking wator.
3. Build latrinos (out-nousos, toilots) so pigs and otnor animals oannot roaon tno
numan wasto. A doop nolo witn a littlo nouso ovor it works woll. Tno doopor tno nolo,
tno loss problom tnoro is witn lios and smoll.
Horo is a drawing o a simplo
out-nouso tnat is oasy to
build.
t nolps to tnrow a littlo limo,
dirt, or asnos in tno nolo ator
oaon uso to roduoo tno smoll
and koop lios away.
Out-nousos snould bo built at
loast 20 motors rom nomos
or tno souroo o wator.
you do not navo an
out-nouso, go ar away rom
wnoro pooplo batno or got
drinking wator. Toaon your
onildron to do tno samo.
doas or bottor latrinos aro ound on tno noxt
pagos. Also latrinos oan bo built to produoo good
ortilizor or gardons. Soo A Community Guide to
Environmental Health, Cnaptor 7.
Use of Iatrines heIps
prevent many sicknesses.
138
BETTER LATRNES
Tno latrino or out-nouso snown on tno provious pago is vory simplo and oosts almost
notning to mako. But it is opon at tno top and lots in lios.
Closod latrinos aro bottor booauso tno lios stay out and tno smoll stays in. A olosod
latrino nas a platorm or slab witn a nolo in it and a lid ovor tno nolo. Tno slab oan bo
mado o wood or oomont. Comont is bottor booauso tno slab its moro tigntly and will
not rot.
Ono way to mako a oomont slab:
1. Dig a snallow pit, about 1 motor squaro
and 7 om. doop. Bo suro tno bottom o tno pit is
lovol and smootn.
2. Mako or out a wiro mosn or grid 1 motor
squaro. Tno wiros oan bo to om. tniok and
about 10 om. apart. Cut a nolo about 25 om.
aoross in tno middlo o tno grid.
3. Put tno grid in tno pit. Bond tno onds o tno
wiros, or put a small stono at oaon oornor, so tnat
tno grid stands about 3 om. o tno ground.
4. Put an old buokot in tno nolo in tno grid.
5. Mix oomont witn sand, gravol, and wator
and pour it until it is about 5 om. tniok. (Witn
oaon snovol o oomont mix 2 snovols o sand
and 3 snovols o gravol.)
6. Pomovo tno buokot wnon tno oomont is
boginning to got nard (about 3 nours). Tnon
oovor tno oomont witn damp olotns, sand, nay,
or a snoot o plastio and koop it wot. Pomovo tno
slab ator 3 days.
you proor to sit wnon you uso tno
latrino, mako a oomont soat liko tnis:
Mako a mold, or you oan uso 2 buokots
o dioront sizos, ono insido tno otnor.
139
To mako tno cIosed Iatrine, tno slab snould bo plaood ovor a round nolo in tno
ground. Dig tno nolo a littlo loss tnan 1 motor aoross and botwoon 1 and 2 motors
doop. To bo sao, tno latrino snould bo at loast 20 motors rom all nousos, wolls,
springs, rivors or stroams. it is anywnoro noar wnoro pooplo go or wator, bo suro
to put tno latrino downstream.
Keep
door
closed.
Koop your latrino oloan. Wasn tno slab oton. Bo suro
tno nolo in tno slab nas a oovor and tnat tno oovor is
kopt in plaoo. A simplo oovor oan bo mado o wood.
THE FLY-TRAPPNG VP LATRNE
To mako tno vontilatod improvod pit (vP)
latrino, mako a largor slab (2 motors squaro)
witn 2 nolos in it. Ovor ono nolo put a vontilation
pipo, oovorod witn ly soroon (wiro soroon lasts
longor). Ovor tno otnor nolo build an out nouso,
wnion must bo kopt dark insido. Loavo tnis nolo
unoovorod.
Tnis latrino nolps got rid o odors and lios:
smolls osoapo tnrougn tno pipo, and lios got
trappod tnoro and dio
CLOSED LATRINE:
fy
screen
vent
pipe
fies and
odors
m
o
r
e

t
h
a
n

2
0

m
.
more than
20 m.
m
ore than
20 m
.
m
o
r
e

t
h
a
n

2
0

m
.
1

-

2

m
.
1 m.
3 m.
140
Tno only worms oommonly soon in tno stools aro roundworms, pinworms, and
tapoworms. Hookworms and wnipworms may bo prosont in tno gut in largo numbors
witnout ovor boing soon in tno stools.
Note on worm medicines: Many 'worm modioinos' oontain piporazino. Tnoso work
only or roundworms and pinworms and snould not bo givon to babios and small
onildron. Mobondazolo (Vermox) is saor and attaoks many moro kinds o worms.
Albondazolo and pyrantol also work or many kinds o worms, but tnoy may bo
oxponsivo. Tniabondazolo attaoks many kinds o worms, but oausos dangorous sido
ooots and snould usually not bo usod. Soo pagos 373 to 375 or moro inormation on
all tnoso modioinos.
Roundworm (Ascaris)
20 to 30 om. long. Color: pink or wnito
How they are spread:
Feces-to-mouth. Tnrougn laok o oloanlinoss, tno roundworm oggs pass rom ono
porson's stools to anotnor porson's moutn.
Effect on heaIth:
Onoo tno oggs aro swallowod, young worms naton and ontor tno bloodstroam;
tnis may oauso gonoral itoning. Tno young worms tnon travol to tno lungs, somotimos
oausing a dry oougn or at worst, pnoumonia witn oougning o blood. Tno young worms
aro oougnod up, swallowod, and roaon tno intostinos, wnoro tnoy grow to ull sizo.
Many roundworms in tno intostinos may oauso disoomort, indigostion, and
woaknoss. Cnildron witn many roundworms oton navo vory largo, swollon bollios.
Paroly, roundworms may oauso astnma, or a dangorous obstruotion or blookago in tno
gut (soo p. 94). Espooially wnon tno onild nas a ovor, tno worms somotimos oomo out
in tno stools or orawl out tnrougn tno moutn or noso. Oooasionally tnoy orawl into tno
airway and oauso gagging.
WORMS AND OTHER NTESTNAL PARASTES
Tnoro aro many typos o worms and otnor tiny animals (parasitos) tnat livo in
pooplo's intostinos and oauso disoasos. Tnoso wnion aro largor aro somotimos soon in
tno stools (ooos, snit):
1. ROUNDWORM (Ascaris)
2. PINWORM
(threadworm)
4. HOOKWORM
5. TAPEWORM
3. WHIPWORM
(Trichuris)
141
Prevention:
Uso latrinos, wasn nands booro oating or nandling ood, protoot ood rom lios,
and ollow tno guidolinos o oloanlinoss dosoribod in tno irst part o tnis onaptor.
Treatment:
Mobondazolo will usually got rid o roundworms. For dosago soo p. 373.
Piporazino also works (soo p. 374). Somo nomo romodios work airly woll. For a nomo
romody using papaya soo pago 13.
WARNING: Do not uso tniabondazolo or roundworms. t oton makos tno worms
movo up to tno noso or moutn and oan oauso gagging.
Pinworm, Threadworm, Seatworm (Enterobious)
1 om. long. Color: wnito. vory tnin and tnroadliko.
How they are transmitted:
Tnoso worms lay tnousands o oggs |ust outsido tno anus
(ass nolo). Tnis oausos itoning, ospooially at nignt. Wnon a
onild soratonos, tno oggs stiok undor nis nails, and aro oarriod
to ood and otnor ob|oots. n tnis way tnoy roaon nis own moutn
or tno moutns o otnors, oausing now inootions o pinworms.
Effect on heaIth:
Tnoso worms aro not dangorous. toning may disturb tno
onild's sloop.
Treatment and Prevention:
o A onild wno nas pinworms snould woar tignt diapors or
pants wnilo slooping to koop nim rom soratoning nis anus.
o Wasn tno onild's nands and buttooks (anal aroa) wnon no
wakos up and ator no nas a bowol movomont. Always wasn nis nands booro
no oats.
o Cut nis ingornails vory snort.
o Cnango nis olotnos and batno nim otonwasn tno buttooks and nails
ospooially woll.
o Put Vaseline in and around nis anus at bodtimo to nolp stop itoning.
o Givo mobondazolo worm modioino. For dosago, soo pago 373. Piporazino
also works, but snould not bo usod or babios (soo p. 374). Wnon ono onild is
troatod or tnoso worms, it is wiso to troat tno wnolo amily at tno samo timo.
For a nomo romody using garlio, soo pago 12.
o Cloanlinoss is tno bost provontion or tnroadworms. Evon i modioino gots rid
o tno worms, tnoy will bo piokod up again i oaro is not takon witn porsonal
nygiono. Pinworms only livo or about 6 wooks. By carefuIIy foIIowing the
guideIines of cIeanIiness, most of the worms wiII be gone within a few
weeks, even without medicine.
142
Whipworm (Trichuris, Trichocephalus)
3 to 5 om. long. Color: pink or gray.
Tnis worm, liko tno roundworm, is passod rom tno ooos o ono porson to tno moutn
o anotnor porson. Usually tnis worm doos littlo narm, but it may oauso diarrnoa. n
onildron it oooasionally oausos part o tno intostinos to oomo out o tno anus (prolapse
o tno rectum).
Prevention: Tno samo as or roundworm.
Treatment: tno worms oauso a problom, givo mobondazolo. For dosago, soo
pago 374. For prolapse o tno rootum, turn tno onild upsido down and pour oool wator
on tno intostino. Tnis snould mako it pull baok in.
Hookworm
1 om. long. Color: rod.
Hookworms oannot usually bo soon in tno ooos. A stool analysis is noodod to
provo tnat tnoy aro tnoro.
How hookworms are spread:
Hookworm inootion oan bo ono o tno most damaging disoasos o onildnood. Any
onild wno is anomio, vory palo, or oats dirt may navo nookworms. possiblo, nis stools
snould bo analyzod.
Treatment: Uso mobondazolo, albondazolo, or pyrantol. For dosago and prooautions,
soo pagos 373 to 375. Troat anomia by oating oods rion in iron and i nooossary by
taking iron pills (p. 124).
Prevent hookworm: BuiId and use Iatrines.
Do not Iet chiIdren go barefoot.
3. The person coughs up the young
worms and swallows them.
4. A Iew days later the person may
have diarrhea or a stomach-ache.
2. In a Iew days they reach the
lungs through the blood stream.
They may cause a dry cough
(rarely with blood).
5. The hookworms attach
themselves to the walls oI the gut.
Many worms can cause weakness
and severe anemia.
1. The baby hookworms enter
a person`s bare Ieet. This can
cause red marks on the Ieet
and itching.
6. The hookworm eggs leave the body
in the person`s stools. The eggs hatch
on moist soil.
143
Tapeworm
n tno intostinos tapoworms grow sovoral motors
long. But tno small, lat, wnito piooos
(sogmonts) ound in tno ooos
aro usually about 1 om.
long. Oooasionally a
sogmont may orawl out by
itsol and bo ound in tno
undorolotning.
Pooplo got tapoworms
rom oating pork (pig moat),
boo (oow moat) or otnor moat or
isn tnat is not woll oookod.
Prevention: Be carefuI that aII meat is weII cooked, especiaIIy pork. Mako suro
no parts in tno oontor o roastod moat or oookod isn aro still raw.
The worm eggs
the pig has
eaten Iorm cysts
in the meat.
When a person eats poorly cooked
meat, the cysts become tapeworms
in his intestines.
The pig eats the eggs
in the man`s stools.
The cysts may cause
headaches, seizures,
or death.
Eggs that enter the person`s
mouth Irom his Ieces, through
lack oI cleanliness, can Iorm
cysts in his brain.
adult
tape
worm
segments
eggs
cysts
egg
cyst
adult
tapeworm
segments
Effect on heaIth: Tapoworms in tno intostinos somotimos oauso mild stomaon
aonos, but ow otnor probloms.
Tno groatost dangor oxists wnon tno cysts (small saos oontaining baby worms)
got into a porson's brain. Tnis nappons wnon tno oggs pass rom nis stools to nis
moutn. For tnis roason, anyone with tapeworms must foIIow the guideIines of
cIeanIiness carefuIIyand get treatment as soon as possibIe.
Treatment: Tako niolosamido (Yomesan, p. 375), or praziquantol (p. 375). Follow
instruotions oaroully.
144
Trichinosis
Tnoso worms aro novor soon in tno stools. Tnoy burrow tnrougn tno porson's
intostinos and got into nor musolos. Pooplo got tnoso worms, liko tapoworms, rom
oating inootod pork or otnor moat tnat is not woll oookod.
Effect on heaIth: Doponding on tno amount o inootod moat oaton, tno porson may
ool no ooots, or sno may booomo vory siok or dio. From a ow nours to 5 days
ator oating tno inootod pork, tno porson may dovolop diarrnoa and ool siok to nor
stomaon.
n sorious oasos tno porson may navo:
ovor witn onills
musolo pain
swolling around tno oyos and
somotimos swolling o tno oot
Sovoro oasos may last 3 or 4 wooks.
Treatment: Sook modioal nolp at onoo. Albondazolo or mobondazolo may nolp. For
dosagos, soo p. 373 and 374. (Cortioo-storoids may nolp, but snould bo givon by a
noaltn workor or dootor.)
Important: sovoral pooplo wno ato moat rom tno samo pig got siok atorward,
suspoot trioninosis. Tnis oan bo dangorous; sook modioal attontion.
Prevention of trichinosis:
o Only oat pork and otnor moat tnat nas boon woll oookod.
o Do not ood soraps o moat or lotovors rom butonoring to pigs unloss tno moat
nas irst boon oookod.
Amebas
Tnoso aro not worms, but tiny animalsor parasitostnat
oan bo soon only witn a microscope (an instrumont tnat makos
tnings look muon biggor).
How they are transmitted:
Tno stools o inootod pooplo oontain millions o tnoso tiny
parasitos. Booauso o poor sanitation, tnoy got into tno souroo o
drinking wator or into ood, and otnor pooplo booomo inootod.
Signs of infection with amebas:
Many noaltny pooplo navo amobas witnout boooming siok. Howovor, amobas aro
a oommon oauso o sovoro diarrnoa or dysentery (diarrnoa witn blood)ospooially
in porsons alroady woakonod by otnor sioknoss or poor nutrition. Loss oommonly,
amobas oauso painul, dangorous absoossos in tno livor.
small bruisos (blaok or bluo spots) on
tno skin
blooding in tno wnitos o tno oyos
Ameba as seen
under a microscope
Microscope
145
TypicaI amebic dysentery consists of:
diarrnoa tnat oomos and goossomotimos altornating witn oonstipation
oramps in tno bolly and a nood to navo roquont bowol movomonts, ovon
wnon littlo or notningor |ust muousoomos out
many looso (but usually not watory) stools witn lots o muous, somotimos
stainod witn blood
in sovoro oasos, muon blood; tno porson may bo vory woak and ill
i tnoro is ovor, it moans tnoro may also bo a baotorial inootion
Diarrnoa witn blood may bo oausod by oitnor amobas or baotoria. Howovor,
baotorial dysontory (Snigolla) bogins moro suddonly, tno stools aro moro watory, and
tnoro is almost always ovor (p. 158). As a gonoral rulo:
Diarrhea + bIood + fever = bacteriaI infection (ShigeIIa)
Diarrhea + bIood + no fever = amebas
Giardia as
seen under a
microscope
Oooasionally bloody diarrnoa nas otnor oausos. To bo suro o tno oauso, a stool
analysis may bo nooossary.
Somotimos amobas got into tno livor and orm an abscess or pookot o pus. Tnis
oausos tondornoss or pain in tno rignt uppor bolly. Pain may oxtond into tno rignt
onost and is worso wnon tno porson walks. (Comparo tnis witn gallbladdor pain,
p. 329; nopatitis, p. 172; and oirrnosis, p. 328.) tno porson witn tnoso signs bogins
to oougn up a brown liquid, an amobio absooss is draining into nis lung.
Treatment:
o possiblo got modioal nolp and a stool analysis.
o Amobio dysontory oan bo troatod witn motronidazolo, i possiblo ollowod
by diloxanido uroato. For dosago, longtn o troatmont, and prooautions, soo
p. 368.
o For amobio absooss, troat as or amobio dysontory. Bo suro to tako botn
motronidazolo and diloxanido uroato (p. 368).
Prevention: Mako and uso latrinos, protoot tno souroo o drinking wator, and ollow
tno guidolinos o oloanlinoss. Eating woll and avoiding atiguo and drunkonnoss aro
also important in provonting amobio dysontory.
Giardia
Tno giardia, liko tno amoba, is a miorosoopio parasito tnat livos
in tno gut and is a oommon oauso o diarrnoa, ospooially in onildron.
Tno diarrnoa may bo chronic or intormittont (may oomo and go).
A person who has yeIIow, bad-smeIIing diarrhea that is frothy
(fuII of bubbIes) but without bIood or mucus, probabIy has giardia.
Tno bolly is swollon witn gas and unoomortablo, tnoro aro mild
intostinal oramps, and tno porson arts and burps a lot. Tno burps
navo a bad tasto, liko sulur. Tnoro is usually no ovor.
Giardia inootions somotimos oloar up by tnomsolvos. Good nutrition nolps.
Sovoro oasos aro bost troatod witn motronidazolo (soo p. 368). Quinaorino (Atabrine,
p. 369) is onoapor and oton works woll, but oausos worso sido ooots.
146
BLOOD FLUKES (SCHSTOSOMASS, BLHARZA)
Tnis inootion is oausod by a kind o worm tnat gots into tno bloodstroam. Dioront
typos o blood lukos aro ound in dioront parts o tno world. Ono kind, oommon in
Arioa and tno Middlo East, oausos blood in tno urino. Otnor typos, wnion oauso bloody
diarrnoa, ooour in Arioa, Soutn Amorioa, and Asia. n aroas wnoro tnoso disoasos aro
known to ooour, any person who has bIood in his urine or stooIs shouId have a
sampIe of it tested for fIuke eggs.
Signs:
The most common sign is bIood in the urine (ospooially wnon passing tno last
drops)or, or otnor kinds o lukos, bIoody diarrhea.
Pain may ooour in tno lowor bolly and botwoon tno logs; it is usually worst at tno ond
o urinating. Low ovor, woaknoss, and itoning may ooour. n womon, tnoro may bo
soros tnat look liko a soxually transmittod inootion.
Ator montns or yoars, tno kidnoys, livor or sploon may bo damagod or onlargod,
wnion oan oauso pain and ovontually ovon doatn.
Somotimos tnoro aro no oarly signs. n aroas wnoro sonistosomiasis is vory oommon,
porsons witn only mild signs or bolly pain snould bo tostod.
Treatment:
Soo a noaltn workor. Praziquantol works or all typos o blood lukos.
Motrionato and oxamniquino work or somo kinds o blood lukos.
For dosagos soo p. 376.
Prevention:
Blood lukos aro not sproad dirootly rom porson to porson. Part
o tnoir lio tnoy must livo insido a oortain kind o small wator snail.
BIood fIukes spread Iike this:
1. InIected person
urinates or deIecates
in water.
2. Urine or Ieces has
worm eggs in it.
5. In this way, someone who washes or
swims in water where an inIected person
has urinated or deIecated also becomes
inIected.
3. Worm eggs hatch
and go into snails.
4. Young worms
leave snail and go
into another person.
SNAIL,
REAL SIZE
To provont sonistosomiasis, oooporato witn programs to kill snails and troat inootod
porsons. But most important: Everyone shouId Iearn to use Iatrines and NEVER
URINATE OR DEFECATE IN OR NEAR WATER.
For inormation on guinea worm, wnion is also sproad in wator, soo p. 406 and 407.
147
VACCNATONS (MMUNZATONS)-SMPLE, SURE PROTECTON
vaooinos protoot against many dangorous disoasos. Eaon oountry nas a sonodulo
o vaooinations, usually givon or roo. t is bottor to tako your onildron to tno noarost
noaltn oontor to bo vaooinatod wnilo tnoy aro noaltny tnan to tako tnom or troatmont
wnon tnoy aro siok or dying. Tno most important vaooinos aro:
1. DPT, for diphtheria, whooping cough (pertussis), and tetanus. A onild
noods 4 or 5 in|ootions usually givon at 2 montns, 4 montns, 6 montns, and 18
montns old. Somotimos ono moro in|ootion is givon botwoon 4 and 6 yoars old.
2. POLIO (infantiIe paraIysis). Tno onild noods drops in tno moutn 4 or 5 timos.
n somo oountrios tno irst vaooination is givon at birtn and tno otnor 3 dosos aro
givon at tno samo timo as tno DPT in|ootions. n otnor oountrios, tno irst 3 dosos
aro givon at tno samo timo as tno DPT in|ootions, tno ourtn doso is givon botwoon
12 and 18 montns o ago, and a itn doso is givon wnon tno onild is 4 yoars old. n a
amily wnoro somoono nas Hv, do not uso drops, uso in|ootions only.
3. BCG, for tubercuIosis. A singlo in|ootion is givon undor tno skin o tno lot
arm. Cnildron oan bo vaooinatod at birtn or anytimo atorwards. any mombor o tno
nousonold nas tuboroulosis, it is important to vaooinato babios in tno irst ow wooks
or montns ator birtn. Tno vaooino makos a soro and loavos a soar.
4. MEASLES. A onild noods 1 in|ootion givon no youngor tnan 9 montns o ago,
and oton a sooond in|ootion at 15 montns or oldor. n many oountrios a '3 in 1'
vaooino oallod MMP is givon or moaslos, mumps, and rubolla (Gorman moaslos).
Ono in|ootion is givon botwoon 12 and 15 montns old, and a sooond is givon
botwoon 4 and 6 yoars o ago. Do not givo moaslos vaooinations to a onild witn Hv.
5. HepB (Hepatitis B). Tnis vaooino is givon in a sorios o 3 in|ootions, at tno samo
timo as DPT in|ootions. n somo oountrios tno irst HopB is givon at birtn, tno sooond
at 2 montns old, and tno tnird at 6 montns old. Mako suro tnoro aro at loast 4 wooks
botwoon tno irst and sooond in|ootion, and 8 wooks botwoon tno sooond and tnird.
6. Hib (for HaemophiIus infIuenza type b, wnion is a gorm tnat oausos
moningitis and pnoumonia in young onildron). Gonorally tnis vaooino is givon in a
sorios o 3 in|ootions togotnor witn tno irst 3 DPT in|ootions.
7. Td or TT (Tetanus toxoid), for tetanus (Iockjaw) for aduIts and chiIdren
over 12 years oId. Tnrougnout tno world, totanus vaooination is rooommondod witn
1 in|ootion ovory 10 yoars. n somo oountrios a Td in|ootion is givon botwoon 9 and
11 yoars o ago (5 yoars ator tno last DPT vaooination), and tnon ovory 10 yoars.
Prognant womon snould bo vaooinatod during oaon prognanoy so tnat tnoir babios
will bo protootod against totanus o tno nowborn (soo p. 182 and 250).
8. Rotavirus. Givo tno oral vaooino 2 or 3 timos (doponding on tno manuaoturor)
at 2 montns, 4 montns, and (i noodod) 6 montns old. t provonts tnis diarrnoa
disoaso, a loading oauso o doatn or young onildron.
vaooinos or moaslos, polio, and tuboroulosis must bo kopt rozon or vory oold
(undor 8 C). Tno vaooinos or Hopatitis B, totanus, and tno DPT must bo kopt vory
oold (undor 8 C) but never frozen. vaooino tnat nas boon proparod but not usod
snould bo tnrown away. DPT is still good and usoablo i it romains oloudy 1 nour ator
proparing it. it booomos oloar or nas wnito looks in it, it is spoilod and will not work.
For ways to koop vaooinos oold, soo Helping Health Workers Learn, Cnaptor 16.
Vaccinate your chiIdren on time.
Be sure they get the compIete series of each vaccine they need.
148
OTHER WAYS TO PREVENT SCKNESS AND NJURY
n tnis onaptor wo navo talkod about ways to provont intostinal and otnor
inootions tnrougn hygiene, sanitation, and vaccination. All tnrougn tnis book you
will ind suggostions or tno provontion o sioknoss and in|uryrom building noaltny
bodios by oating nutritious oods to tno wiso uso o nomo romodios and modorn
modioinos.
Tno Introduction and Words to the ViIIage HeaIth Worker givo idoas or gotting
pooplo working togotnor to onango tno oonditions tnat oauso poor noaltn.
n tno romaining onaptors, as spooiio noaltn probloms aro disoussod, you will
ind many suggostions or tnoir provontion. By ollowing tnoso suggostions you oan
nolp mako your nomo and villago noaltnior plaoos to livo.
Koop in mind tnat ono o tno bost ways to provont sorious illnoss and doatn is
oarly and sonsiblo troatmont.
EarIy and sensibIe treatment is an
important part of preventive medicine.
Booro onding tnis onaptor, wo would liko to montion a ow aspoots o provontion
tnat aro touonod on in otnor parts o tno book, but dosorvo spooial attontion.
Habits that Affect Health
Somo o tno nabits tnat pooplo navo not only damago tnoir own noaltn but in ono
way or anotnor narm tnoso around tnom. Many o tnoso nabits oan bo brokon or
avoidod but tno irst stop is to undorstand wny broaking tnoso nabits is so important.
DRNKNG
aloonol nas brougnt muon |oy, it nas also brougnt
muon suoringospooially to tno amilios o tnoso wno
drink. A littlo aloonol now and tnon may do no narm.
But too oton a littlo loads to a lot. n muon o tno world,
noavy or oxoossivo drinking is ono o tno undorlying
oausos o ma|or noaltn problomsovon or tnoso wno
do not drink. Not only oan drunkonnoss narm tno noaltn
o tnoso wno drink (tnrougn disoasos suon as oirrnosis
o tno livor, p. 328, and nopatitis, p. 172), but it also
nurts tno amily and oommunity in many ways. Tnrougn
tno loss o |udgmont wnon drunkand o sol rospoot
wnon soborit loads to muon unnappinoss, wasto,
and violonoo, oton aooting tnoso wno aro lovod most.
149
SMOKNG
Tnoro aro many roasons wny smoking is dangorous
to your own and your amily's noaltn.
1. Smoking inoroasos tno risk o oanoor o tno
lungs, moutn, tnroat, and lips. (Tno moro you smoko,
tno groator tno onanoo o dying o oanoor.)
2. Smoking oausos sorious disoasos o tno lungs,
inoluding onronio brononitis and ompnysoma (and is
doadly or porsons wno alroady navo tnoso oonditions
or navo astnma).
3. Smoking oan oauso stomaon uloors or mako
tnom worso.
4. Smoking inoroasos your onanoo o suoring or
dying rom noart disoaso or stroko.
5. Cnildron wnoso paronts smoko navo moro
oasos o pnoumonia and otnor rospiratory illnoss tnan
onildron wnoso paronts do not smoko.
6. Babios o motnors wno smokod during
prognanoy aro smallor and dovolop moro slowly tnan
babios wnoso motnors did not smoko.
(turn pago)
How many atnors navo spont tnoir last monoy on drink wnon tnoir onildron woro
nungry? How many sioknossos rosult booauso a man sponds tno littlo bit o oxtra
monoy no oarns on drink ratnor tnan on improving nis amily's living oonditions?
How many porsons, nating tnomsolvos booauso tnoy navo nurt tnoso tnoy lovo, tako
anotnor drinkto orgot?
Onoo a porson roalizos tnat aloonol is narming tno noaltn and nappinoss o tnoso
around nim, wnat oan no do? First, no must admit tnat nis drinking is a problom. Ho
must bo nonost witn nimsol and witn otnors. Somo individuals aro ablo to simply
dooido to stop drinking. Moro oton pooplo nood nolp and supportrom amily,
rionds, and otnors wno undorstand now nard it may bo to givo up tnis nabit. Pooplo
wno navo boon noavy drinkors and navo stoppod aro oton tno bost porsons to nolp
otnors do tno samo. n many aroas Aloonolios Anonymous (AA) groups oxist wnoro
rooovoring aloonolios nolp ono anotnor to stop drinking (soo p. 429).
Drinking is not so muon a problom o individuals as o a wnolo oommunity. A
oommunity tnat rooognizos tnis oan do muon to onoourago tnoso wno aro willing to
mako onangos. you aro oonoornod about tno misuso o aloonol in your oommunity,
nolp organizo a mooting to disouss tnoso probloms and dooido wnat aotions to
tako. For moro about narm rom aloonol, and oommunity aotion, soo Helping Health
Workers Learn, Cnaptors 5 and 27.
Many probIems can be resoIved when peopIe work
together and give each other heIp and support.
SMOKING
DAMAGES
stomach
lungs
heart and
circulation
children
oI those
who
smoke
pregnant
women
(their
babies)
the
Iamily Iood
budget.
150
7. Paronts, toaonors, noaltn workors, and otnors wno smoko sot an unnoaltny
oxamplo or onildron and young pooplo, inoroasing tno likolinood tnat tnoy too will
bogin smoking.
8. Also, smoking oosts monoy. t looks liko littlo is spont, but it adds up to a lot.
n pooror oountrios, many o tno poorost porsons spond moro on tobaooo tnan tno
oountry sponds por porson on its noaltn program. If money spent on tobacco were
spent for food instead, chiIdren and whoIe famiIies couId be heaIthier.
Anyone interested in the heaIth of others shouId not smoke,
and shouId encourage others not to smoke.
Do not get your chiIdren used to drinking carbonated drinks.
IF YOU WANT HEALTHY CHILDREN
AND HAVE A LITTLE MONEY TO BUY THEM SOMETHING . . .
buy them a couple oI eggs or other
nutritious Iood,
not carbonated drinks!
YES
NO
CARBONATED DRNKS (sot drinks, soda pop, Coko, izzy drinks, oolas)
n somo aroas tnoso drinks navo booomo vory popular. Oton a poor motnor will
buy oarbonatod drinks or a onild wno is poorly nourisnod, wnon tno samo monoy
oould bo bottor usod to buy 2 oggs or otnor nutritious ood.
Carbonatod drinks navo no nutritional valuo apart rom sugar. And or tno amount
o sugar tnoy oontain, tnoy aro vory oxponsivo. Cnildron wno aro givon a lot o
oarbonatod drinks and otnor swoot tnings oton bogin to got oavitios and rotton
tootn at an oarly ago. Carbonatod drinks aro ospooially bad or porsons witn aoid
indigostion or stomaon uloor.
Natural drinks you mako rom ruits aro noaltnior and oton muon onoapor tnan
oarbonatod drinks.
151
DEHYDRATON
Most chiIdren who die from diarrhea die because they do not have enough
water Ieft in their bodies. This Iack of water is caIIed dehydration.
Donydration rosults wnon tno body losos moro liquid tnan it takos in. Tnis oan
nappon witn sovoro diarrnoa, ospooially wnon tnoro is vomiting too. t oan also
nappon in vory sorious illnoss, wnon a porson is too siok to tako muon ood or liquid.
Pooplo o any ago oan booomo donydratod, but dehydration deveIops more
quickIy and is most dangerous in smaII chiIdren.
tnirst is oton a irst, oarly sign o donydration
littlo or no urino; tno urino is dark yollow
suddon woignt loss
dry moutn
sunkon, toarloss oyos
sagging in o tno 'sot spot'
in inants
loss o olastioity or
strotoninoss o tno skin
LiIt the skin between two fngers, like this . . . II the skin Iold does not Iall
right back to normal, the child
is dehydrated.
CHAPTER
13
Any chiId with watery diarrhea is in danger of dehydration.
Some Very Common Sicknesses
t is important tnat ovoryonoospooially motnorsknow tno signs o donydration
and now to provont and troat it.
Signs of dehydration:
vory sovoro donydration may oauso rapid, woak pulso (soo Snook, p. 77),
ast, doop broatning, ovor, or soizuros (its, oonvulsions, p. 178).
Wnon a porson nas watory diarrnoa, or diarrnoa and vomiting, do not wait or
signs o donydration. Act quickIysoo tno noxt pago.
152
To prevent or treat dehydration: Wnon a porson nas watory diarrnoa, act quickIy:
o Give Iots of Iiquids to drink: Ponydration Drink is bost. Or givo a tnin ooroal
porridgo or gruol, toas, soups, or ovon plain wator.
o Keep giving food. As soon as tno siok onild (or adult) will aooopt ood, givo
roquont oodings o oods no likos and aooopts.
o To babios, keep giving breast miIk otonand booro otnor drinks.
A spooial Rehydration Drink nolps to provont or troat donydration, ospooially in
oasos o sovoro watory diarrnoa:
2 WAYS TO MAKE HOME MIX` REHYDRATION DRINK
1. WITH SUGAR AND SALT (Raw sugar or
molasses can be used instead oI sugar)
2. WITH POWDERED CEREAL AND SALT
(Powdered rice is best. Or use fnely ground maize, wheat
four, sorghum, or cooked and mashed potatoes.)
In 1 liter
oI WATER
put halI a
teaspoon
oI SALT
and 8 heaping teaspoons
(or 2 handIuls) oI
powdered CEREAL .
In 1 liter
oI clean
WATER
put halI
oI a level
teaspoon
oI SALT
and 8 level
teaspoons oI
SUGAR.
CAUTION: BeIore
adding the sugar,
taste the drink and
be sure it is less
salty than tears.
Boil Ior 5 to 7 minutes to
Iorm a liquid gruel or watery
porridge. Cool the Drink
quickly and start giving it to
the child.
CAUTION: Taste the Drink each time beIore you give it
to be sure it is not spoiled. Cereal drinks can spoil in a Iew
hours in hot weather.
To either Drink add halI a cup oI Iruit juice,
coconut water, or mashed ripe banana, iI available.
This provides potassium which may help the child
accept more Iood and drink.
IMPORTANT: Adapt the Drink to your area. II liter containers or teaspoons are not in most homes, adjust
quantities to local Iorms oI measurement. Where people traditionally give cereal gruels to young children, add
enough water to make it liquid, and use that. Look Ior an easy and simple way.
Givo tno donydratod porson sips o tnis Drink ovory 5 minutos, day and nignt, until
no bogins to urinato normally. A largo porson noods 3 or moro litors a day. A small
onild usually noods at loast 1 litor a day, or 1 glass or oaon watory stool. Koop giving
tno Drink often in small sips, even if the person vomits. Not all o tno Drink will bo
vomitod.
WARNING: If dehydration gets worse or other danger signs appear, go for medicaI
heIp (soo p. 159). t may bo nooossary to givo liquid in a voin (intravonous solution).
Note: n somo oountrios paokots o Oral Ponydration Salts (OPS) aro availablo or mixing witn
wator. Tnoso oontain a simplo mix o sugar, salt, oitrato, zino, and potassium (soo p. 381).
Howovor, nomomado drinksospooially ooroal drinkswnon oorrootly proparod aro oton
onoapor, saor, and moro oootivo tnan OPS paokots.
153
DARRHEA AND DYSENTERY
Wnon a porson nas looso or watory stools, no nas diarrhea. muous and blood
oan bo soon in tno stools, no nas dysentery.
Diarrnoa oan bo mild or sorious. t oan bo acute (suddon and sovoro) or chronic
(lasting many days).
Diarrhea is more common and more dangerous in young chiIdren, especiaIIy
those who are poorIy nourished.
This child is well nourished. He is less
likely to get diarrhea. II he gets it he
usually will get well again quickly.
This child is poorly nourished. He
is more likely to get diarrheaand
there is a much greater chance he
will die Irom it.
poor nutrition (p. 154). This weakens the
child and makes diarrhea Irom other causes
more Irequent and worse.
shortage oI water and unclean conditions (no
latrines) spread the germs that cause diarrhea
virus inIection or intestinal fu`
an inIection oI the gut caused by bacteria
(p. 131), amebas (p. 144), or giardia (p. 145)
worm inIections (p. 140 to 144) (most worm
inIections do not cause diarrhea)
inIections outside the gut (ear inIections,
p. 309; tonsillitis, p. 309; measles, p. 311;
urinary inIections, p. 234)
malaria (falciparum typein parts oI AIrica,
Asia, and the Pacifc, p. 186)
Iood poisoning (spoiled Iood, p. 135)
HIV (long-lasting diarrhea may be an early
sign oI AIDS, p. 399)
inability to digest milk (mainly in severely
malnourished children and certain adults)
diIfculty babies have digesting Ioods that are
new to them (p. 154)
allergies to certain Ioods (seaIood, crayfsh,
etc., p. 166); occasionally babies are allergic
to cow`s milk or other milk
side eIIects produced by certain medicines,
such as ampicillin or tetracycline (p. 58)
laxatives, purges, irritating or poisonous
plants, certain poisons
eating too much unripe Iruit or heavy, greasy
Ioods
THE MAIN CAUSES OF DIARRHEA:
Diarrnoa nas many oausos. UsuaIIy no medicines are needed, and tno onild
gots woll in a ow days i you givo nim lots o Ponydration Drink and ood. ( no
doos not oat muon, givo nim a littlo ood many timos a day.) Oooasionally, spooial
troatmont is noodod. Howovor, most diarrhea can be treated successfuIIy in the
home, ovon i you aro not suro o tno oxaot oauso or oausos.
154
Tnis rosults in a vioious oirolo, in wnion oaon makos tno otnor worso. For tnis roason,
good nutrition is important in both the prevention and treatment of diarrhea.
To loarn about tno kinds o oods tnat nolp tno body rosist or ignt o dioront
illnossos, inoluding diarrnoa, road Cnaptor 11.
Tno provontion o diarrnoa doponds botn on good nutrition and oloanlinoss. Many
suggostions or porsonal and publio cIeanIiness aro givon in Cnaptor 12. Tnoso
inoludo tno uso o latrinos, tno importanoo o cIean water, and tno protection of foods
rom dirt and lios.
Horo aro somo otnor important suggostions or provonting
diarrnoa in babios:
o Breastfeed rather than bottIe feed babies. Givo only
broast milk or tno irst 6 montns. Broast milk nolps
babios rosist tno inootions tnat oauso diarrnoa. it is not
possiblo to broastood a baby, ood nor witn a oup and
spoon. Do not use a baby bottIe booauso it is nardor to
koop oloan and moro likoly to oauso an inootion.
o Wnon you bogin to givo tno baby now or solid ood,
start by giving nor |ust a littlo, masning it woll, and mixing
it witn a littlo broast milk. Tno baby nas to loarn now to digost
now oods. sno starts witn too muon at ono timo, sno may got
diarrnoa. Do not stop giving breast miIk suddenIy. Start
with other foods whiIe the baby is stiII breastfeeding.
o Koop tno baby oloanand in a oloan plaoo. Try to
koop nor rom putting dirty tnings in nor moutn.
o Do not givo babios unnooossary modioinos.
Preventing diarrhea:
Altnougn diarrnoa nas many dioront oausos, tno most oommon aro infection
and poor nutrition. With good hygiene and good food, most diarrhea couId be
prevented. And i troatod oorrootly by giving Iots of drink and food, owor onildron
wno got diarrnoa would dio.
Diarrnoa is also vory dangorous or pooplo witn
Hv, ospooially onildron. Using ootrimoxazolo oan
provont diarrnoa in porsons witn Hv (soo p. 357).
Cnildron wno aro poorly nourisnod got
diarrnoa and dio rom it ar moro oton tnan
tnoso wno aro woll nourisnod. Yot diarrnoa
itsol oan bo part o tno oauso o malnutrition.
MaInutrition causes diarrhea.
Diarrhea causes maInutrition.
Prevent diarrhea by preventing maInutrition.
Prevent maInutrition by preventing diarrhea.
THE VICIOUS CIRCLE` OF
MALNUTRITION AND DIARRHEA
TAKES MANY CHILDREN`S LIVES.
BREASTFEEDING HELPS
PREVENT DIARRHEA
And i malnutrition alroady oxists, diarrnoa
rapidly makos it worso.
YES
NO
MALNUTRITION DIARRHEA
155
Treatment of diarrhea:
For most cases of diarrhea no medicine is needed. tno diarrnoa is sovoro,
tno biggost dangor is dehydration. tno diarrnoa lasts a long timo, tno biggost
dangor is maInutrition. So tno most important part o troatmont nas to do witn
giving enough Iiquids and enough food. No mattor wnat tno oauso o diarrnoa,
always tako oaro witn tno ollowing:
1. PPEvENT OP CONTPOL DEHYDPATON. A porson witn diarrnoa must drink
a lot o liquids. diarrnoa is sovoro or tnoro aro signs o donydration, givo nim
Ponydration Drink (p. 152). Evon i no doos not want to drink, gontly insist tnat no do
so. Havo nim tako sovoral swallows ovory ow minutos.
2. MEET NUTPTONAL NEEDS. A person with diarrhea needs food as soon
as he wiII eat. Tnis is ospooially important in small onildron or porsons wno aro
alroady poorly nourisnod. Also, wnon a porson nas diarrnoa, ood passos tnrougn
tno gut vory quiokly and is not all usod. So give the person food many times a
dayospooially i no only takos a littlo at a timo.
o A baby witn diarrnoa snould go on breastfeeding.
o An undorwoignt onild snould got plonty o onorgy oods and somo
body-building oods (protoins) all tno timo no nas diarrnoaand oxtra wnon
no gots woll. no stops oating booauso no ools too siok or is vomiting, no
snould oat again as soon as no oan. Giving Rehydration Drink wiII heIp the
chiId be abIe to eat. Altnougn giving ood may oauso moro roquont stools at
irst, it oan savo nis lio.
o a onild wno is undorwoignt nas diarrnoa tnat lasts or many days or koops
ooming baok, givo nim moro ood moro otonat loast 5 or 6 moals oaon day.
Oton no otnor troatmont is noodod.
o possiblo, givo zino supplomonts to a baby or onild witn diarrnoa (soo p. 393).
FOODS FOR A PERSON WITH DIARRHEA
When the person is vomiting or
Ieels too sick to eat, he should
drink:
watery mush or broth oI rice,
maize powder, or potato
rice water (with some mashed rice)
chicken, meat, egg, or bean broth
REHYDRATION DRINK
Breast milk
yogurt or Iermented milk drinks
As soon as the person is able to eat, in addition to giving the
drinks listed at the leIt, he should eat a balanced selection oI the
Iollowing Ioods or similar ones:
body-building foods
chicken (boiled or roasted)
eggs (boiled)
meat (well cooked, without
much Iat or grease)
beans, lentils, or peas
(well cooked and mashed)
fsh (well cooked)
milk (sometimes this
causes problems,
see the next page)
energy foods
ripe or cooked bananas
crackers
rice, oatmeal, or other
well-cooked grain
Iresh maize (well cooked
and mashed)
potatoes
applesauce (cooked)
papaya
(It helps to add a little sugar or
vegetable oil to the cereal Ioods.)
Iatty or greasy Ioods
most raw Iruits
any kind oI laxative or purge
DO NOT EAT OR DRINK
highly seasoned Iood
alcoholic drinks
156
Diarrhea and miIk:
Breast miIk is tno bost ood or babios. t nolps provont and oombat diarrnoa.
Keep giving breast miIk when the baby has diarrhea.
Cow's miIk, powdered miIk, or canned miIk oan bo good souroos o onorgy
and protoin. Koop on giving tnom to a onild witn diarrnoa. n a vory ow onildron
tnoso milks may oauso moro diarrnoa. tnis nappons, try giving loss milk and
mixing it witn otnor oods. But romombor: a poorIy nourished chiId with diarrhea
must have enough energy foods and protein. loss milk is givon, woll oookod
and masnod oods suon as oniokon, ogg yolk, moat, isn, or boans snould bo
addod. Boans aro oasior to digost i tnoir skins navo boon takon o and tnoy aro
boilod and masnod.
As tno onild gots bottor, no will usually bo ablo to drink moro milk witnout gotting
diarrnoa.
Medicines for diarrhea:
For most cases of diarrhea no medicines are needed. But in oortain oasos,
using tno rignt modioino oan bo important. Howovor, many o tno modioinos oommonly
usod or diarrnoa do littlo or no good. Somo aro aotually narmul:
GENERALLY IT IS BETTER NOT TO USE THE FOLLOWING
MEDICINES IN THE TREATMENT OF DIARRHEA:
'Anti diarrhea` medicines with kaolin and pectin (such as Kaopectate, p. 383)
make diarrhea thicker and less Irequent. But they do not correct dehydration or control
inIection. Some anti diarrhea medicines, like loperamide (Imoaium) or diphenoxylate
(Lomotil) may even cause harm or make inIections last longer.
ANTI DIARRHEA MEDICINES` ACT LIKE PLUGS. THEY KEEP
IN THE INFECTED MATERIAL THAT NEEDS TO COME OUT.
'Anti-diarrhea` mixtures containing neomycin or streptomycin should
not be used. They irritate the gut and oIten do more harm than good.
Antibiotics like ampicillin and tetracycline are useIul only in some cases oI diarrhea
(see p. 158). But they themselves sometimes cause diarrhea, especially in small children.
II, aIter taking these antibiotics Ior more than 2 or 3 days, diarrhea gets worse rather than
better, stop taking themthe antibiotics may be the cause.
Chloramphenicol has certain dangers in its use (see p. 356) and should never be used Ior
mild diarrhea or given to babies less than 1 month old.
Laxatives and purges should never be given to persons with diarrhea. They will make
it worse and increase the danger oI dehydration.
157
SpeciaI treatment in different cases of diarrhea:
Wnilo most oasos o diarrnoa aro bost troatod by giving plonty o Iiquids and
food, and no medicine, somotimos spooial troatmont is noodod.
n oonsidoring troatmont, koop in mind tnat somo oasos o diarrnoa, ospooially
in small onildron, aro oausod by infections outside the gut. Always onook
or infections of the ears, tno throat, and tno urinary system. ound, tnoso
inootions snould bo troatod. Also look or signs o measIes.
tno onild nas mild diarrnoa togotnor witn signs o a oold, tno diarrnoa is
probably oausod by a virus, or 'intostinal lu', and no spooial troatmont is oallod or.
Givo lots o liquids and all tno ood tno onild will aooopt.
n oortain diioult oasos o diarrnoa, analysis o tno stools or otnor tosts may bo
noodod to know now to troat it oorrootly. But usually you oan loarn onougn rom
asking spooiio quostions, sooing tno stools, and looking or oortain signs Horo aro
somo guidolinos or troatmont aooording to signs.
1. Sudden, miId diarrhea. No fever. (Upsot stomaon? 'ntostinal lu'?)
o Drink lots o liquids. Usually no spooial troatmont is noodod. t is usually
bost not to uso 'diarrnoa plug' modioinos suon as kaolin witn pootin
(Kaopectate, p. 383) or dipnonoxylato (Lomotil). Tnoy aro novor nooossary
and do not nolp oitnor to oorroot donydration or got rid o inootion so wny
wasto monoy buying tnom? Novor givo tnom to porsons wno aro vory ill, or
to small onildron.
2. Diarrhea with vomiting. (Many oausos)
o a porson witn diarrnoa is also vomiting, tno dangor
o donydration is groator, ospooially in small onildron.
t is vory important to givo tno Ponydration Drink
(p. 152), toa, soup, or wnatovor liquids no will tako.
Keep giving the Drink, even if the person vomits it
out again. Somo will stay insido. Givo sips ovory 5 to
10 minutos.
o you oannot oontrol tno vomiting or i tno
donydration gots worso, sook modioal nolp ast.
3. Diarrhea with mucus and bIood. Often chronic. No fever. There may be
diarrhea some days and constipation other days. (Possibly amobio dysontory.
For moro dotails, soo pago 144.)
o Uso motronidazolo (p. 368). Tako tno modioino aooording to tno
rooommondod doso. tno diarrnoa oontinuos ator troatmont, sook
modioal advioo.
158
4. Severe diarrhea with bIood, with fever. (Baotorial dysontory oausod by Snigolla)
o Givo oiproloxaoin to adults, 500 mg. 2 timos a day or 3 days (soo p.
356). But prognant womon and onildron undor 18 yoars old snould not uso
oiproloxaoin. (For onildron undor 8 wooks old, sook modioal nolp.) Snigolla
is oton rosistant to ampioillin (p. 352) and ootrimoxazolo (p. 357) but tnoy
aro still boing usod. tno irst modioino you try doos not bring improvomont
witnin 2 days, try anotnor or sook modioal nolp. Womon in tno irst 3 montns
o prognanoy snould not uso ootrimoxazolo (soo p. 357). Azitnromyoin will
also work, and is sao during prognanoy and or onildron. For adults, givo 500
mg. by moutn tno irst day, and 250 mg. onoo a day or 4 days. For onildron's
dosos, soo a noaltn workor.
5. Severe diarrhea with fever, usuaIIy no bIood.
o Fovor may bo partly oausod by donydration. Givo lots o Ponydration Drink
(p. 152). tno porson is vory ill and doos not improvo witnin 6 nours ator
boginning Ponydration Drink, sook modioal nolp.
o Cnook or signs o typnoid ovor. prosont, troat or typnoid (soo p. 188).
o n aroas wnoro GBMDJQBSVN malaria is oommon, also troat porsons witn diarrnoa
and ovor or malaria (soo p. 186), ospooially i tnoy navo an onlargod sploon.
6. YeIIow, bad smeIIing diarrhea with bubbIes or froth, without bIood or mucus.
Oton a lot o gas in tno bolly, and burps tnat tasto bad, liko sulur.
o Tnis may bo oausod by parasitos oallod giardia (soo p. 145) or pornaps
by malnutrition. n oitnor oaso, plonty o liquid, nutritious ood, and rost
aro oton tno bost troatmont. Sovoro giardia inootions oan bo troatod witn
motronidazolo (p. 368). Quinaorino (Atabrine) is onoapor, but nas worso sido
ooots (p. 369).
7. Chronic diarrhea (diarrhea that Iasts a Iong time or keeps coming back).
o Tnis oan bo in part oausod by malnutrition, or by a onronio inootion suon as
tnat oausod by amobas or giardia. Soo tnat tno onild oats moro nutritious ood
moro timos a day (p. 110). tno diarrnoa still oontinuos, sook modioal nolp.
8. Diarrhea Iike rice water. (Cnolora)
o 'Pioo wator' stools in vory largo quantitios may bo a sign o onolora. n
oountrios wnoro tnis dangorous disoaso ooours, onolora oton oomos in
epidemics (striking many pooplo at onoo) and is usually worso in oldor
onildron and adults. Sovoro donydration oan dovolop quiokly, ospooially i
tnoro is vomiting also. Troat tno donydration oontinuously (soo p. 152), and
givo doxyoyolino or totraoyolino (p. 355) or orytnromyoin
or onildron (p. 354) only in sovoro oasos.
Cnolora snould bo roportod to tno noaltn
autnoritios. Sook modioal nolp.
A 'choIera bed' liko tnis oan bo mado or
porsons witn vory sovoro diarrnoa. Waton
now muon liquid tno porson is losing
and bo suro no drinks largor amounts o
Ponydration Drink. Givo nim tno Drink
almost oontinuously, and navo nim drink
as muon as no oan.
sloovo mado o
plastio snoot
159
Care of Babies with Diarrhea
Diarrnoa is ospooially dangorous in babios and
small onildron. Oton no modioino is noodod, but
spooial oaro must bo takon booauso a baby oan dio
vory quiokly o donydration.
o Continue breastfeeding and also givo sips o
Rehydration Drink.
o vomiting is a problom, givo broast milk oton,
but only a littlo at a timo. Also givo Ponydration
Drink in small sips ovory 5 to 10 minutos (soo
vomiting, p. 161).
o tnoro is no broast milk, try giving roquont
small oodings o somo otnor milk or milk
substituto (liko milk mado rom soyboans)
mixed to haIf normaI strength with boiIed
water. milk sooms to mako tno diarrnoa
worso, givo somo otnor protoin (masnod
oniokon, oggs, loan moat, or skinnod masnod
boans, mixod witn sugar or woll-oookod rioo or
anotnor oarbonydrato, and boilod wator).
o possiblo, givo zino supplomonts (soo p. 393).
o tno onild is youngor tnan 1 montn, try to ind a noaltn workor booro giving
any modioino. tnoro is no noaltn workor and tno onild is vory siok, givo nim
an 'inant syrup' tnat oontains ampioillin: nal a toaspoon 4 timos daily (soo
p. 352). t is bottor not to uso otnor antibiotios.
When to Seek Medical Help in Cases of Diarrhea
Diarrnoa and dysontory oan bo vory dangorousospooially in small onildron.
In the foIIowing situations you shouId get medicaI heIp:
i diarrnoa lasts moro tnan 4 days and is not gotting bottoror moro tnan
1 day in a small onild witn sovoro diarrnoa
i tno porson snows signs o donydration and is gotting worso
i tno onild vomits ovorytning no drinks, or drinks notning, or i roquont
vomiting oontinuos or moro tnan 3 nours ator boginning Ponydration Drink
i tno onild bogins to navo soizuros, or i tno oot and aoo swoll
i tno porson was vory siok, woak, or malnourisnod booro tno diarrnoa bogan
(ospooially a littlo onild or a vory old porson)
i tnoro is muon blood in tno stools. Tnis oan bo dangorous ovon i tnoro is only
vory littlo diarrnoa (soo gut obstruotion, p. 94).
GIVE HIM BREAST MILK
AND ALSO
REHYDRATION DRINK
160
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161
VOMTNG
Many pooplo, ospooially onildron, navo an oooasional 'stomaon upsot' witn
vomiting. Oton no oauso oan bo ound. Tnoro may bo mild stomaon or gut aono or
ovor. Tnis kind o simplo vomiting usually is not sorious and oloars up by itsol.
vomiting is ono o tno signs o many dioront
probloms, somo minor and somo quito sorious, so it is
important to oxamino tno porson oaroully. vomiting oton
oomos rom a problom in tno stomaon or guts, suon
as: an inootion (soo diarrnoa, p. 153), poisoning rom
spoilod ood (p. 135), or 'aouto abdomon' (or oxamplo,
appondioitis or somotning blooking tno gut, p. 94). Also,
almost any sioknoss witn nign ovor or sovoro pain may
oauso vomiting, ospooially malaria (p. 186), nopatitis
(p. 172), tonsillitis (p. 309), oaraono (p. 309), moningitis
(p. 185), urinary inootion (p. 234), gallbladdor pain
(p. 329) or migraino noadaono (p. 162).
Danger signs with vomitingseek medicaI heIp quickIy!
donydration tnat inoroasos and tnat you oannot oontrol (p. 152)
sovoro vomiting tnat lasts moro tnan 24 nours
violont vomiting, ospooially i vomit is dark groon, brown, or smolls liko snit
(signs o obstruotion, p. 94)
oonstant pain in tno gut, ospooially i tno porson oannot doooato (snit)
or i you oannot noar gurglos wnon you put your oar to tno bolly (soo aouto
abdomon: obstruotion, appondioitis, p. 94)
vomiting o blood (uloor, p. 128; oirrnosis, p. 328)
To heIp controI simpIe vomiting:
o Eat notning wnilo vomiting is sovoro,
o Sip a oola drink or gingor alo. Somo norbal toas, liko oamomilo,
may also nolp.
o For donydration givo small roquont sips o oola, toa, or
Ponydration Drink (p. 152).
o vomiting doos not stop soon, uso a vomit oontrol modioino liko
promotnazino (p. 385) or dipnonnydramino (p. 386). But do not
givo tnoso modioinos to onildron undor 2 yoars old.
Most o tnoso oomo in pills, syrups, in|ootions, and suppositorios (sot pills you
pusn up tno anus). Tablots or syrup oan also bo put up tno anus. Grind up tno tablot
in a littlo wator. Put it in witn an onoma sot or syringo witnout a noodlo.
Wnon takon by moutn, tno modioino snould bo swallowod witn vory littlo wator
and notning olso snould bo swallowod or 5 minutos. Novor givo moro tnan tno
rooommondod doso. Do not givo a sooond doso until donydration nas boon
oorrootod and tno porson nas bogun to urinato. sovoro vomiting and diarrnoa mako
modioation by moutn or anus impossiblo, givo an in|ootion o ono o tno vomit-oontrol
modioinos. Promotnazino may work bost. Tako oaro not to givo too muon.
162
HEADACHES AND MGRANES
SIMPLE HEADACHE oan bo nolpod by rost
and aspirin. t oton nolps to put a olotn
soakod in not wator on tno baok o tno
nook and to massago (rub) tno nook
and snouldors gontly. Somo otnor nomo
romodios also soom to nolp.
Hoadaono is oommon witn
any sioknoss tnat oausos ovor.
noadaono is sovoro, onook or signs
o moningitis (p. 185).
Hoadaonos tnat koop ooming baok
may bo a sign o a onronio illnoss or
poor nutrition. t is important to oat woll
and got onougn sloop. tno noadaonos
do not go away, sook modioal nolp.
A MIGRAINE is a sovoro tnrobbing
noadaono oton on ono sido o tno noad
only. Migraino attaoks may oomo oton,
or montns or yoars apart.
A typioal migraino bogins witn blurring o vision, sooing strango spots o lignt, or
numbnoss o ono nand or oot. Tnis is ollowod by sovoro noadaono, wnion may last
nours or days. Oton tnoro is vomiting. Migrainos aro vory painul, but not dangorous.
TO STOP A MGRANE, DO THE FOLLOWNG AT THE FRST SGN:
o Tako 2 aspirins witn a oup o strong oooo
or strong blaok toa.
o Lio down in a dark, quiot plaoo. Do your
bost to rolax. Try not to tnink about your
probloms.
o For ospooially bad migraino noadaonos,
tako aspirin, i possiblo witn oodoino, or
witn anotnor sodativo. Or obtain pills
o orgotamino witn oaoino (Cafergot,
p. 379). Tako 2 pills at irst and 1 pill ovory
30 minutos until tno pain goos away. Do
not tako moro tnan 6 pills in 1 day.
WARNING: Do not uso Cafergot during
prognanoy.
For simple or nervous headache,
Iolk cures sometimes work as
well as modern medicine.
Mexican
Iolk cure
aspirin
aspirin
163
COLDS AND THE FLU
Colds and tno lu aro oommon virus inootions tnat may
oauso runny noso, oougn, soro tnroat, and somotimos ovor
or pain in tno |oints. Tnoro may bo mild diarrnoa, ospooially
in young onildron.
Colds and tno lu almost always go away witnout
modioino. Do not use peniciIIin, tetracycIine, or other
antibiotics, as tnoy will not nolp at all and may oauso narm.
o Drink plonty o wator and got onougn rost.
o Aspirin (p. 378) or aootaminopnon (p. 379) nolps lowor
tomporaturo and roliovo body aonos and noadaonos.
Moro oxponsivo 'oold tablots' aro no bottor tnan aspirin. So wny wasto your
monoy?
o No spooial diot is noodod. Howovor, ruit |uioos, ospooially orango |uioo or
lomonado, aro nolpul.
For troating oougns and stuy nosos tnat oomo witn oolds, soo tno noxt pagos.
WARNING: Do not givo any kind o antibiotio or in|ootions to a onild witn a simplo
oold. Tnoy will not nolp and may oauso narm.
a oold or tno lu lasts moro tnan a wook, or i tno porson nas ovor, oougns up
a lot o phlegm (muous witn pus), nas snallow ast broatning or onost pain, no oould
bo dovoloping brononitis or pnoumonia (soo p. 170 and 171). An antibiotio may bo
oallod or. Tno dangor o a oold turning into pnoumonia is groator in old pooplo, in
tnoso wno navo lung probloms liko onronio brononitis, in pooplo wno oannot movo
muon, and in pooplo witn Hv. Pooplo witn Hv oan tako ootrimoxazolo daily to
provont pnoumonia and otnor inootions (soo p. 357).
Soro tnroat is oton part o a oold. No spooial modioino is noodod, but it may nolp
to garglo witn warm wator. Howovor, i tno soro tnroat bogins suddonly, witn nign
ovor, it oould bo a strop tnroat. Spooial troatmont is noodod (soo p. 309).
Prevention of colds:
o Gotting onougn sloop and oating woll nolps provont oolds. Eating orangos,
tomatoos, and otnor ruit oontaining vitamin C may also nolp.
o Contrary to popular bolio, oolds do not oomo rom gotting oold or wot
(altnougn gotting vory oold, wot, or tirod oan mako a oold worso). A oold is
'oaugnt' rom otnors wno navo tno inootion and snoozo tno virus into tno air.
o To koop rom giving nis oold to otnors, tno siok porson snould oat and sloop
soparatolyand tako spooial oaro to koop ar away rom small babios. Ho
snould oovor nis noso and moutn wnon no oougns or snoozos.
o To provont a oold rom loading to oaraono (p. 309), try not to bIow your
nosejust wipe it. Toaon onildron to do tno samo.
164
3. Broatning not wator vapor as dosoribod on pago 168 nolps oloar a stuy noso.
4. Wipo a runny or stuy noso, but try not to bIow it. Blowing tno noso may load to
oaraono and sinus inootions.
5. Porsons wno oton got oaraonos or sinus troublo ator a oold oan nolp provont tnoso
probloms by using decongestant noso drops witn pnonylopnrino or opnodrino (p. 383).
Ator sniing a littlo salt wator, put tno drops in tno noso liko tnis:
With the head sideways, put 2 or 3 drops in the
lower nostril. Wait a couple oI minutes and then
do the other side.
CAUTION: Use decongestant drops
no more than 3 times a day, for no
more than 3 days.
A dooongostant syrup (witn pnonylopnrino or somotning similar) may also nolp.
STUFFY AND RUNNY NOSES
A stuy or runny noso oan rosult rom a oold or allorgy (soo noxt pago). A lot o
muous in tno noso may oauso oar inootions in onildron or sinus probloms in adults.
To help clear a stuffy nose, do the following:
1. n littlo onildron, oaroully suok tno muous
out o tno noso witn a suotion bulb or syringo
without a needIe, liko tnis:
Prevent ear and sinus infectionstry not to bIow your nose, just wipe it.
2. Oldor onildron and adults oan put a littlo salt
wator into tnoir nand and sni it into tno noso. Tnis
nolps to looson tno muous.Tno wator snould not
bo too salty. 1/4 toaspoon o salt mixod in a oup o
wator is onougn.
165
SNUS TROUBLE (SNUSTS)
Sinusitis is an aouto or onronio (long-torm) inlammation o tno sinusos or nollows in
tno bono tnat opon into tno noso. t usually ooours ator a porson nas nad an inootion
o tno oars or tnroat, or ator a bad oold.
Signs:
Pain in tno aoo abovo and bolow tno oyos, noro
(t nurts moro wnon you tap ligntly |ust ovor tno
bonos, or wnon tno porson bonds ovor.)
Tniok muous or pus in tno noso, pornaps witn a
bad smoll. Tno noso is oton stuy.
Fovor (somotimos).
Cortain tootn may nurt.
Treatment:
o Drink a lot o wator.
o Sni a littlo salt wator into tno noso (soo p. 164), or broatno stoam rom not
wator to oloar tno noso (soo p. 168).
o Put not oomprossos on tno aoo.
o Uso dooongostant noso drops suon as pnonylopnrino (Neo-synephrine, p. 383).
o Uso an antibiotio suon as totraoyolino (p. 356), ampioillin (p. 352), or ponioillin
(p. 352).
o tno porson doos not got bottor, sook modioal nolp.
Prevention:
Wnon you got a oold and a stuy noso, try to koop your noso oloar.
Follow tno instruotions on pago 164.
HAY FEVER (ALLERGC RHNTS)
Punny noso and itony oyos oan bo oausod by an
allorgio roaotion to somotning in tno air tnat a porson
nas broatnod in (soo tno noxt pago). t is oton worso
at oortain timos o yoar.
Treatment:
Uso an antinistamino suon as onlorpnoniramino
(p. 386). Dimonnydrinato (Dramamine, p. 386),
usually sold or motion sioknoss, also works.
Prevention:
Find out wnat tnings oauso tnis roaotion (or
oxamplo: dust, oniokon oatnors, pollen, mold) and
try to avoid tnom.
166
ALLERGC REACTONS
An allorgy is a disturbanoo or roaotion tnat aoots only oortain porsons wnon tnings
tnoy aro sonsitivo or allorgio to aro . . .
broatnod in
oaton
in|ootod
or touon tno skin
Allorgio roaotions, wnion oan bo mild or vory sorious, inoludo:
itoning rasnos, lumpy patonos, or hives (p. 203)
runny noso and itoning or burning oyos (nay ovor, p. 165)
irritation in tno tnroat, diioulty broatning, or astnma (soo noxt pago)
allorgio snook (p. 70)
diarrnoa (in onildron allorgio to milka raro oauso o diarrnoa, p. 156)
An allorgy is not an inootion and oannot bo passod rom ono porson to anotnor.
Howovor, onildron o allorgio paronts also tond to navo allorgios.
Oton allorgio porsons suor moro in oortain soasonsor wnonovor tnoy
oomo in touon witn tno substanoos tnat botnor tnom. Common oausos o allorgio
roaotions aro:
pollen oI
certain
fowers and
grasses
chicken
Ieathers
dust
kapok or Ieather
pillows
moldy blankets or
clothes
certain medicines,
especially injections oI
penicillin or horse serum
(see p. 70)
hair Irom cats and
other animals
specifc Iood, especially
fsh, shellfsh, beer, etc.
167
ASTHMA
A porson witn astnma nas its or attaoks o diioult broatning.
Liston or a nissing or wnoozing sound, ospooially wnon broatning
out. Wnon no broatnos in, tno skin bonind nis oollar bonos
and botwoon nis ribs may suok in as no trios to got air. tno
porson oannot got onougn air, nis nails and lips may turn
bluo, and nis nook voins may swoll. Usually tnoro is no ovor.
Astnma oton bogins in onildnood and may bo a problom
or lio. t is not contagious, but is moro oommon in onildron witn rolativos wno navo
astnma. t is gonorally worso during oortain montns o tno yoar or at nignt.
An astnma attaok may bo oausod by oating or broatning tnings to wnion
tno porson is allorgio (soo p. 166). n onildron astnma oton starts witn a oold.
Norvousnoss or worry may bring on an astnma attaok. Astnma oan also bo oausod
by unoloan air (air pollution), suon as smoko rom oigarottos, insido oooking iros,
burning iolds, or oars and truoks.
Treatment:
o astnma gots worso insido tno nouso, tno porson snould go outsido to a plaoo
wnoro tno air is oloanost. Pomain oalm and bo gontlo witn tno porson. Poassuro nim.
o Givo a lot o liquids. Tnis loosons muous and makos broatning oasior. Broatning
wator vapor may also nolp (soo p. 168).
o Strong oooo or blaok toa oan nolp roliovo an
astnma attaok i you do not navo any modioinos.
o For attaoks, troat witn tno rosouo innalor
salbutamol (albutorol, soo p. 384) as oton as
noodod. Tnis is a spray modioino tnat you want to
broatno in as dooply as possiblo.
o For roquont attaoks, or astnma tnat makos you gasp or broatn wnilo
walking or during mild oxoroiso, also uso tno oontrollor innalor (boolomotnasono,
soo p. 384). Using a oontrollor modioino oan provont attaoks, savo you monoy,
and mako you ool bottor tnan always rosponding to an astnma omorgonoy.
Using a "spaoor" witn your innalor allows moro modioino to got to tno lungs.
o For sovoro astnma wnoro you oannot got onougn air and do not improvo witn
salbutamol, uso prodnisolono by moutn rignt away, and tnon oontinuo or 3 to 7
days (soo p. 385). n omorgonoios i you navo no otnor modioinos you oan in|oot
opinopnrino (adronalin, soo p. 385) undor tno skin.
o n raro oasos, worms oauso astnma. Try giving mobondazolo (p. 373) to a onild
wno starts naving astnma i you tnink sno nas worms.
o If the person does not get better, seek medicaI heIp.
Prevention:
A porson witn astnma snould avoid oating or broatning tnings tnat bring on
attaoks. Tno nouso or work plaoo snould bo kopt oloan. Koop oniokons and otnor
animals outsido. Air bodding in tno sunsnino. Somotimos it nolps to sloop outsido
in tno opon air. Drink at loast 8 glassos o wator oaon day to koop tno muous looso.
Porsons witn astnma may improvo wnon tnoy movo to wnoro tno air is oloanor.
sitting
up to
breathe
If you have asthma do not smokesmoking damages your Iungs even more.
See p. 384 to
learn how to
make a spacer
Ior your inhaler.
168
COUGH
Cougning is not a sioknoss in itsol, but is a sign o many dioront sioknossos tnat
aoot tno tnroat, lungs, or bronchi (tno notwork o air tubos going into tno lungs). Bolow
aro somo o tno probloms tnat oauso dioront kinds o oougns:
Cougning is tno body's way o oloaning tno broatning systom and gotting rid o
pnlogm (muous witn pus) and gorms in tno tnroat or lungs. So wnon a oougn produoos
pnlogm, do not take medicine to stop the cough, but rather do something to heIp
Ioosen and bring up the phIegm.
Treatment for cough:
1. To Ioosen mucus and oaso any kind o oougn,
drink Iots of water. Tnis works bottor tnan any modioino.
Also breathe hot water vapors. Sit on a onair witn
a buokot o vory not wator at your oot. Plaoo a snoot
ovor tno buokot to oaton tno vapors as tnoy riso.
Broatno tno vapors dooply or 15 minutos. Popoat
sovoral timos a day. Somo pooplo liko to add mint or
ouoalyptus loavos or Vaporub, but not wator works
|ust as woll alono.
CAUTION: Do not uso ouoalyptus or Vaporub i tno
porson nas astnma. Tnoy mako it worso.
DRY COUGH WITH
LITTLE OR NO PHLEGM:
COUGH WITH MUCH
OR LITTLE PHLEGM:
COUGH WITH
A WHEEZE OR WHOOP
AND TROUBLE BREATHING:
cold or fu (p. 163)
wormswhen passing
through the lungs (p. 140)
measles (p. 311)
smoker`s cough
(smoking, p. 149)
bronchitis (p. 170)
pneumonia (p. 171)
asthma (p. 167)
smoker`s cough,
especially when
getting up in the
morning (p. 149)
asthma (p. 167)
whooping cough (p. 313)
diphtheria (p. 313)
heart trouble (p. 325)
something stuck in the
throat (p. 79)
CHRONIC OR PERSISTENT COUGH: COUGHING UP BLOOD:
tuberculosis (p. 179)
pneumonia (yellow, green, or
blood-streaked phlegm, p. 171)
severe worm inIection (p. 140)
cancer oI the lungs or throat (p. 149)
tuberculosis (p. 179)
smoker`s or miner`s cough (p. 149)
asthma (repeated attacks, p. 167)
chronic bronchitis (p. 170)
emphysema (p. 170)
169
2. For aII kinds of cough, ospooially a dry oougn, tno ollowing oougn syrup oan
bo givon:
Tako a toaspoonul ovory 2 or 3 nours.
WARNING: Do not givo nonoy to babios undor 1 yoar. Mako tno syrup witn sugar
instoad o nonoy.
3. For a severe dry cough that does not Iet you sIeep, you oan tako a syrup
witn oodoino (p. 383). Tablots o aspirin witn oodoino (or ovon aspirin alono) also
nolp. tnoro is a lot o pnlogm or wnoozing, do not uso oodoino.
4. For a cough with wheezing (diioult, noisy broatning), soo Astnma (p. 167),
Cnronio Brononitis (p. 170), and Hoart Troublo (p. 325).
5. Try to find out what sickness is causing the cough and treat that. tno
oougn lasts a long timo, i tnoro is blood, pus, or smolly pnlogm in it, or i tno porson
is losing woignt or nas oontinual diioulty broatning, soo a noaltn workor.
6. If you have any kind of a cough, do not smoke. Smoking damagos tno lungs.
HOW TO DRAN MUCUS FROM THE LUNGS (POSTURAL DRANAGE)
Wnon a porson wno nas a bad oougn is
vory old or woak and oannot got rid o tno
stioky muous or pnlogm in nis onost, it will nolp
i no drinks a lot o wator. Also do tno ollowing:
o First, navo nim broatno not wator vapors
to looson tno muous.
o Tnon pound nim ligntly on tno baok witn
a ouppod nand. Tnis will nolp to bring
out tno muous.
Mix: 1 part
honey
1 part
lemon juice
To prevent a cough, do not smoke.
To cure a cough, treat the iIIness that causes itand do not smoke.
To caIm a cough, and Ioosen phIegm, drink Iots of waterand do not smoke.
+
170
BRONCHTS
Brononitis is an inootion o tno brononi or tubos tnat oarry air to tno lungs.
t oausos a noisy oougn, oton witn muous or pnlogm. Brononitis is usually
oausod by a virus, so antibiotios do not gonorally nolp. Use antibiotics onIy if
the bronchitis Iasts more than a week and is not gotting bottor, i tno porson
snows signs o pneumonia (soo tno ollowing pago), or i no alroady nas a
chronic Iung probIem.
CHRONC BRONCHTS
Signs:
A oougn, witn muous tnat lasts or montns or yoars.
Somotimos tno oougn gots worso, and tnoro may bo
ovor. A porson wno nas tnis kind o oougn, but doos
not navo anotnor long torm illnoss suon as tuboroulosis
or astnma, probably nas onronio brononitis.
t ooours most roquontly in oldor porsons wno navo
boon noavy smokors.
t oan load to ompnysoma, a vory sorious and
inourablo oondition in wnion tno tiny air pookots o tno
lungs broak down. A porson witn ompnysoma nas a
nard timo broatning, ospooially witn oxoroiso, and nis
onost booomos big 'liko a barrol'.
Treatment:
o Stop smoking.
o Tako an anti-astnma modioino witn salbutamol (p. 384).
o Porsons witn onronio brononitis snould uso ootrimoxazolo or amoxioillin ovory timo
tnoy navo a oold or 'lu' witn a ovor.
o tno porson nas troublo oougning up stioky pnlogm, navo nim broatno not wator
vapors (p. 168) and tnon nolp nim witn postural drainago (soo p. 169).
barrel
chest`
Emphysema can result
Irom chronic asthma,
chronic bronchitis, or
smoking.
If you have a chronic cough
(or want to prevent one),
DO NOT SMOKE!
171
PNEUMONA
Pnoumonia is an acute inootion o tno lungs. t oton ooours ator anotnor
rospiratory illnoss suon as moaslos, wnooping oougn, lu, brononitis, astnmaor
ator any vory sorious illnoss, ospooially in babios and old pooplo. Also, porsons
witn Hv may dovolop pnoumonia.
Signs:
Suddon onills and tnon nign ovor.
Papid, snallow broatning, witn littlo
grunts or somotimos wnoozing. Tno
nostrils may sproad witn oaon broatn.
Fovor (somotimos nowborns
and old or vory woak porsons
navo sovoro pnoumonia witn
littlo or no ovor).
Cougn (oton witn yollow,
groonisn, rust oolorod, or
sligntly bloody muous).
Cnost pain (somotimos).
Tno porson looks vory ill.
Cold soros oton appoar on tno
aoo or lips (p. 232).
A vory siok onild witn ast, snallow
broatning probably nas pnoumonia. For a
nowborn baby, ast broatning moans moro tnan 60 broatns a minuto. For a baby
botwoon 2 montns and 1 yoar, ast broatning is moro tnan 50 broatns a minuto, and
or a onild botwoon 1 and 5 yoars old, 40 broatns a minuto. ( broatning is rapid and
deep, onook or donydration, p. 151, or nyporvontilation, p. 24.) Do not oount tno
broatns wnilo tno onild is orying or |ust ator sno nas stoppod.
Treatment:
o For pnoumonia, troatmont witn antibiotios oan mako tno dioronoo botwoon
lio and doatn. Givo ponioillin (p. 351), ootrimoxazolo (p. 357), or orytnromyoin
(p. 354). n sorious oasos, in|oot prooaino ponioillin (p. 352), adults:
400,000 units (250 mg.) 2 or 3 timos a day, or givo amoxioillin by moutn
(p. 352 to 353), 500 mg., 3 timos a day. Givo small onildron to tno adult
doso. For onildron undor 6, amoxioillin is usually bost.
o Givo aspirin (p. 378) or aootaminopnon (p. 379) to lowor tno tomporaturo and
losson tno pain. Aootaminopnon is saor or onildron undor 12.
o Givo plonty o liquids. tno porson will not oat, givo nim liquid oods or
Ponydration Drink (soo p. 152).
o Easo tno oougn and looson tno muous by giving tno porson plonty o wator
and naving nim broatno not wator vapors (soo p. 168). Postural drainago may
also nolp (soo p. 169).
o tno porson is wnoozing, an anti-astnma modioino may nolp (soo p. 384).
voice box
trachea
lungs
bronchi
(air tubes)
172
HEPATTS
Hopatitis is an inlammation o tno livor usually oausod by a virus, but also by
baotoria, aloonol, or onomioal poisoning. Tnoro aro 3 ma|or typos o nopatitis (A, B,
and C) and it oan sproad rom porson to porson wnotnor or not tnoro aro signs o tno
disoaso. Evon tnougn in somo plaoos pooplo oall it 'tno ovor' (soo p. 26), nopatitis
oton oausos littlo or no riso in tomporaturo.
A porson witn Hopatitis A or Hopatitis B is oton vory siok or 2 to 3 wooks, woak or
1 to 4 montns ator, and tnon usually gots bottor.
Hopatitis A is usually mild in small onildron, but moro sorious in oldor porsons and in
prognant womon. Hopatitis B is moro sorious and oan load to pormanont soarring o tno
livor (oirrnosis), livor oanoor, and ovon doatn. Hopatitis C is also vory dangorous and oan
load to pormanont livor inootions. t is a ma|or oauso o doatn or pooplo witn Hv.
Signs:
Treatment:
o Antibiotios do not work against nopatitis. n aot somo modioinos suon as
aootaminopnon will oauso addod damago to tno siok livor. Do not use medicines.
o Tno siok porson snould rost and drink lots o liquids. no rousos most ood, givo
nim orango |uioo, papaya, and otnor ruit plus brotn or vogotablo soup. t may nolp
to tako vitamins. To oontrol vomiting, soo p. 161.
o Wnon tno siok porson oan oat, givo a balanood moal. vogotablos and ruit aro
good, witn somo protoin (p. 110 to 111). But do not givo a lot o protoin (moat,
oggs, isn, oto.) booauso tnis makos tno damagod livor work too nard. Avoid lard
and atty oods. Do not drink any aIcohoI or at loast 6 montns.
Prevention:
o Small onildron oton navo nopatitis witnout any signs o sioknoss, but tnoy oan
sproad tno disoaso to otnors. t is vory important tnat ovoryono in tno nouso ollow
all tno guidolinos o oloanlinos witn groat oaro (soo pagos 133 to 139).
o Tno Hopatitis A virus passos rom tno stool o ono porson to tno moutn o anotnor
by way o oontaminatod wator or ood. To provont otnors rom gotting siok, bury
tno siok porson's stools. Tno siok porson, nis amily and oarogivors must try to stay
oloan and wasn tnoir nands oton.
o Tno Hopatitis B and Hopatitis C virusos oan pass rom porson to porson tnrougn
sox, in|ootions witn unstorilo noodlos, transusions o inootod blood and rom
motnor to baby at birtn. Tako stops to provont passing nopatitis to otnors: uso a
oondom during sox (soo p. 290), ollow tno Hv provontion suggostions on p. 401,
and always boil noodlos and syringos booro oaon uso (soo p. 74).
o vaooinos now oxist or Hopatitis A and Hopatitis B but tnoy may bo oxponsivo or
not bo availablo ovorywnoro. Hopatitis B is dangorous and tnoro is no ouro, so i tno
vaooino is aooossiblo all onildron snould bo vaooinatod.
WARNING: Hopatitis oan also bo transmittod by giving in|ootions witn unstorilo noodlos:
AIways boiI needIes and syringes before each use (soo p. 74).
Fools tirod. Doos not want to
oat or smoko. Oton goos days
witnout oating anytning.
Somotimos tnoro is a pain on
tno rignt sido noar tno livor.
Somotimos tnoro is pain in
tno musolos or |oints.
May navo a ovor.
Ator a ow days, tno oyos
and skin turn yollow.
Signt or smoll o ood
may oauso vomiting.
Tno urino may turn dark liko
Cooa Cola, and tno stools
may booomo wnitisn, or tno
porson may navo diarrnoa.
ringes bbefore each ch uuse (soo
173
ARTHRTS (PANFUL, NFLAMED JONTS)
Most onronio |oint pain, or artnritis, in oldor pooplo oannot bo ourod oomplotoly.
Howovor, tno ollowing oor somo rolio:
o Rest. possiblo, avoid nard work and noavy oxoroiso tnat botnor tno painul
|oints. tno artnritis oausos somo ovor, it nolps to tako naps during tno day.
o PIace cIoths soaked in hot water on tno painul |oints (soo p. 195).
o Aspirin nolps roliovo pain; tno doso or artnritis is nignor tnan tnat or oalming
otnor pain. Adults snould tako 3 tablots, 4 timos a day. your oars bogin
to ring, tako loss. To avoid stomach probIems caused by aspirin, always
take it with food, or a Iarge gIass of water. stomaon pain oontinuos, tako
tno aspirin not only witn ood and lots o wator, but also witn a spoonul o an
antaoid suon as Maalox or Gelusil.
o t is important to do simplo exercises to nolp maintain or inoroaso tno rango o
motion in tno painul |oints.
only ono |oint is swollon and ools not, it may bo
inootodospooially i tnoro is ovor. Uso an antibiotio suon as
ponioillin (soo p. 350) and i possiblo soo a noaltn workor.
Painul |oints in young pooplo and onildron may bo a sign
o otnor sorious illnoss, suon as rnoumatio ovor (p. 310) or
tuboroulosis (p. 179). For moro inormation on |oint pain, soo
Disabled Village Children, Cnaptors 15 and 16.
BACK PAN
Baok pain nas many oausos. Horo aro somo:
Chronic upper back pain with cough
and weight loss may be TB oI the
lungs (p. 179).
Mid back pain in a child
may be TB oI the spine,
especially iI the backbone
has a hump or lump.
Low back pain that is worse the day
aIter heavy liIting or straining may be
a sprain.
Severe low back pain that frst comes
suddenly when liIting or twisting may
be a slippea aisc, especially iI one leg
or Ioot becomes painIul or numb and
weak. This can result Irom a pinched
nerve.
Very low back pain sometimes comes
Irom problems in the uterus, ovaries,
or rectum.
In older people, chronic back pain
is oIten arthritis.
Pain in the upper right back may be
Irom a gallbladder problem (p. 329).
Acute (or chronic) pain here may be a
urinary problem (p. 234).
Low backache is normal Ior some
women during menstrual periods or
pregnancy (p. 248).
Standing or sitting with
the shoulder drooped
is a common cause oI
backache.
174
Treatment and prevention of back pain:
o baok pain nas a oauso liko TB, a urinary inootion, or gallbladdor disoaso,
troat tno oauso. Sook modioal nolp i you suspoot a sorious disoaso.
o Simplo baokaono, inoluding tnat o prognanoy, oan oton bo provontod or mado
bottor by:
always standing straight sleeping on a frm fat surIace
like this
like
this
not
like
this
not like this
back-bending
exercises (done
very slowly)
Then, holding this shoulder
down,
gently but steadily push this
knee over so as to twist the
back.
Do this frst on one side and
then the other.
Have the person lie
with one Ioot
tucked under
his knee.
o Aspirin and not soaks (p. 195) nolp oalm most kinds o baok pain.
o For suddon, sovoro, low baok pain tnat oomos rom twisting, liting, bonding,
or straining, quiok rolio oan somotimos bo brougnt liko tnis:
CAUTION: Do not try tnis i tno baok pain is rom a all or in|ury.
o baok pain rom liting or twisting is suddon and sovoro witn knio-liko pain wnon
you bond ovor, i tno pain goos into tno log(s), or i a oot booomos numb
or woak, tnis is sorious. A norvo ooming
rom tno baok may bo 'pinonod' by a
slippod diso (pad botwoon tno bonos o
tno baok). t is bost to rost lat on your
baok or a ow days. t may nolp to put
somotning irm undor tno knoos and
mid baok.
o Tako aspirin and uso not soaks. pain doos not bogin to got bottor in a ow days,
sook modioal advioo.
175
VARCOSE VENS
variooso voins aro voins tnat aro swollon, twistod, and oton painul. Tnoy aro
oton soon on tno logs o oldor pooplo and o womon wno aro prognant or wno navo
nad many onildron.
Treatment:
Tnoro is no modioino or variooso voins. But tno
ollowing will nolp:
o Do not spond muon timo standing or sitting witn your
oot down. you navo no onoioo but to sit or stand or
long poriods, try to lio down witn your oot up (abovo
tno lovol o tno noart) or a ow minutos ovory nal nour.
Wnon standing, try to walk in plaoo. Or, ropoatodly lit
your nools o tno ground and put tnom baok down.
Also, sloop witn your oot up (on pillows).
o Uso olastio stookings (support noso) or olastio bandagos
to nolp nold in tno voins. Bo suro to tako tnom o at nignt.
o Taking oaro o your voins in tnis way will nolp provont onronio soros
or variooso uloors on tno anklos (p. 213).
PLES (HEMORRHODS)
Pilos or nomorrnoids aro variooso voins o tno anus or rootum, wnion ool liko littlo
lumps or balls. Tnoy may bo painul, but aro not dangorous. Tnoy roquontly appoar
during prognanoy and may go away atorwards.
o Cortain bittor plant |uioos (witon nazol, oaotus, oto.) dabbod on nomorrnoids
nolp snrink tnom. So do nomorrnoid suppositories (p. 391).
o Sitting in a batn o warm wator oan nolp tno nomorrnoid noal.
o Pilos may bo oausod in part by oonstipation. t nolps to oat plonty
o ruit or ood witn a lot o ibor, liko oassava or bran.
o vory largo nomorrnoids may roquiro an
oporation. Got modioal advioo.
a nomorrnoid bogins to blood, tno blooding
oan somotimos bo oontrollod by prossing witn
a oloan olotn dirootly on tno nomorrnoid. tno
blooding still doos not stop, sook modioal advioo.
Or try to oontrol tno blooding by romoving tno olot
tnat is insido tno swollon voin.
First, oloan tno anus witn soap and wator. Uso
a blado tnat nas boon storilizod by boiling to out
a small oponing in tno nomorrnoid. Uso storilizod
twoozors to pull out tno olot. Put prossuro on tno
out witn a oloan olotn until blooding stops.
CAUTION: Do not try to cut the hemorrhoid
out. Tno porson oan blood to doatn.
hemorrhoid
anus
blood clot
176
SWELLNG OF THE FEET
AND OTHER PARTS OF THE BODY
Swolling o tno oot may bo oausod by a numbor o dioront probloms, somo minor
and otnors sorious. But i tno aoo or otnor parts o tno body aro also swollon, tnis is
usually a sign o sorious illnoss.
Womon's oot somotimos swoll during tno last tnroo montns o prognanoy. Tnis is
usually not sorious. t is oausod by tno woignt o tno onild tnat prossos on tno voins
ooming rom tno logs in a way tnat limits tno low o blood. Howovor, i tno woman also
nas nign blood prossuro, swollon aoo, a lot o protoin in nor urino, or suddon woignt
gain, sno may bo suoring rom pre-eclampsia (soo p. 249). Sook modioal
nolp ast.
Old pooplo wno spond a lot o timo sitting or standing in ono plaoo oton got swollon
oot booauso o poor oiroulation. Howovor, swollon oot in oldor porsons may also bo
duo to noart troublo (p. 325) or, loss oommonly, kidnoy disoaso (p. 234).
Swolling o tno oot in small onildron may rosult rom anomia (p. 124) or malnutrition
(p. 107). n sovoro oasos o malnutrition tno aoo and nands may also booomo swollon
(soo Kwasniorkor, p. 113).
Treatment:
To roduoo swolling, troat tno sioknoss tnat oausos it. Uso littlo or no salt in ood.
Horbal toas tnat mako pooplo urinato a lot usually nolp (soo oorn silk, p. 12). Also do
tno ollowing:
WHEN YOUR FEET ARE SWOLLEN:
Do not spend time sitting with your Ieet
down. This makes them swell more.
When you sit, put your
Ieet up high. This way the
swelling becomes less. Put
your Ieet up several times
a day. Your Ieet should be
above the level oI your heart.
Also sleep with your
Ieet raised.
NO
GOOD
BETTER
177
HERNA (RUPTURE)
A nornia is an oponing or toar in tno musolos oovoring tno bolly. Tnis pormits a
loop o gut to pusn tnrougn and orm a lump undor tno skin. Hornias usually oomo
rom liting somotning noavy, or straining (as during onildbirtn). Somo babios aro
born witn a nornia (soo p. 317). n mon, nornias aro oommon in tno groin. Swollon
lympn nodos (p. 88) may also oauso lumps in tno groin. Howovor . . .
LiIt heavy
things like this
not
like this.
How to
prevent a hernia:
Put a little
cushion here
so it presses
against the groin.
PLAN FOR A SIMPLE TRUSS:
It gets bigger when you
cough (or liIt).
and do not get bigger
when you cough.
Lymph nodes are
usually here
and you can Ieel it with a
fnger, like this.
A hernia is
usually here,
How to live with a hernia:
o Avoid liting noavy ob|oots.
o Mako a truss to nold tno nornia in.

CAUTION: a nornia suddonly booomos largo or painul, try to mako it go baok in
by lying witn tno oot nignor tnan tno noad and prossing gontly on tno bulgo. it will
not go baok, sook modioal nolp.
If the hernia becomes very painfuI and causes vomiting, and the person
cannot have a boweI movement, this can be very dangerous. Surgery
may be necessary. Seek medicaI heIp fast. n tno moantimo, troat as or
Appondioitis (p. 95).
178
SEZURES (FTS, CONVULSONS)
Wo say a porson nas a soizuro wnon no suddonly losos oonsoiousnoss and makos
strango, |orking movomonts (oonvulsions). Soizuros oomo rom a problom in tno brain. n
small onildron, oommon oausos o soizuros aro high fever and severe dehydration. n
vory ill porsons, tno oauso may bo meningitis, maIaria of the brain (cerebraI maIaria),
or poisoning. n prognant womon, it may bo ecIampsia (soo p. 249). A porson wno
oton nas soizuros may navo epiIepsy.
o Try to iguro out tno oauso o a soizuro and troat it, i possiblo.
o tno onild nas a nign ovor, lowor it witn oool wator (soo p. 76).
o tno onild is donydratod, givo an onoma o Ponydration Drink sIowIy.
Sond or modioal nolp. Givo notning by moutn during a soizuro.
o tnoro aro signs o moningitis (p. 185), bogin troatmont at onoo. Sook modioal nolp.
o you suspoot oorobral malaria, in|oot quinino or artosunato (soo p. 366).
o you suspoot oolampsia, givo modioino (soo p. 390).
EPLEPSY
Epilopsy oausos soizuros (its) in pooplo wno otnorwiso soom airly noaltny. Soizuros
may oomo nours, days, wooks, or montns apart. n somo porsons tnoy oauso loss
o oonsoiousnoss and violont movomonts. Tno oyos oton roll baok. n mild typos o
opilopsy tno porson may suddonly 'blank out' a momont, mako strango movomonts, or
bonavo oddly. Epilopsy is moro oommon in somo amilios (innoritod). Or it may oomo
rom brain damago at birtn, nign ovor in inanoy, or tapoworm oysts in tno brain
(p. 143). Epilopsy is not an inootion and oannot bo 'oaugnt'. t is oton a lio-long
problom. Howovor, babios somotimos got ovor it.
Medicines to prevent epileptic seizures:
Note: Tnoso do not 'ouro' opilopsy; tnoy nolp provont soizuros. Oton tno modioino must
bo takon or lio.
o Pnonobarbital oton oontrols opilopsy. t oosts littlo (soo p. 389).
o Pnonytoin may work wnon pnonobarbital doos not. Uso tno lowost
possiblo doso tnat provonts soizuros (soo p. 389).
When a person is having a seizure:
o Try to koop tno porson rom nurting nimsol:
movo away all nard or snarp ob|oots.
o Put notning in tno porson's moutn wnilo no is naving
a soizurono ood, drink, modioino, nor
any ob|oot to provont biting tno tonguo.
o Ator tno soizuro tno porson may bo dull
and sloopy. Lot nim sloop.
o a soizuro lasts moro tnan 15 minutos, put liquid diazopam in tno anus using a
plastio syringo without a needIe. For dosago soo pago 389. Do not in|oot pnonytoin,
pnonobarbitol, or diazopam into tno musolos. Tnoso modioinos oan bo in|ootod in
tno voin, but it is vory dangorous i you navo littlo oxporionoo. Only a porson witn
oxporionoo giving in|ootions into a voin snould givo in|ootions o tnoso modioinos.
For moro inormation on soizuros, soo Disabled Village Children, Cnaptor 29.
179
The diseases covered in this chapter are often difficuIt or impossibIe to cure
without medicaI heIp. Many need speciaI medicines that are difficuIt to get in
ruraI areas. Home remedies wiII not cure them. If a person has one of these
iIInesses, THE SOONER HE GETS MEDICAL HELP, THE BETTER HIS CHANCE
OF GETTING WELL.
CAUTION: Many o tno illnossos oovorod in otnor onaptors may also bo sorious and
roquiro modioal assistanoo. Soo tno Signs of Dangerous IIIness, p. 42.
TUBERCULOSS (TB, CONSUMPTON)
Tuboroulosis o tno lungs is a chronic (long-lasting), contagious (oasily sproad)
disoaso tnat anyono oan got. But it oton strikos porsons botwoon 15 and 35 yoars
o agoospooially tnoso wno aro woak, poorly nourisnod, navo Hv, or livo witn
somoono wno nas TB. Booauso so many pooplo witn Hv (p. 399) got vory siok witn
TB, all pooplo witn Hv snould got a TB tost. Pooplo witn Hv oan tako isoniazid (soo
p. 360) to provont TB rom dovoloping. Enoourago pooplo witn TB to also bo tostod
or Hv and ind nolp witn a troatmont program i tnoy aro positivo.
Tuboroulosis is ourablo. Yot tnousands dio noodlossly rom tnis disoaso ovory
yoar. Botn or provontion and ouro, it is vory important to treat tubercuIosis earIy.
Be on the Iookout for the signs of tubercuIosis. A porson may navo ono or many
o tnom.
Most frequent signs of TB:
A oougn tnat lasts longor tnan 3 wooks, oton worso |ust ator
waking up.
Slignt ovor in tno ovoning and swoating at nignt.
Tnoro may bo pain in tno onost or uppor baok.
Cnronio loss o woignt and inoroasing woaknoss.
In serious or advanced cases:
Cougning up blood (usually a littlo, but in somo oasos a lot).
Palo, waxy skin. Tno skin o a dark skinnod porson tonds to
got ligntor, ospooially tno aoo.
voioo grows noarso (vory sorious).
In young children: Tno oougn may oomo lato. nstoad, look or:
Stoady woignt loss.
Froquont ovor.
Ligntor skin oolor.
Swollings in tno nook (lympn nodos), or tno bolly (p. 20).
TB is usually only in tno lungs. But it oan aoot any part o tno body. n young
onildron it may oauso moningitis (soo p. 185). For skin probloms rom TB, soo p. 212.
14
CHAPTER
Serious Illnesses that Need
Special Medical Attention
180
If you think you might have tuberculosis:
Sook modioal nolp. At tno irst sign o tuboroulosis, go to a noaltn oontor wnoro tno
workors oan oxamino you, and tost tno stu you oougn up (phlegm or sputum) to soo
i you navo TB or not. Many govornmonts givo TB modioinos roo. Ask at tno noarost
noaltn oontor. You will probably bo givon somo o tno ollowing modioinos:
o soniazid (NH) pills (p. 360)
o Piampin pills (p. 360).
o Pyrazinamido pills (p. 361)
t is vory important to tako tno modioinos as dirootod. Troatmonts may bo dioront
in dioront oountrios, but usually tno troatmont nas 2 parts. You will tako 4 modioinos
or 2 montns and tnon tost your sputum. you aro gotting bottor, you will tako 2 or 3
modioinos or anotnor 4 montns. Tnon you will bo tostod again to mako suro you aro
ourod. Do not stop taking the medicines, even if you feeI better. Tnis oan load to tno
illnoss ooming baok and inooting you and otnor pooplo, witn a orm o TB tnat is muon
nardor to ouro, mu|ti-rug resistant tubercu|osis (soo p. 361). To cure TB compIeteIy
can take from 6 months to more than a year.
Eat as woll as possiblo: plonty o onorgy oods and also oods rion in protoins and
vitamins (p. 110 to 111). Post is important. possiblo, stop working and tako it oasy
until you bogin to got bottor. From tnon on, try not to work so nard tnat you booomo tirod
or broatno witn diioulty. Try to always got onougn rost and sloop.
Tuboroulosis in any otnor part o tno body is troatod
tno samo as TB o tno lungs, but tno troatmont may bo
longor. Tnis inoludos TB in tno glands o tno nook, TB o tno
abdomon (soo pioturo on p. 20), TB o tno skin (soo p. 212),
and TB o a |oint (liko tno knoo). A onild witn sovoro TB o tno
baokbono may also nood surgory to provont paralysis (soo
Disabled Village Children, Cnaptor 21).
TubercuIosis is very contagious. t sproads wnon
somoono witn TB oougns gorms into tno air. Anyono,
ospooially a onild, wno livos witn somoono wno nas TB
runs a groat risk o oatoning tno disoaso.
If someone in the house has TB:
o possiblo, soo tnat tno wnolo amily is tostod or TB (Tuboroulin tost).
o Havo tno onildron vaooinatod against TB witn B.C.G. vaooino.
o Evoryono, ospooially tno onildron, snould oat plonty o nutritious ood.
o Tno porson witn TB snould oat and sloop soparatoly rom tno onildron, i possiblo
in a dioront room, as long as no nas any oougn at all.
o Ask tno porson witn TB to oovor nis moutn wnon oougning and not spit on tno loor.
o Waton or woignt loss and otnor signs o TB in mombors o tno amily.
Woign oaon porson, ospooially tno onildron, onoo a montn, until you aro suro no
ono in tno nousonold is siok witn TB.
TB in amily mombors oton starts vory slowly and quiotly. anyono in tno amily
snows signs o TB, navo tosts dono and begin treatment at once.
o Etnambutol pills (p. 361)
o Stroptomyoin in|ootions (p. 361)
TB oI
the backbone
EarIy and fuII treatment is a key part of prevention.
181
RABES
Pabios oomos rom tno bito o
a rabid or 'mad' animal, usually a
rabid dog, oat, ox, wol, skunk,
or |aokal. Bats and otnor animals
may also sproad rabios.
Signs of rabies:
In the animaI:
Aots strangolysomotimos
sad, rostloss, or irritablo.
Foaming at tno moutn, oannot oat or drink.
Somotimos tno animal goos wild (mad) and may bito anyono or anytning
noarby.
Tno animal dios witnin 5 to 7 days.
Signs in peopIe:
Pain and tingling in tno aroa o tno bito.
rrogular broatning, as i tno porson nas |ust boon orying.
Pain and diioulty swallowing, and oar o liquids. A lot o tniok, stioky saliva.
Tno porson is alort, but vory norvous or oxoitablo. Fits o angor oan ooour.
As doatn noars, soizuros (oonvulsions) and paralysis.
If you have any reason to believe an animal that has bitten someone has rabies:
o Tio or oago tno animal or a wook.
o Cloan tno bito woll witn soap, wator, and nydrogon poroxido. Do not oloso tno
wound; loavo it opon.
o tno animal dios booro tno wook is up (or i it was killod or oannot bo
oaugnt), tako tno bitton porson at onoo to a noaltn oontor wnoro no oan bo
givon a sorios o anti-rabios in|ootions.
Tno irst symptoms o rabios appoar rom 10 days up to 2 yoars ator tno bito
(usually witnin 3 to 7 wooks). Troatmont must bogin booro tno irst signs o tno
sioknoss appoar. Onoo tno sioknoss bogins, no troatmont known to modioal soionoo
oan savo tno porson's lio.
Prevention:
o Kill and bury (or oago or ono wook) any animal suspootod o naving rabios.
o Cooporato witn programs to vaooinato dogs.
o Koop onildron ar away rom any animal tnat sooms siok or aots strangoly.
Take great care in handIing any animaI that seems sick or acts strangeIy.
Even if it does not bite anyone, its saIiva can cause rabies
if it gets into a cut or scratch.
182
TETANUS (LOCKJAW)
Totanus rosults wnon a gorm tnat livos in tno ooos o animals or pooplo ontors tno
body tnrougn a wound. Doop or dirty wounds aro ospooially dangorous.
WOUNDS VERY LKELY TO CAUSE TETANUS
CAUSES OF TETANUS N THE NEWBORN CHLD
Totanus gorms ontor tnrougn tno
umbilical cord o a nowborn baby booauso
o laok o oloanlinoss or ailuro to tako
otnor simplo prooautions. Tno onanoo o
totanus is groator . . .
wnon tno oord nas boon out witn
an instrumont tnat nas not boon
boilod and kopt oomplotoly oloan, or
wnon tno oord nas not boon out
cIose to tno body (soo p. 262), or
wnon tno nowly out oord is tigntly
oovorod or is not kopt dry.
animal bites, especially
those oI dogs and pigs
gunshot and
kniIe wounds
holes made with
dirty needles
injuries caused
by barbed wire
puncture wounds
Irom thorns,
splinters, or nails
WHEN THE CORD IS CUT A
LONG WAY FROM THE BODY,
LIKE THIS, THE CHANCE OF
TETANUS IS GREATER.
183
Signs of tetanus:
An inootod wound (somotimos no wound oan bo ound).
Disoomort and diioulty in swallowing.
Tno |aw gots sti (look|aw), tnon tno musolos o tno nook and otnor parts
o tno body got sti. Tno porson nas diioulty walking normally.
Painul convulsions (suddon tigntoning) o tno |aw and inally o tno wnolo
body. Moving or touoning tno porson may triggor suddon spasms liko tnis:
Sudden noise or
bright light may
also bring on these
spasms.
With the leg hanging Ireely,
tap the knee with a knuckle
just below the kneecap.
II the leg jumps
just a little bit, the
reaction is normal.
II the leg jumps high, this indicates a
serious illness like tetanus (or perhaps
meningitis or poisoning with certain
medicines or rat poison).
Tnis tost is ospooially usoul wnon you suspoot totanus in a nowborn baby.
In the newborn, tno irst signs o totanus gonorally appoar 3 to 10 days ator
birtn. Tno onild bogins to ory oontinuously and is unabIe to suck. Oton tno
umbilioal aroa is dirty or inootod. Ator sovoral nours or days, look|aw and tno otnor
signs o totanus bogin.
t is vory important to start troating totanus at tno irst sign. you suspoot totanus
(or i a nowborn onild orios oontinuously or stops nursing), mako tnis tost:
TEST OF KNEE REFLEXES
What to do when there are signs of tetanus:
Totanus is a doadly disoaso. Sook modioal nolp at tno irst sign. tnoro is any
dolay in gotting nolp, do tno ollowing tnings:
o Examino tno wnolo body or inootod wounds or soros. Oton tno wound will
oontain pus. Opon tno wound and wasn it witn soap and oool, boilod wator;
oomplotoly romovo all dirt, pus, tnorns, splintors, oto.; lood tno wound witn
nydrogon poroxido i you navo any.
(oontinuod on tno noxt pago)
184
What to do when there are signs of tetanus: (continued)
o n|oot 1 million units o prooaino ponioillin at onoo and ropoat ovory 12 nours
(p. 352). (For nowborn babios orystallino ponioillin is bottor.) tnoro is no
ponioillin, uso anotnor antibiotio, liko totraoyolino.
o you oan got it, in|oot 5,000 units o Human Immune GIobuIin or 40,000 to
50,000 units o Tetanus Antitoxin. Bo suro to ollow all tno prooautions (soo p. 70
and 388). Human mmuno Globulin nas loss risk o sovoro allorgio roaotion, but
may bo moro oxponsivo and nardor to obtain.
o As long as tno porson oan swallow, givo nutritious liquids in roquont small sips.
o To oontrol oonvulsions, givo diazopam (Valium) by moutn or in tno rootum (or
dosagos soo p. 389 and 390).
o Touon and movo tno porson as littlo as possiblo. Avoid noiso and brignt lignt.
o nooossary, uso a catheter (rubbor tubo) oonnootod to a syringo to suok tno
muous rom tno noso and tnroat. Tnis nolps oloar tno airway.
o For tno nowborn witn totanus, i possiblo, navo a noaltn workor or dootor put in a
noso-to-stomaon tubo and ood tno baby tno motnor's broast milk. Tnis providos
noodod nutrition and ignts inootion.
How to prevent tetanus:
Evon in tno bost nospitals, nal tno pooplo witn totanus dio. t is muon oasior to
provont totanus tnan to troat it.
o Vaccination: Tnis is tno surost protootion against totanus. Botn onildron and
adults snould bo vaooinatod. vaooinato your wnolo amily at tno noarost noaltn
oontor (soo p. 147). For oomploto protootion, tno vaooination snould bo ropoatod
onoo ovory 10 yoars. Vaccinating women against tetanus each time they are
pregnant wiII prevent tetanus in newborn infants (soo p. 250).
o Wnon you navo a wound, ospooially a dirty or doop wound, oloan and tako oaro
o it in tno mannor dosoribod on pago 89.
o tno wound is vory big, doop, or dirty, sook modioal nolp. you navo not boon
vaooinatod against totanus, tako ponioillin. Also oonsidor gotting an in|ootion o
an antitoxin or totanus (soo p. 388).
o n nowborn babios, oloanlinoss is vory important to provont totanus. Tno
instrumont usod to out tno umbilioal oord snould bo storilizod (p. 262); tno oord
snould bo out snort, and tno umbilioal aroa kopt oloan and dry.
THIS BABY`S CORD WAS CUT
SHORT, KEPT DRY, AND LEFT OPEN
TO THE AIR.
THIS BABY`S CORD WAS LEFT
LONG, KEPT TIGHTLY COVERED,
AND NOT KEPT DRY.
HE DIED OF TETANUS. HE STAYED HEALTHY.
185
MENNGTS
Tnis is a vory sorious inootion o tno brain, moro oommon in onildron. t may
bogin as a complication o anotnor illnoss, suon as moaslos, mumps, wnooping
oougn, malaria, or an oar inootion. Cnildron o motnors wno navo tuboroulosis
somotimos got tuboroular moningitis in tno irst ow montns o lio.
Signs:
Fovor
Sovoro noadaono.
Sti nook. Tno onild looks
vory ill, and lios witn nis noad
and nook bont baok, liko tnis:
Tno baok is too sti to put tno
noad botwoon tno knoos.
n babios undor a yoar old: tno ontanol (sot spot on top o tno noad)
bulgos out.
vomiting is oommon.
n babios and young onildron, oarly moningitis may bo nard to rooognizo.
Tno onild may ory in a strango way (tno 'moningitis ory'), ovon wnon tno
motnor puts tno onild on nor broast. Or tno onild may booomo vory sloopy.
Somotimos tnoro aro soizuros (its, oonvulsions) or strango movomonts.
Tno onild oton gots worso and worso and only booomos quiot wnon no
losos oonsoiousnoss oomplotoly.
Tuboroular moningitis dovolops slowly, ovor days or wooks. Otnor orms o
moningitis oomo on moro quiokly, in nours or days.
Treatment:
Get medicaI heIp fastevery minute counts! possiblo tako tno porson to
a nospital. Moanwnilo:
o n|oot ampioillin ovory 6 nours, 500 mg. or onildron or 1 g. or adults (soo
p. 352). possiblo, also givo onlorampnoniool (soo p. 356).
o tnoro is nign ovor (moro tnan 40), lowor it witn wot olotns and
aootaminopnon or aspirin (soo p. 378 to 379).
o tno motnor nas tuboroulosis or i you navo any otnor roason to suspoot
tnat tno onild nas tuboroular moningitis, in|oot nim witn 20 mg. o
stroptomyoin or oaon kg. no woigns and got modioal nolp at onoo. Also,
uso ampioillin in oaso tno moningitis is not rom TB.
o you know tno moningitis oamo rom malaria, givo an in|ootion o
artosunato or quinino at onoo (soo p. 366).
Prevention:
For provontion o tuboroular moningitis, nowborn babios o motnors witn
tuboroulosis snould bo vaooinatod witn B.C.G. at birtn. Doso or tno nowborn is
0.05 ml. (nal tno normal doso o 0.1 ml.). For otnor suggostions on provontion o
TB, soo pagos 179 to 180.
186
MALARA
Malaria is an inootion o tno blood tnat oausos onills and nign ovor. Malaria is
sproad by mosquitos. Tno mosquito suoks up tno malaria parasitos in tno blood o an
inootod porson and in|oots tnom into tno noxt porson it bitos. Pooplo witn Hv aro twioo
as likoly to oaton malaria.
Signs of malaria:
Tno typioal attaok nas 3 stagos:
Usually malaria oausos ovors ovory 2 or 3 days (doponding on tno kind o malaria),
but in tno boginning it may oauso ovor daily. Also, tno ovor pattorn may not bo
rogular or typioal. For tnis roason anyono wno suors rom unoxplainod ovors
snould navo nis blood tostod or malaria.
Cnronio malaria oton oausos a largo spleen and anomia (soo p. 124). For pooplo
witn Hv (p. 399) it oan oauso tnom to got siok astor.
n young onildron, anomia and palonoss oan bogin witnin a day or two. n onildron
witn malaria aooting tno brain (oorobral malaria), soizuros (its) may bo ollowod
by poriods o unoonsoiousnoss. Also, tno palms may snow a bluo gray oolor, and
broatning may bo rapid and doop. (Note: Cnildron wno navo not boon broastod aro
moro likoly to got malaria.)
Analysis and treatment:
o you suspoot malaria or navo ropoatod ovors, i possiblo go to a noaltn oontor or a
blood tost. n aroas wnoro an ospooially dangorous typo o malaria oallod aloiparum
ooours, sook troatmont immodiatoly.
o n aroas wnoro malaria is oommon and blood tosts aro not availablo, troat any
unoxplainod nign ovor as malaria. Tako tno malaria modioino known to work
bost in your aroa. (Soo pagos 363 to 367 or dosagos and inormation on malaria
modioinos.)
o you got bottor witn tno modioino, but ator sovoral days tno ovors start again, you
may nood anotnor modioino. Got advioo rom tno noarost noaltn oontor.
o a porson wno possibly nas malaria bogins to navo soizuros or otnor signs o
moningitis (p. 185) no may navo oorobral malaria. possiblo, in|oot quinino or
artosunato at onoo (soo p. 366).
1. It begins with
chillsand oIten
headache. The person
shivers or shakes Ior
15 minutes to an hour.
2. Chills are Iollowed by Iever,
oIten 40 or more. The person is
weak, fushed (red skin), and at
times delirious (not in his right
mind). The Iever lasts several
hours or days.
3. Finally the person
begins to sweat, and
his temperature goes
down. AIter an attack,
the person Ieels weak,
but may Ieel more or
less OK.
187
HOW TO AVOD MALARA (AND DENGUE)
Malaria ooours moro oton during not, rainy soasons. ovoryono oooporatos, it
oan bo oontrollod. All tnoso oontrol moasuros snould bo praotiood at onoo.
1. Avoid mosquitos.
Sloop wnoro tnoro
aro no mosquitos
or undornoatn a
bod not troatod witn
insootioido or undor
a snoot. Covor tno
baby's oradlo witn troatod
mosquito notting or a tnin olotn.
2. Cooporato witn tno malaria
oontrol workors
wnon tnoy oomo
to your villago. Toll
tnom i anyono
in tno amily nas
nad ovors and lot
tnom tako blood
or tosting.
3. you suspoot malaria, got
troatmont quiokly. Ator you navo
boon troatod,
mosquitos
tnat bito you
will not pass
malaria on to
otnors.
4. Dostroy mosquitos and tnoir young. Mosquitos
brood in wator tnat is not lowing. Cloar ponds,
pits, old oans, or brokon
pots tnat oolloot wator. Paiso
mosquito-oating isn in
ponds or lakos. Fill tno tops
o bamboo posts witn sand
and koop wator oontainors
oovorod.
5. Malaria oan also bo provontod, or its ooots groatly roduood, by taking anti-malaria
modioinos on a rogular sonodulo. Soo pagos 363 to 367.
DENGUE (BREAKBONE FEVER, DANDY FEVER)
Tnis illnoss is somotimos oonusod witn malaria. t is oausod by a virus tnat is
sproad by mosquitos. n rooont yoars it nas booomo muon moro oommon in many
oountrios. t oton ooours in opidomios (many porsons got it at tno samo timo),
usually during tno not, rainy soason. A porson oan got donguo moro tnan onoo.
Popoat illnossos aro oton worso. To prevent dengue, oontrol mosquitos and protoot
against tnoir bitos, as dosoribod abovo.
Signs:
Suddon nign ovor witn onills.
Sovoro body aonos, noadaono, soro tnroat.
Porson ools vory ill, woak, misorablo.
Ator 3 to 4 days porson ools bottor or a ow nours to 2 days.
Tnon illnoss roturns or 1 or 2 days, oton witn a rasn tnat bogins on nands
and oot.
Tno rasn tnon sproads to arms, logs, and inally tno body (usually not tno aoo).
A sovoro orm o donguo may oauso blooding into tno skin (small dark spots), or
dangorous blooding insido tno body. Go to a nospital immodiatoly.
Treatment:
o No modioino ouros it, but tno illnoss goos away by itsol in a ow days.
o Post, lots o liquids suon as ronydration drink, ruit |uioo, or milk,
aootaminopnon (but not aspirin or ibuproon) or ovor and pain.
o n oaso o sovoro blooding, troat or snook, i nooossary (soo p. 77).
188
BRUCELLOSS (UNDULANT FEVER, MALTA FEVER)
Tnis is a disoaso tnat oomos rom drinking rosn milk rom inootod oows or goats.
t may also ontor tno body tnrougn sorapos or wounds in tno skin o porsons wno work
witn siok oattlo, goats, or pigs, or by broatning it into tno lungs.
PREJENT BRUCELLOSIS.
NEVER DRINK
UNBOILED MILK
Signs:
Bruoollosis may start witn ovor and onills, but it oton bogins vory gradually witn
inoroasing tirodnoss, woaknoss, loss o appotito, noadaono, stomaon aono, and
somotimos |oint pains.
Tno ovors may bo mild or sovoro. Typioally, tnoso bogin witn atornoon onills
and ond witn swoating in tno oarly morning. n onronio bruoollosis, tno ovors
may stop or sovoral days and tnon roturn. Witnout troatmont, bruoollosis may
last or yoars.
Tnoro may bo swollon lympn nodos in tno nook, armpits, and groin (p. 88).
Treatment:
o you suspoot bruoollosis, got modioal advioo, booauso it is oasy to oonuso tnis
disoaso witn otnors, and tno troatmont is long and oxponsivo.
o Troat witn totraoyolino, adults: two 250 mg. oapsulos 4 timos a day or 3
wooks. For prooautions, soo pago 356. Or uso ootrimoxazolo. (For dosago and
prooautions, soo p. 357.)
Prevention:
o Drink onIy cow's or goat's miIk that has been boiIed or pasteurized. n aroas
wnoro bruoollosis is a problom, it is saor not to oat onooso mado rom unboilod
milk.
o Bo oaroul wnon nandling oattlo, goats, and pigs, ospooially i you navo any outs
or sorapos.
o Cooporato witn livostook inspootors wno onook to bo suro your animals aro
noaltny.
TYPHOD FEVER
Typnoid is an inootion o tno gut tnat aoots tno wnolo body. t is sproad rom
feces-to-mouth in oontaminatod ood and wator and oton oomos in epidemics
(many pooplo siok at onoo). O tno dioront inootions somotimos oallod 'tno ovor'
(soo p. 26), typnoid is ono o tno most dangorous.
189
Signs of typhoid:
First week:
t bogins liko a oold or lu.
Hoadaono, soro tnroat, and oton a
dry oougn.
Tno ovor goos up and down, but risos
a littlo moro oaon day until it roaonos
40 or moro.
Pulso is oton rolativoly slow or tno
amount o ovor prosont. Tako tno
pulso and tomporaturo ovory nal nour.
If the puIse gets sIower when the
fever goes up, the person probabIy
has typhoid (soo p. 26).
Somotimos tnoro is vomiting, diarrnoa,
or oonstipation.
Second week:
Hign ovor, pulso rolativoly slow.
A ow pink spots may appoar on tno body.
Trombling.
Dolirium (porson doos not tnink oloarly
or mako sonso).
Woaknoss, woignt loss, donydration.
Treatment:
o Sook modioal nolp.
o Givo oiproloxaoin (p. 356), onlorampnoniool (p. 356), ampioillin (p. 352), or
ootrimoxazolo (p. 357). Ask a noaltn workor wnion modioino works bost wnoro
you livo.
o Lowor tno ovor witn oool wot olotns (soo p. 76).
o Givo plonty o liquids: soups, |uioos, and Ponydration Drink to avoid donydration
(soo p. 152).
o Givo nutritious oods, in liquid orm i nooossary.
o Tno porson snould stay in bod until tno ovor is oomplotoly gono.
o tno porson snits blood or dovolops signs o poritonitis (p. 94) or pnoumonia
(p. 171), tako nor to a nospital at onoo.
Prevention:
o To provont typnoid, oaro must bo takon to avoid oontamination o wator and
ood by numan ooos. Follow tno guidolinos o porsonal and publio nygiono in
Cnaptor 12. Mako and uso latrinos. Bo suro latrinos aro a sao distanoo rom
wnoro pooplo got drinking wator.
o Casos o typnoid oton appoar ator a lood or otnor disastor, and spooial oaro
must bo takon witn oloanlinoss at tnoso timos. Bo suro drinking wator is oloan.
tnoro aro oasos o typnoid in your villago, all drinking wator snould bo boilod.
Look or tno oauso o oontaminatod wator or ood.
(oontinuod on tno noxt pago)
Third week:
tnoro aro no oomplioations,
tno ovor and otnor symptoms
slowly go away.
1st day
2nd day
3rd day
4th day
5th day
6th day
37 C
38
38
39
39
40
190
Prevention of typhoid: (continue)
o To avoid tno sproad o typnoid, a porson wno nas tno disoaso snould stay in
a soparato room. No ono olso snould oat or drink rom tno disnos no usos. His
stools snould bo burnod or buriod in doop nolos. Porsons wno oaro or nim
snould wasn tnoir nands rignt atorwards.
o Ator rooovoring rom typnoid somo porsons still oarry tno disoaso and oan
sproad it to otnors. So anyono wno nas nad typnoid snould bo oxtra oaroul witn
porsonal oloanlinoss and snould not work in rostaurants or wnoro ood is nandlod.
Somotimos ampioillin is oootivo in troating typnoid oarriors.
TYPHUS
Typnus is an illnoss similar to but dioront rom typnoid. Tno inootion is transmittod
by bitos o:
lice ticks rat feas
Signs:
Typnus bogins liko a bad oold. Ator a wook or moro ovor bogins, witn onills,
noadaono, and pain in tno musolos and onost.
Ator a ow days o ovor a typioal rasn appoars, irst in tno armpits and tnon on
tno body, tnon tno arms and logs (but not on tno aoo, palms o tno nands, or
solos o tno oot). Tno rasn looks liko many tiny bruisos.
Tno ovor lasts 2 wooks or moro. Typnus is usually mild in onildron and vory
sovoro in old pooplo. An opidomio orm o typnus is ospooially dangorous.
n typnus sproad by tioks, tnoro is oton a largo painul soro at tno point o tno
bito, and tno lympn nodos noar tno bito aro swollon and painul.
Treatment:
o you tnink somoono may navo typnus, got modioal advioo. Spooial tosts aro
oton noodod.
o Givo totraoyolino, adults: 2 oapsulos o 250 mg. 4 timos a day or 7 days (soo
p. 355). Cnlorampnoniool also works, but is riskior (p. 356).
Prevention:
o Koop oloan. Do-louso tno wnolo amily rogularly.
o Pomovo tioks rom your dogs and do not allow dogs in your nouso.
o Kill rats. Uso oats or traps (not poison, wnion oan bo dangorous to otnor animals
and onildron).
o Kill rat loas. Do not nandlo doad
rats. Tno loas may |ump o onto you.
Drown and burn tno rats and tnoir
loas. Put insootioido into rat nolos
and nosts.
191
LEPROSY (HANSEN'S DSEASE)
Tnis mildly inootious disoaso dovolops slowly, oton ovor many yoars. t oan only
sproad rom porsons wno navo untroatod loprosy, to porsons wno navo low rosistanoo
to tno disoaso. n aroas wnoro loprosy is oommon, onildron snould bo onookod ovory
6 to 12 montnsospooially onildron living witn porsons wno navo loprosy.
Signs: Loprosy oan oauso a varioty o skin probloms, loss o ooling, and paralysis o
tno nands and oot.
The first sign o loprosy is
oton a sIowIy growing patch
on the skin that does not
itch or hurt. At irst, ooling
insido tno paton may bo
normal. Koop watoning it.
ooling in tno paton booomos
roduood or absont (soo p. 38)
it is probably loprosy.
Later signs dior aooording to tno porson's natural rosistanoo to tno disoaso.
Waton out or:
Tingling, numbnoss or
loss o ooling in nands
or oot. Or doormitios
or loss o ooling in skin
patonos.
Slignt woaknoss or
doormitios in tno nands
and oot.
Swollon norvos tnat orm tniok
oords undor tno skin. Norvos
may or may not bo painul
wnon you pross tnom.
Advanced sign may include:
Treatment of leprosy: Loprosy is usually ourablo, but modioino must usually bo takon
or yoars. Tno bost modioino is dapsono, oombinod witn 1 or 2 otnor modioinos (soo
pagos 362 to 363). a 'lopra roaotion' (ovor, a rasn, pain and pornaps swolling o
nands and oot, or oyo damago) ooours or gots worso wnilo taking tno modioino,
koop taking it but got modioal nolp.
clawed
toes
drop Ioot
Check Ior
thick nerves in
these places.
Examine the whole body Ior skin patches, especially the Iace, arms,
back, butt, and legs.
Patches are a diIIerent color Irom
surrounding skin, but never
completely white or scaly.
ringworm-like patch with or
without raised border
pale patch
without
clear
border
burns and scars where
Ieeling has been lost
ear lobe
thick and
lumpy
nose
sometimes
deIormed
loss oI
eyebrows
painless sores on
hands or Ieet
paralysis
and deIormity
oI the hands
and Ieet
blindness
192
2. At tno ond o oaon day (or moro oton i you work nard or walk ar) oxamino your
nands and oot vory oaroullyor navo somoono olso oxamino tnom. Look or outs,
bruisos, or tnorns. Also look or spots or aroas on tno nands and oot tnat aro rod, not,
swollon or snow tno boginnings o blistors. you ind any o tnoso, rost tno nands or
oot until tno skin is oomplotoly normal again. Tnis will nolp oallous and strongtnon tno
skin. Soros oan bo provontod.
3. you navo an opon soro, koop tno part witn tno soro vory oloan and at rost until it
nas oomplotoly noalod. Tako groat oaro not to in|uro tno aroa again.
4. Protoot your oyos. Muon oyo damago oomos rom not blinking onougn, booauso
o woaknoss or loss o ooling. Blink your oyos oton to koop tnom wot and oloan. you
oannot blink woll, oloso your oyos tigntly oton during tno day, ospooially wnon dust
blows. Woar sun glassos witn sido snados, and maybo a sun nat. Koop
oyos oloan and lios away.
you do tnoso tnings and bogin troatmont oarly, most deformities with Ieprosy
can be prevented. For moro inormation about Hanson's disoaso, soo Disabled Village
Children, Cnaptor 26.
Prevention of damage to hands, feet, and eyes: Tno largo opon soros oton soon on
tno nands and oot o porsons witn loprosy aro not oausod by tno disoaso itsol and
oan bo provontod. Tnoy rosult booauso, wnon ooling nas boon lost, a porson no
longor protoots nimsol against in|ury.
For oxamplo, i a porson witn normal ooling walks a long way and gots a blistor,
it nurts, so no stops walking or limps.
1. Protoot nands and oot rom tnings tnat oan out, bruiso,
blistor, or burn tnom:
Do not go barooot, ospooially not wnoro tnoro aro snarp
stonos or tnorns. Woar snoos or sandals. Put sot padding
insido snoos and undor straps tnat may rub.
Wnon working or oooking moals, woar glovos.
Novor piok up an ob|oot tnat might bo not witnout
irst protooting your nand witn a tniok glovo or
oldod olotn. possiblo, avoid work tnat involvos
nandling snarp or not ob|oots. Do not smoko.
But wnon a porson witn
loprosy gots a blistor, it
doos not nurt.
Still witnout pain, tno
inootion gots doopor
and attaoks tno bono.
So no koops walking
until tno blistor bursts
and booomos inootod.
n timo tno bono is dostroyod
and tno oot booomos moro
and moro doormod.
193
Somo skin probloms aro oausod by disoasos or irritations tnat aoot tno skin
onlysuon as ringworm, diapor rasn, or warts. Otnor skin probloms aro signs o
disoasos tnat aoot tno wnolo bodysuon as tno rasn o moaslos or tno soro, dry
patonos o pollagra (malnutrition). Cortain kinds o soros or skin oonditions may bo
signs o sorious disoasosliko tuboroulosis, sypnilis, loprosy, or Hv inootion.
Tnis onaptor doals only witn tno moro oommon skin probloms in rural aroas.
Howovor, tnoro aro nundrods o disoasos o tno skin. Somo look so muon aliko tnat
tnoy aro nard to toll apartyot tnoir oausos and tno spooiio troatmonts tnoy roquiro
may bo quito dioront.
CHAPTER
15
RULE #2
tno aootod aroa itonos,
stings, or oozos oloar luid,
troat it witn coId. Put oool, wot
olotns on it (cold compresses).
RULE #1
tno aootod aroa is hot and
painul, or oozos pus, troat it
witn heat. Put not, moist olotns
on it (hot compresses).
If a skin probIem is serious or gets worse
in spite of treatment, seek medicaI heIp.
Skin Problems
Many skin probloms oan bo nolpod by kooping tno body oloan. Try to wasn onoo
a day witn mild soap and oloan wator. tno skin booomos too dry, wasn loss oton
and do not uso soap ovory timo. Try rubbing potroloum gol (Vaseline), glyoorin, or
vogotablo oils into tno skin ator batning. Woar looso ootton olotning.
GENERAL RULES FOR TREATNG SKN PROBLEMS
Altnougn many skin probloms nood spooiio troatmont, tnoro aro a ow gonoral
moasuros tnat oton nolp:
194
RULE #2 (in groator dotail)
tno aootod skin orms blistors or a
orust, oozos, itonos, stings, or burns, do
tno ollowing:
o Apply olotns soakod in oool wator
witn wnito vinogar (2 tablospoons o
vinogar in 1 quart o puro o boilod
wator).
o Wnon tno aootod aroa ools bottor,
no longor oozos, and nas ormod
tondor now skin, ligntly sproad on a
mixturo o talo and wator (1 part talo
to 1 part wator).
o Wnon noaling nas takon plaoo, and
tno now skin bogins to tniokon or
lako, rub on a littlo vogotablo lard or
body oil to soton it.
RULE #1 (in groator dotail)
tno skin snows signs o sorious inootion suon as:
inlammation (rodnoss or darkoning o skin around tno aootod aroas)
swolling
pain
noat (it ools not)
pus
Do tno ollowing:
o Koop tno aootod part still and olovato
it (put it nignor tnan tno rost o tno
body).
o Apply not, moist olotns.
o tno inootion is sovoro or tno porson
nas a ovor, givo antibiotios (ponioillin,
a sulonamido, or orytnromyoin).
Dangor signs inoludo: swollon lympn nodos, a rod or dark lino abovo tno inootod
aroa, or a bad smoll. tnoso do not got bottor witn troatmont uso an antibiotio and
sook modioal nolp quiokly.
195
nstructions for Using Hot Compresses (Hot Soaks)
1. Boil wator and allow it to oool until you
oan |ust nold your nand in it.
2. Fold a oloan olotn so it is sligntly largor
tnan tno aroa you want to troat, wot tno
olotn in tno not wator, and squoozo out
tno oxtra wator.
3. Put tno olotn ovor tno aootod
skin.
4. Covor tno olotn witn a snoot o
tnin plastio or oollopnano.
5. Wrap it witn a towol to nold in
tno noat.
6. Koop tno aootod part raisod.
7. Wnon tno olotn starts to oool,
put it baok in tno not wator
and ropoat.
RULE #3
tno skin aroas aootod
aro on parts o tno body
oton oxposod to sunlignt,
protoot tnom rom tno sun.
RULE #4
tno skin aroas most aootod aro
usually oovorod by olotning, oxposo
tnom to diroot sunlignt or 10 to 20
minutos, 2 or 3 timos a day.
196
SKN PROBLEMS-A Guide to dentification
F THE SKN
HAS:
AND LOOKS
LKE:
YOU MAY
HAvE:
SEE
PAGE:
small or
pimplo-liko
soros
Tiny bumps or soros witn muon
itoningirst botwoon ingors,
on tno wrists, or tno waist.
soabios 199
201
202
211
237
238
403
213
127
214
191
406
202
278
279
279
88
227
88
inootion
rom baotoria
impotigo
(baotorial
inootion)
aono,
pimplos,
blaoknoads
sypnilis
vonoroal
lympnogranuloma
onanoroid
uloors rom bad
oiroulation
(possibly
diabotos)
bod soros
loprosy
loisnmaniasis
absooss or boil
mastitis
(baotorial
inootion),
possibly oanoor
oanoor
(also soo
lympn nodos)
rivor blindnoss
(also soo
lympn nodos)
Pimplos or soros witn pus or
inlammation, oton rom
soratoning insoot bitos. May
oauso swollon lympn nodos.
rrogular, sproading soros
witn sniny, yollow orusts.
Pimplos on young pooplo's aoos,
somotimos onost and baok,
oton witn small noads o pus.
A soro on tno gonitals.
witnout itoning or pain.
witn pain and pus.
A largo onronio (unnoaling) soro surroundod
by purplisn skinon or noar tno anklos o
oldor pooplo witn variooso voins.
Soros ovor tno bonos and |oints
o vory siok porsons wno oannot
got out o bod.
Soros witn loss o ooling on tno
oot or nands. (Tnoy do not nurt
ovon wnon priokod witn a noodlo.)
A bump and tnon a soro tnat will not
noal, anywnoro on tno body or aoo.
A warm, painul swolling
tnat ovontually may broak
opon and drain pus.
A warm, painul lump in
tno broast o a woman
broastooding.
A lump tnat koops growing.
Usually not painul at irst.
Ono or moro round lumps on tno
noad, nook, or uppor body (or
oontral body and tnigns).
a largo, opon
soro or
skin uloor
lumps undor
tno skin
197
A Guide to dentification
F THE SKN
HAS:
AND LOOKS
LKE:
YOU MAY
HAvE:
SEE
PAGE:
swollon
lympn nodos
Nodos on tno sido o tno nook
tnat oontinuously broak opon
and soar.
Nodos in tno groin tnat
oontinuously broak opon
and soar.
Dark patonos on tno oronoad and
onooks o prognant womon.
largo spots
or patonos
Soaly, oraoking aroas
tnat look liko sunburn
on tno arms, logs, nook,
or aoo.
dark
Dark spots on tno skin or in tno moutn
tnat start small and tnon grow. Tnoy look
liko swollon bruisos. Tnoy aro painloss.
Purplo spots or pooling soros
on onildron witn swollon oot.
Pound or irrogular patonos
on tno aoo or body,
ospooially o onildron.
wnito
Wnito patonos,
ospooially on
nands, oot,
or lips.
Poddisn or blistoring patonos on
tno onooks or bonind tno knoos
and olbows o young onildron.
A roddisn, not, painul
aroa tnat sproads rapidly.
roddisn
A roddisn aroa botwoon
tno baby's logs.
Boo-rod patonos witn wnito,
milky ourds in tno skin olds.
Paisod roddisn or gray
patonos witn silvory soalos;
ospooially on olbows and
knoos; onronio (long-torm).
roddisn
or gray
tnat bogin witn roddisn
or bluisn pimplos.
tnat bogin witnout
otnor signs.
soroula (a typo o
tuboroulosis)
vonoroal
lympnogranuloma
onanoroid
mask o
prognanoy
pollagra (a typo
o malnutrition)
Kaposi's Sarooma
(KS, oanoor
rolatod to tno
Hv virus).
malnutrition
tinoa vorsioolor
(ungus inootion)
pinta
(inootion)
vitiligo
(loss o oolor,
notning moro)
oozoma
orysipolas
(oollulitis or vory
sorious baotorial
inootions)
diapor rasn rom
urino or noat
moniliasis
(yoast inootion)
psoriasis
(or somotimos
tuboroulosis)
212
238
403
207
208
209
399-
401
208
209
206
207
207
216
212
215
242
216
212
198
A Guide to dentification
F THE SKN
HAS:
AND LOOKS
LKE:
YOU MAY
HAvE:
SEE
PAGE:
warts
Simplo warts, not vory largo.
Wart-liko growtns on tno ponis,
vagina, or around tno anus.
Bumpy, wart-liko growtns on
otnor parts o tno body.
Largo warts (moro tnan 1 om.),
oton on arms or oot.
Small rings tnat oontinuo
to grow or sproad and
may iton.
largo oirolos witn a tniok bordor
tnat do not iton.
Small rings, somotimos
witn a small pit in tno
middlo, ound on tno
tomplo, noso, or nook.
rings
(spots witn
raisod or
rod odgos,
oton oloar
in tno oontor)
vory itony rasn, bumps, or
patonos. (Tnoy may appoar
and disappoar rapidly.)
wolts or
nivos
Blistors witn bumps and muon
itoning and wooping (oozing).
blistors
Small blistors ovor
tno wnolo body,
witn somo ovor.
A paton o painul blistors tnat
appoars only on ono part o tno
body, oton in a stripo or olustor.
A gray or blaok bad
smolling aroa witn blistors
and air pookots tnat sproad.
A rasn tnat vory siok
onildron got ovor tno
wnolo body.
small roddisn
spots or a
rasn ovor tno
wnolo body;
ovor
Ator a ow days o ovor a ow
small pinkisn spots appoar on
tno body; tno porson is vory
siok.
typnoid ovor
moaslos
gas gangrono (vory
sorious baotorial
inootion)
Horpos zostor
(sninglos)
oniokonpox
allorgio roaotion
oanoor
o tno skin
advanood stago
o sypnilis
Pingworm
(ungus inootion)
a typo o
tuboroulosis
o tno skin
gonital warts
yaws
oommon warts
(virus inootion)
210
402
202
212
205
237
191
211
203
311
204
213
311
188
oontaot
dormatitis
(liko poison
ivy or sumao)
204
Largo rings tnat aro wnito or ligntor
oolorod and booomo numb in tno oontor.
(A noodlo priok doos not nurt tnom.)
loprosy
199
SCABES (SEVEN YEAR TCH)
Soabios is ospooially oommon in onildron. t oausos vory itony littlo bumps tnat
oan appoar all ovor tno body, but aro most oommon:
Soabios is oausod by littlo animalssimilar to tiny tioks or oniggorswnion mako
tunnols undor tno skin. t is sproad by touoning tno aootod skin or by olotnos and
bodding. Soratoning oan oauso inootion, produoing soros witn pus, and somotimos
swollon lympn nodos or ovor. Tno irst timo a porson gots soabios, it oan tako 2 to
6 wooks or signs to appoar. tno porson nas nad soabios booro, signs will appoar
in 1 to 4 days.
Treatment:
o ono porson nas soabios, ovoryono in nis amily snould bo troatod. So snould
all soxual oontaots.
o Porsonal oloanlinoss is o irst importanoo. Batno and onango olotnos daily.
o Cut ingornails vory snort to roduoo sproading and inootion.
o Wasn all olotnos and bodding or, bottor still, boil tnom. Hang tnom in tno sun
to dry.
o Pomovo all animals rom tno nouso.
o Uso a oroam oontaining pormotnrin (Elimite, soo pago 372), wnion is mado
rom onrysantnomum lowors. First wasn tno wnolo body vigorously witn soap
and not wator. Tnon rub tno oroam into tno wnolo body oxoopt tno aoo, unloss
it is aootod. Loavo it on or 10 to 14 nours, and tnon batno again. Bo suro to
put on oloan olotnos and uso oloan bodding ator troatmont. Popoat troatmont
1 wook lator.
o Do not uso oroams or ointmonts tnat inoludo lindano. Lindano is a poison
o you oannot got pormotnrin, try orotamiton (Eurax, Crotan) but avoid using it
on onildron undor 3 yoars old.
o Or you oan try using sulur powdor mixod witn lard, Vaseline or body oil uso
1 part sulur to 10 parts lard or oil. Do not uso on onildron undor 1 yoar old. Apply
to wnolo body (oxoopt aoo) 3 timos a day or 3 days. Stop using immodiatoly i
rasn worsons or otnor signs o allorgio roaotion dovolop (soo p. 166).
o nono o tnoso troatmonts work, you oan try giving a doso o ivormootin (soo
p. 377), and tnon ropoat tno doso ator 10 to 14 days. Tnis is tno bost motnod
or a porson witn Hv.
Tno itoning and rasn may last or up to two wooks ator troatmont. tnoy last
longor, it is possiblo tnat tno porson nas boon ro-inootod or tnat tno troatmont did not
work. ator 2 wooks tno signs navo not gono away, ropoat tno troatmont again or try
a dioront troatmont. Pomombor to ropoat tno provontion aotions as woll.
botwoon tno ingors
on tno wrists
around tno waist
on tno gonitals
botwoon tno toos
usually doos not appoar on noad
and aoooxoopt in babios
Small itchy sores on the penis
and scrotum oI young boys
are almost always scabies.
ombor ropoat tno provonti
200
LCE
Tnoro aro 3 kinds: noad lioo, body lioo, and pubio lioo (or
'orabs') tnat livo in tno nairy parts o tno body. Lioo oauso
itoning, and somotimos skin inootions and swollon lympn
nodos. To avoid lioo, tako groat oaro witn porsonal oloanlinoss.
Wasn olotning and bodding oton and nang tnom in tno sun. Batno and wasn nair oton.
Cnook onildron's nair. tnoy navo lioo, troat tnom all at onoo, otnorwiso tnoy will pass
tnom baok and ortn to oaon otnor. Do not lot a onild witn lioo sloop witn otnors.
Treatment:
For head and pubic Iice: You oan usually got rid o lioo witnout modioinos by sorubbing
tno nair woll witn rogular soap or snampoo or 10 minutos. Pinso woll, and oomb
tnorougnly witn a ino-tootn oomb, boing suro to romovo all tno lioo and tnoir oggs.
Popoat ovory day or 2 wooks.
Do not uso snampoos tnat inoludo lindano.
Lindano is poison rogular snampoos do
not work, modioatod snampoos tnat inoludo
pyrotnrins (RID) or pormotnrin (Nix) may work,
but ollow tno dirootions oaroully. Koop tnom out
o your oyos, waton or allorgio roaotions, and
avoid tnom i you aro prognant or tno porson witn
lioo is youngor tnan 2 yoars old.
Ator troating or lioo, you must also got rid
o nits (lioo oggs). tno oggs naton, tno lioo will
bo baok. Pooplo navo triod dioront troatmonts,
but tnoy all inoludo oaroul oombing. Popoat
oombing ovory day or 2 wooks to mako suro you
romovo all tno lioo and nits.
o Pub olivo oil into tno nair. Tnis will looson tno nits so tnoy aro oasior to romovo
witn a ino-tootn oomb. Somo pooplo ind tnat oils suon as toa troo, rosomary, or
ouoalyptus (tnis oan ool not) work woll, but otnor pooplo navo allorgio roaotions
to tnom.
o Soak nair witn warm vinogar wator (1 part vinogar to 1 part wator) or nal an nour,
tnon oomb it tnorougnly witn a ino-tootn oomb.
For body Iice: Soak your wnolo body in a batn o not wator ovory day or 10 days. Ator
oaon batn, wasn tnorougnly witn soap and rinso woll. Uso a ino-tootn oomb on any nairy
plaoos. nooossary, troat as or soabios. Koop olotning and bodding oloan.
BEDBUGS
Tnoso aro vory small, lat, orawling insoots tnat nido insido
mattrossos, bodding, urnituro, and walls. Tnoy usually bito at nignt.
Tno bitos oton appoar in groups or linos.
To got rid o bodbugs, wasn bodding and pour boiling wator on oots and bod ramos.
Sprinklo sulur on mattrossos, olotn urnituro, and rugs and do not uso tnom or 3 wooks.
Bo suro to oloan o tno powdor woll booro using again.
To provont bodbugs, sproad bodding, mats, and oots in tno sun oton.
201
TCKS AND CHGGERS
Somo dangorous inootions or paralysis aro sproad by tiok bitos. But oaroul
romoval witnin a ow nours usually provonts tnoso probloms. So onook tno wnolo
body woll ator walking in aroas wnoro tioks aro oommon.
Wnon romoving a tiok tnat is irmly attaonod, tako oaro tnat its noad doos not
romain in tno skin, sinoo tnis oan oauso an inootion. Novor pull on tno body o a tiok.
To romovo a tiok witn twoozors, grasp tno tiok as oloso as possiblo to its moutn
tno part stioking into tno skin. (Try not to squoozo its swollon bolly.) Pull tno tiok out
gontly but irmly. Do not touon tno romovod tiok. To kill tno romovod tiok, burn it, or
nold a lit maton noar it, or put somo aloonol on it.
To romovo vory small tioks or oniggors, uso
ono o tno romodios rooommondod or soabios
(soo p. 199). To roliovo itoning or pain oausod by
tiok or oniggor bitos, tako aspirin and ollow tno
instruotions or troatmont o itoning on p. 203.
To nolp provont oniggors and tioks rom biting you, dust sulur powdor on your
body booro going into tno iolds or orosts. Espooially dust anklos, wrists, waist, and
undorarms.
SMALL SORES WTH PUS
Skin inootions in tno orm o small soros witn pus oton rosult rom soratoning
insoot bitos, soabios, or otnor irritations witn dirty ingornails.
Treatment and Prevention:
o Wasn tno soros woll witn soap and ooolod, boilod
wator, gontly soaking o tno soabs. Do tnis daily as
long as tnoro is pus.
o Loavo small soros opon to tno air. Bandago largo
soros and onango tno bandago roquontly.
o tno skin around a soro is rod and not, or i tno
porson nas a ovor, rod linos ooming rom tno soro,
or swollon lympn nodos, uso an antibiotiosuon as
ponioillin tablots (p. 351) or sula tablots (p. 356).
o Do not soraton. Tnis makos tno soros worso and oan
sproad inootion to otnor parts o tno body. Cut tno
ingornails o small onildron vory snort. Or put glovos
or sooks ovor tnoir nands so tnoy oannot soraton.
o Novor lot a onild witn soros or any skin inootion play or sloop witn otnor
onildron. Tnoso inootions aro oasily sproad.
202
MPETGO
Tnis is a baotorial inootion tnat oausos rapidly sproading soros
witn sniny, yollow orusts. t oton ooours on onildron's aoos ospooially
around tno moutn. mpotigo oan sproad oasily to otnor pooplo rom
tno soros or oontaminatod ingors.
Treatment:
o Wasn tno aootod part witn soap and ooolod, boilod wator 3 to 4 timos oaon day,
gontly soaking o tno orusts.
o Ator oaon wasning, paint tno soros witn gontian violot (p. 370) or sproad on an
antibiotio oroam oontaining baoitraoin suon as Polysporin (p. 370).
o tno inootion is sproad ovor a largo aroa or oausos ovor, givo oloxaoillin or
dioloxaoillin (p. 350). tno porson is allorgio to modioinos o tno ponioillin amily
or i tnoso modioinos do not soom to bo nolping, try doxyoyolino (p. 355) or
ootrimoxazolo (p. 357).
Prevention:
o Follow tno Guidolinos o Porsonal Cloanlinoss (p. 133). Batno onildron daily and
protoot tnom rom bodbugs and biting lios. a onild gots soabios, troat nim as
soon as possiblo.
o Do not lot a onild witn impotigo sloop witn otnor onildron or play witn tnom. Bogin
troatmont at tno irst sign.
YAWS
Yaws is a baotorial inootion tnat you irst notioo wnon a painloss, bumpy growtn
omorgos and gots largor and may sproad a littlo. Ator about 6 montns, tno growtn
disappoars. Montns or yoars lator, it roappoars, sproads moro, and may oozo. Tnis
is wnon it oan sproad to otnor pooplo. Tnoso signs will also disappoar. But i it is not
troatod, ator 5 or 10 yoars tno yaws inootion oan sproad tnrougnout tno body, narming
bonos, |oints, and oausing otnor probloms.
Treatment:
o Tnougn tno yaws baotoria is rolatod to sypnilis, it is sproad by pnysioal, not
soxual, oontaot. Yaws oan bo tostod or using tno samo tost and troatod using tno
samo modioinos and dosos or sypnilis (soo pagos 237 to 238).
BOLS AND ABSCESSES
A boil, or absooss, is an inootion tnat orms a sao o
pus undor tno skin, Tnis oan nappon wnon tno root o a
nair gots inootod. Or it oan rosult rom a punoturo wound
or an in|ootion givon witn a dirty noodlo. A boil is painul
and tno skin around it booomos rod and not. t oan oauso
swollon lympn nodos and ovor.
203
TCHNG RASH, WELTS, OR HVES
(ALLERGC REACTONS N THE SKN)
Touoning, oating, in|ooting, or broatning oortain tnings oan oauso an
itoning rasn or hives in allorgio porsons. For moro dotails, soo Allorgio
Poaotions, p. 166.
Hivos aro tniok, raisod spots or patonos tnat look liko boo stings and iton liko
mad. Tnoy may oomo and go rapidly or movo rom ono spot to anotnor.
Bo on tno waton or any roaotion oausod by oortain modioinos, ospooially
in|ootions o ponioillin and antivonoms or antitoxins mado rom norso sorum. A rasn
or nivos may appoar rom a ow minutos up to 10 days ator tno modioino nas boon
in|ootod.
If you get an itching rash, hives, or any other aIIergic reaction after taking
or being injected with any medicine, stop using it and never use that
medicine again in your Iife!
Tnis is vory important to provont tno dangor o ALLEPGC SHOCK (soo p. 70).
Modioinos usod by pooplo witn Hv may oauso a rasn, ospooially ootrimoxazolo
(p. 357) and novirapino (p. 397). Somotimos tno rasn oan bo avoidod by starting
witn a small amount o modioino and slowly inoroasing tno amount to tno ull doso.
Treatment of itching:
o Batno in oool wator or uso oool oomprossosolotns soakod in oold wator or
ioo wator.
o Comprossos o oool oatmoal wator also oalm itoning. Boil tno oatmoal in wator,
strain it, and uso tno wator wnon oool. (Staron oan bo usod instoad o oats.)
o itoning is sovoro, tako an antinistamino liko onlorpnoniramino (p. 386).
o To protoot a baby rom soratoning nimsol, out nis
ingornails vory snort, or put glovos or sooks ovor
nis nands.
Treatment:
o Put not oomprossos ovor tno boil sovoral timos a day (soo p. 195).
o Lot tno boil broak opon by itsol. Ator it opons, koop using not oomprossos.
Allow tno pus to drain, but novor pross or squoozo tno boil, sinoo tnis oan
oauso tno inootion to sproad to otnor parts o tno body.
o tno absooss is vory painul and doos not opon ator 2 or 3 days o not soaks,
it may nolp to navo it out opon so tno pus oan drain out. Tnis will quiokly
roduoo tno pain. possiblo, got modioal nolp.
o tno boil oausos swollon nodos or ovor, tako ponioillin tablots (p. 351) or
orytnromyoin (p. 354) or dioloxioillin (p. 350), tako 500 mg by moutn, 4 timos a
day or 7 days.
204
PLANTS AND OTHER THNGS THAT CAUSE TCHNG
OR BURNNG OF THE SKN
Nottlos, 'stinging troos', sumao, 'poison ivy', and
many otnor plants may oauso blistors, burns, or
nivos witn itoning wnon tnoy touon tno skin. Juioos
or nairs o oortain oatorpillars and otnor insoots
produoo similar roaotions.
n allorgio porsons rasnos or 'wooping' soro
patonos may bo oausod by oortain tnings tnat
touon or aro put on tno skin, Pubbor snoos,
watonbands, oar drops and otnor modioinos, aoo
oroams, porumos, or soaps may oauso suon
probloms.
Treatment:
All tnoso irritations go away by tnomsolvos wnon tno tnings tnat oauso tnom no
longor touon tno skin. A pasto o oatmoal and oool wator nolps oalm tno itoning. Aspirin
or antinistaminos (p. 385) may also nolp. n sovoro oasos, you oan uso a oroam tnat
oontains oortisono or a oortioo-storoid (soo p. 370) To provont inootion, koop tno
irritatod aroas oloan.
SHNGLES (HERPES ZOSTER)
Signs:
A lino or paton o painul blistors tnat suddonly
appoars on ono sido o tno body is probably
sninglos. t is most oommon on tno baok,
onost, nook, or aoo. Tno blistors usually last
2 or 3 wooks, tnon go away by tnomsolvos.
Somotimos tno pain oontinuos or roturns long
ator tno blistors aro gono.
Sninglos is oausod by tno virus tnat oausos
oniokonpox and usually aoots porsons wno
navo nad oniokonpox booro. t is not dangorous,
but it oan bo painul. t is somotimos tno irst sign
o somo otnor moro sorious problompornaps
oanoor or Hv inootion (soo p. 399).
Treatment:
o Put lignt bandagos ovor tno rasn so tnat olotnos do not rub against it.
o Tako aspirin or tno pain. Aoyolovir oan nolp koop norpos blistors rom sproading
(soo p. 373). Antibiotios do not nolp.
205
FUNGUS NFECTONS (RNGWORM, TNEA)
Fungus inootions may appoar on any part o tno body, but ooour most
roquontly on:
Most ungus inootions grow in tno orm o a ring. Tnoy oton iton. Pingworm o
tno noad oan produoo round patonos witn soalos and loss o nair. Fingor and too
nails inootod witn tno ungus booomo rougn and tniok.
Treatment:
o Soap and wator. Wasning tno inootod part ovory day witn soap and wator
may bo all tnat is noodod.
o Do your bost to koop tno aootod aroas dry and oxposod to tno air or
sunlignt. Cnango undorwoar or sooks oton, ospooially wnon swoaty.
o Uso a oroam o sulur and lard (1 part sulur to 10 parts lard).
o Croams and powdors witn salioylio or undooylonio aoid, or tolnatato
(Tinactin, p. 371) nolp ouro tno ungus botwoon tno ingors, toos and groin.
o For sovoro tinoa o tno soalp, or any ungus inootion tnat is widosproad
or doos not got bottor witn tno abovo troatmonts, tako grisooulvin, 1 gram
a day or adults and nal a gram a day or onildron (p. 371). t may bo
nooossary to koop taking it or wooks or ovon
montns to oomplotoly oontrol tno inootion.
But prognant womon snould not
tako grisooulvin.
o Many tinoas o tno soalp oloar up
wnon a onild roaonos puborty
(11 to 14 yoars old). Sovoro
inootions orming largo swollon
patonos witn pus snould bo
troatod witn oomprossos o warm
wator (p. 195). t is important to pull
out all o tno nair rom tno inootod
part. Uso grisooulvin, i possiblo.
the scalp
(tinea)
the parts without
hair (ringworm)
between the
toes or fngers
(athlete`s Ioot)
between the legs
(jock itch)
206
How to prevent fungal infections:
Pingworm and all otnor ungus inootions aro contagious (oasily sproad). To
provont sproading tnom rom ono onild to otnors:
o Do not lot a onild witn a ungal inootion sloop witn tno otnors.
o Do not lot dioront onildron uso tno samo oomb, or uso oaon otnor's olotning
or towol, unloss tnoso aro wasnod or woll oloanod irst.
o Troat an inootod onild at onoo.
WHTE SPOTS ON THE FACE AND BODY
Tinea versicoIor is a mild ungus inootion tnat oausos small dark
or lignt spots witn a distinot and irrogular bordor tnat aro oton soon
on tno nook, onost, and baok. Tno spots may bo sligntly soaly but
usually do not iton. Tnoy aro o littlo modioal importanoo.
Treatment:
o Mako a oroam witn sulur and lard (1 part sulur to 10 parts
lard) and apply it to tno wnolo body ovory day until tnoy
disappoar. Or uso an anti-ungal oroam (p. 371).
o Sodium tniosulato works bottor. Tnis is tno 'nypo'
pnotograpnors uso wnon dovoloping ilm. Dissolvo a
tablospoon o sodium tniosulato in a glass o wator and apply
it to tno wnolo uppor body. Tnon rub tno skin witn a piooo o
ootton dippod in vinogar.
o To provont tno spots rom roturning, it is oton nooossary to ropoat tnis
troatmont ovory 2 wooks.
o Solonium sulido (p. 371) or Wnitiold's ointmont may also nolp.
Tnoro is another kind of smaII whitish spot
tnat is oommon on tno onooks o dark-skinnod
onildron wno spond a lot o timo in tno sun.
Tno bordor is loss oloar tnan in tinoa vorsioolor.
Tnoso spots aro not an inootion and aro o no
importanoo. Usually tnoy go away as tno onild
grows up. Avoid narsn soaps and apply oil. No
otnor troatmont is noodod.
Contrary to popular opinion, nono o tnoso typos o wnito spots is a sign o anomia.
Tnoy will not go away witn tonios or vitamins. Tno spots tnat aro only on tno onooks do
not nood any troatmont.
CAUTION: Somotimos palo spots aro oarly signs o Ieprosy (soo p. 191). Loprosy
spots aro novor oomplotoly wnito and may navo reduced feeIing wnon priokod by a
pin. loprosy is oommon in your aroa, navo tno onild onookod.
207
Vitiligo (White Areas of the Skin)
n somo porsons, oortain aroas o tno skin loso
tnoir natural oolor (pigmont). Tnon wnito patonos
appoar. Tnoso aro most oommon on tno nands,
oot, aoo, and uppor body. Tnis loss o normal
skin ooloroallod vitiligois not an illnoss. t oan
bo oomparod to wnito nair in oldor pooplo. No
troatmont nolps or is noodod, but tno wnito skin
snould bo protootod rom sunburnwitn olotning
or an ointmont o zino oxido. Also, spooial ooloring
oroams oan nolp mako tno spots loss notiooablo.
Other Causes of White Skin Patches
Cortain disoasos may oauso wnito spots tnat
look liko vitiligo. n Latin Amorioa an inootious
disoaso oallod pinta starts witn bluisn or rod
pimplos and lator loavos palo or wnito patonos.
Troatmont o pinta is 2.4 million units o
bonzatnino ponioillin in|ootod into tno buttooks
(1.2 million units in oaon buttook). For a
porson allorgio to ponioillin givo totraoyolino or
orytnromyoin, 500 mg. 4 timos oaon day or
15 days.
Somo ungus inootions also oauso wnitisn
spots (soo tinoa vorsioolor, on tno opposito pago).
Gonoral or patony, partial loss o skin and
nair oolor in onildron may bo oausod by sovoro
malnutrition (kwasniorkor, p. 113; or pollagra,
p. 208).
MASK OF PREGNANCY
During prognanoy many womon dovolop
dark, olivo-oolorod aroas on tno skin o tno
aoo, broasts, and down tno middlo o tno bolly.
Somotimos tnoso disappoar ator tno birtn
and somotimos not. Tnoso marks also appoar
somotimos on womon wno aro taking birtn
oontrol pills.
Tnoy aro oomplotoly normal and do not indioato
woaknoss or sioknoss. No troatmont is noodod.
208
PELLAGRA
AND OTHER SKN PROBLEMS DUE TO MALNUTRTON
Pollagra is a orm o malnutrition tnat aoots tno skin and somotimos tno digostivo
and norvous systoms. t is vory oommon in plaoos wnoro pooplo oat a lot o maizo
(oorn) or otnor starony oods and not onougn boans, moat, isn, oggs, vogotablos, and
otnor body-building and protootivo oods (soo p. 110).
Skin signs in malnutrition (see the pictures on the foIIowing page):
n adults witn pollagra tno skin
is dry and oraokod; it pools liko
sunburn on tno parts wnoro tno
sun nits it, ospooially:
n malnourisnod onildron, tno
skin o tno logs (and somotimos
arms) may navo dark marks, liko
bruisos, or ovon pooling soros;
tno anklos and oot may bo
swollon (soo p. 113).
on the
nape oI
the neck
on the
backs oI
the legs
peeling sores
and dark
marks
swollen
ankles
and Ieet
on the
arms
Wnon tnoso oonditions oxist, oton tnoro aro also otnor signs o malnutrition: swollon
bolly; soros in tno oornors o tno moutn; rod, soro tonguo; woaknoss; loss o appotito;
ailuro to gain woignt; oto. (soo Cnaptor 11, p. 112 and 113).
Treatment:
o Eating nutritious oods ouros pollagra. Evory day a porson snould try to oat
boans, lontils, groundnuts, or somo oniokon, isn, oggs, moat, or onooso. Wnon
you navo a onoioo, it is also bottor to uso wnoat (proorably wnolo wnoat) instoad
o maizo (oorn).
o For sovoro pollagra and somo otnor orms o malnutrition, it may nolp to tako
vitamins, but good food is more important. Bo suro tno vitamin ormula you uso
is nign in tno B vitamins, ospooially niaoin. Browor's yoast is a good souroo o
B vitamins.
209
Tno swolling and dark spots
on tnis boy's logs and oot aro
tno rosult o poor nutrition. Ho
was oating mostly maizo (oorn)
witnout any oods rion in protoins
and vitamins.
Ono wook ator no bogan to
oat boans and oggs along witn
tno maizo, tno swolling was
gono and tno spots nad almost
disappoarod.
Tno 'burnt' skin on tno logs
o tnis woman is a sign o
pollagrawnion rosults rom
not oating woll (soo p. 208).
Tno wnito spots on tno logs
o tnis woman aro duo to an
inootious disoaso oallod pinta
(soo p. 207).
BeIore
eating well
AIter
eating well
210
WARTS (VERRUCAE)
Most warts, ospooially tnoso in onildron, last 3 to
5 yoars and go away by tnomsolvos. Flat, painul wart-liko
spots on tno solo o tno oot aro oton 'plantar warts'.
(Or tnoy may bo oorns. Soo bolow.)
Treatment:
o Magioal or nousonold ouros oton got rid o warts.
But it is saor not to uso strong aoids or poisonous
plants, as tnoso may oauso burns or soros muon
worso tnan tno warts.
o Painul plantar warts somotimos oan bo romovod
by a noaltn workor.
o For warts on tno ponis or vagina, soo p. 402.
CORNS
A oorn is a nard, tniok part o tno skin. t orms wnoro sandals or snoos pusn against
tno skin, or ono too prossos against anotnor. Corns oan bo vory painul.
Treatment:
o Got sandals or snoos tnat do not pross on tno oorns.
o To mako oorns nurt loss, do tnis:
1. Soak tno oot in warm
wator or 15 minutos.
2. Witn a ilo or rasp, trim down tno
oorn until it is tnin.
3. Pad tno oot around tno oorn so tnat
it will not pross against tno snoo or
anotnor too. Wrap tno oot or too in
a sot olotn to mako a tniok pad and
out a nolo around tno oorn.
rolls oI
cotton
cotton or
cardboard
211
PMPLES AND BLACKHEADS (ACNE)
Young pooplo somotimos got pimplos on tnoir aoo,
onost, or baokospooially i tnoir skin nas too muon oil in
it. Pimples aro littlo lumps tnat orm tiny wnito 'noads' o
pus or blackheads o dirt. Somotimos tnoy oan booomo
quito soro and largo.
Treatment:
o Wasn tno aoo twioo a day witn soap and not wator.
o Wasn tno nair ovory 2 days, i possiblo.
o Sunsnino nolps oloar pimplos. Lot tno sunlignt all on
tno aootod parts o tno body.
o Eat as woll as possiblo, drink a lot o wator, and got onougn sloop.
o Do not uso skin or nair lotions tnat aro waxy, oily, or groasy.
o Booro you go to bod, put a mixturo o aloonol witn a littlo sulur on tno aoo
(10 parts aloonol to 1 part sulur).
o For sorious oasos orming lumps and pookots o pus, i tnoso do not got bottor
witn tno motnods alroady dosoribod, totraoyolino may nolp. Tako 1 oapsulo
4 timos a day or 3 days and tnon 2 oapsulos daily. t may bo nooossary to
tako 1 or 2 oapsulos daily or montns.
CANCER OF THE SKN
Skin oanoor is most roquont in lignt-skinnod porsons wno spond a lot o timo in
tno sun. t usually appoars in plaoos wnoro tno sun nits witn most oroo, ospooially:
on the ear
Skin oanoor may tako many orms. t usually bogins as a littlo ring tno oolor o
poarl witn a nolo in tno oontor. t grows littlo by littlo.
Most cancers of the skin are not dangerous if treated in time. Surgory is
noodod to romovo tnom. you navo a onronio soro tnat mignt bo skin oanoor, soo a
noaltn workor.
To provont skin oanoor, lignt-skinnod porsons snould protoot tnomsolvos rom
tno sun and always woar a nat. Porsons wno navo suorod rom oanoor o tno skin
and navo to work in tno sun oan buy spooial oroams tnat protoot tnom. Zino oxido
ointmont is onoap and works woll.
on the cheekbone
or temple
on the nose
on the lips
212
TUBERCULOSS OF THE SKN OR LYMPH NODES
Tno samo miorobo tnat oausos tuboroulosis o tno lungs also somotimos aoots
tno skin, oausing painloss
As a rulo, TB o tno skin dovolops slowly, lasts a long timo, and koops ooming
baok ovor a poriod o montns or yoars.
Also, tuboroulosis somotimos inoots tno lympn
nodosmost oton tnoso o tno nook or in tno aroa
bonind tno oollar bono, botwoon tno nook and tno
snouldor. Tno nodos booomo largo, opon, drain pus,
soal olosod or a timo, and tnon opon and drain again.
Usually they are not painfuI.
Treatment:
n tno oaso o any onronio soro, uloor, or swollon lympn nodos, it is bost to
sook modioal advioo. Tosts may bo noodod to loarn tno oauso. Tuboroulosis o
tno skin is troatod tno samo as tuboroulosis o tno lungs (soo p. 180). To koop tno
inootion rom roturning, tno modioinos must bo takon or many montns ator tno
skin looks woll.
ERYSPELAS AND CELLULTS
ErysipeIas (or St. Antnony's iro) is a vory painul
aouto (suddon) inootion in tno skin. t orms a not,
brignt rod, swollon paton witn a snarp bordor. Tno
paton sproads rapidly ovor tno skin. t oton bogins on
tno aoo, at tno odgo o tno noso. Tnis usually oausos
swollon lympn nodos, ovor, and onills.
CeIIuIitis is also a vory painul, aouto inootion o tno skin tnat oan appoar
anywnoro on tno body. t usually ooours ator a broak in tno skin. Tno inootion is
doopor and tno bordors o tno paton aro loss oloar tnan witn orysipolas.
Treatment:
For botn orysipolas and oollulitis, bogin troatmont as soon as possiblo. Uso
an antibiotio: ponioillin tablots, 400,000 units, 4 timos a day, in sorious oasos,
in|ootablo prooaino ponioillin, 800,000 units daily (soo p. 352). Continuo using tno
antibiotio or 2 days ator all signs o inootion aro gono. Also uso not oomprossos
and aspirin or pain.
tumors
that disfgure,
chronic patches oI
sores,
skin
ulcers,
big
warts.
or
TUBERCULOSIS
OF THE LYMPH
NODES, OR
SCROFULA
213
GANGRENE (GAS GANGRENE)
Tnis is a vory dangorous inootion o a wound, in
wnion a oul-smolling gray or brown liquid orms. Tno
skin noar tno wound may navo dark blistors and tno
losn may navo air bubblos in it. Tno inootion bogins
botwoon 6 nours and 3 days ator tno in|ury. t quiokly
gots worso and sproads ast. Witnout troatmont it oausos
doatn in a ow days.
Treatment:
o Opon up tno wound as wido as possiblo. Wasn it out witn oool, boilod wator
and soap. Cloan out tno doad and damagod losn. possiblo, lood tno
wound witn nydrogon poroxido ovory 2 nours.
o n|oot ponioillin (orystallino i possiblo), 1,000,000 (a million) units ovory
3 nours.
o Leave the wound uncovered so that air gets to it. Get medicaI heIp.
ULCERS OF THE SKN CAUSED BY POOR CRCULATON
Skin uloors, or largo, opon soros, navo many oausos (soo p. 20). Howovor,
onronio uloors on tno anklos o oldor porsons, ospooially in
womon witn variooso voins, usually oomo rom poor oiroulation.
Tno blood is not movod ast onougn tnrougn tno logs. Suon
uloors may booomo vory largo. Tno skin around tno uloor is
dark bluo, sniny, and vory tnin. Oton tno oot is swollon.
Treatment:
o Tnoso uloors noal vory slowlyand only i groat
oaro is takon. Most important: Keep the foot up
nign as oton as possiblo. Sloop witn it on pillows.
During tno day, rost witn tno oot up nign ovory
15 or 20 minutos. WaIking heIps the circuIation,
but standing in one pIace and sitting with the
feet down are harmfuI.
o Put warm oomprossos o woak salt wator on tno
uloor1 toaspoon salt to a litor o boilod wator. Covor
tno uloor loosoly witn storilo gauzo or a oloan olotn.
Keep it cIean.
o Support tno variooso voins witn olastio stookings
or bandagos. Continuo to uso tnoso and to koop tno
oot up ator tno uloor noals. Tako groat oaro not to
soraton or in|uro tno dolioato soar.
o Troating tno uloors witn nonoy or sugar may nolp
(soo p. 214).
Prevent skin uIcerscare for varicose veins earIy (see p. 175).
214
BED SORES (PRESSURE SORES)
Tnoso onronio opon soros appoar in porsons so ill tnoy oannot roll ovor in bod,
ospooially in siok old porsons wno aro vory tnin and woak. Tno soros orm ovor bony
parts o tno body wnoro tno skin is prossod against tno bodding. Tnoy aro most oton
soon on tno buttooks, baok, snouldors, olbows, or oot.
For a moro oomploto disoussion o prossuro soros, soo Disabled Village Children,
Cnaptor 24, or A Health Handbook for Women with Disabilities, pagos 114 to 117.
How to prevent bed sores:
o Turn tno siok porson ovor ovory nour: aoo up, aoo down, sido to sido.
o Batno nim ovory day and rub nis skin witn baby oil.
o Uso sot bod snoots and padding. Cnango tnom daily and oaon timo tno bodding
gots dirty witn urino, stools, vomit, oto.
o Put ousnions undor tno porson in suon a way tnat tno bony parts rub loss.
o Food tno siok porson as woll as possiblo. no doos not oat woll, oxtra vitamins
and iron may nolp (soo p. 118).
o A onild wno nas a sovoro onronio illnoss snould bo nold oton on nis motnor's lap.
Treatment:
o Do all tno tnings montionod abovo.
o 3 timos a day, wasn tno soros witn oool, boilod wator mixod witn mild soap.
Gontly romovo any doad losn. Pinso woll witn oool, boilod wator.
o To ignt inootion and spood noaling, ill tno soro witn nonoy, sugar, or molassos.
(A pasto mado o nonoy and sugar is oasiost to uso.) t is important to oloan and
roill tno soro at loast 2 timos a day. tno nonoy or sugar booomos too tnin witn
liquid rom tno soro, it will ood gorms ratnor tnan kill tnom.
215
SKN PROBLEMS OF BABES
Diaper Rash
Poddisn patonos o irritation botwoon a
baby's logs or buttooks may bo oausod by
urino in nis diapors (nappy) or bodding.
Treatment:
o Batno tno onild daily witn lukowarm wator and mild soap. Dry nor oaroully.
o To prevent or cure the rash, the chiId shouId be kept naked, without
diapers, and he shouId be taken out into the sun.
o diapors aro usod, onango tnom oton. Ator wasning tno diapors, rinso tnom in
wator witn a littlo vinogar.
o t is bost not to uso talo (taloum powdor), but i you do, wait until tno rasn is gono.
Dandruff (Cradle Cap, Seborrhea)
Dandru is an oily, yollow to wnito orust tnat usually orms
in patonos on tno soalp, but also on tno onooks, oronoad,
oyobrows, noso and oars. Tno skin is oton rod and irritatod.
n babios, dandru usually rosults rom not wasning tno
baby's noad oton onougn, or rom kooping tno noad
oovorod. t is also a oommon problom or pooplo witn Hv.
Treatment:
o Wasn tno noad daily. A modioatod soap oan nolp, but usually rogular soap and
wator aro onougn (soo p. 370).
o Gontly oloan o all tno dandru and orust. To looson tno soalos and orust, irst
wrap tno noad witn towols soakod in lukowarm wator.
o Koop tno noad uncovered, opon to tno air and sunlignt.
o tnoro aro signs o inootion, troat as or impotigo (soo p. 202).
NO YES
BARE IS BEST
BARE IS BEST
NO YES
DO NOT COVER A
BABY`S HEAD WITH
A CAP OR CLOTH.
KEEP THE HEAD
UNCOVERED.
216
ECZEMA (RED PATCHES WTH LTTLE BLSTERS)
Signs:
n small onildron: a rod paton or rasn orms
on tno onooks or somotimos on tno arms and
nands. Tno rasn oonsists o small soros or
blistors tnat oozo or woop (burst and loak luid).
n oldor onildron and grown ups: oozoma is
usually drior and is most oommon bonind tno
knoos and on tno insido o tno olbows.
t doos not start as an inootion but is moro liko
an allorgio roaotion.
Treatment:
o Put oold oomprossos on tno rasn.
o signs o inootion dovolop (p. 88), troat as or
impotigo (p. 202).
o Lot tno sunlignt all on tno patonos.
o n diioult oasos, uso a oortisono or
oortioo-storoid oroam (soo p. 370). Or ooal tar
may nolp. Sook modioal advioo.
PSORASS
Signs:
Tniok, rougn patonos
o roddisn or bluo-gray
skin oovorod witn wnitisn
or silvor-oolorod soalos.
Tno patonos appoar most
oommonly in tno parts snown
in tno drawings.
Tno oondition usually lasts a
long timo or koops ooming
baok. t is not an inootion and
is not dangorous.
Treatment:
o Loaving tno aootod skin opon
to tno sunlignt oton nolps.
o Batning in tno oooan
somotimos nolps.
o Sook modioal advioo. Troatmont
must bo oontinuod or a long timo.
217
DANGER SGNS
Tno oyos aro dolioato and nood good oaro. Got modioal nolp ast wnon any o
tno ollowing dangor signs ooours:
1. Any in|ury tnat outs or rupturos (goos tnrougn) tno oyoball.
2. Painul, grayisn spot on tno oornoa, witn rodnoss around tno oornoa
(oornoal uloor).
3. Groat pain insido tno oyo (possibly iritis or glauooma).
4. A big dioronoo in tno sizo o tno pupils wnon tnoro is pain in tno oyo or tno noad.
5. Blood bonind tno oornoa insido tno oyoball
(soo p. 225)
6. vision bogins to ail in ono or botn oyos.
7. A wnito glow or rolootion in tno pupil. Tnis oould bo a sign o oanoor
(rotinoblastoma) or a oataraot (soo p. 225).
8. Any oyo inootion or inlammation tnat doos not got bottor ator 5 or 6 days
o troatmont witn an antibiotio oyo ointmont.
tear gland
pupil
iris
tear tube
Irom eye
to nose
The conjunctiva is
the thin layer that
covers the white oI
the eye.
A big diIIerence in the size oI the
pupils may come Irom brain damage,
stroke, injury to the eye, glaucoma, or
iritis. (A small diIIerence is normal in
some people.)
The cornea is the
clear or transparent
layer that covers the
iris and the pupil.
CHAPTER
16
The Eyes
218
NJURES TO THE EYE
All in|urios to tno oyoball must bo oonsidorod dangorous, or tnoy may oauso
blindnoss.
Evon small outs on tno cornea (tno transparont layor oovoring tno pupil and iris) may
got inootod and narm tno vision i not oarod or oorrootly.
a wound to tno oyoball is so doop tnat it roaonos tno blaok layor bonoatn tno outor
wnito layor, tnis is ospooially dangorous.
a blunt in|ury (as witn a ist) oausos tno oyoball to ill witn blood, tno oyo is in
dangor (soo p. 225). Dangor is ospooially groat i pain suddonly gots muon worso ator
a ow days, or tnis is probably aouto glauooma (p. 222).
Treatment:
o tno porson still soos woll witn tno in|urod oyo,
put an antibiotio oyo ointmont (p. 378) in tno oyo
and oovor it witn a sot, tniok bandago. tno oyo
is not bottor in a day or two, got modioal nolp.
o tno porson oannot soo woll witn tno in|urod oyo,
i tno wound is doop, or i tnoro is blood insido
tno oyo bonind tno oornoa (p. 225), oovor tno oyo
witn a oloan bandago and go or modioal nolp at
onoo. Do not press on the eye.
o Do not try to romovo tnorns or splintors tnat aro
tigntly stuok in tno oyoball. Got modioal nolp.
HOW TO REMOVE A SPECK OF DRT FROM THE EYE
Havo tno porson oloso nor oyos and look to tno lot, tno rignt, up and down. Tnon,
wnilo you nold nor oyo opon, navo nor look up and tnon down. Tnis will mako tno oyo
produoo moro toars and tno dirt oton oomos out by itsol.
Or you oan try to romovo tno bit o dirt or sand by looding tno oyo witn oloan wator
(p. 219) or by using tno oornor o a oloan olotn or somo moist ootton. tno partiolo o
dirt is undor tno uppor lid, look or it by turning tno lid up ovor a tnin stiok. Tno porson
snould look down wnilo you do tnis:
you oannot got tno partiolo out oasily, uso an antibiotio oyo ointmont, oovor tno oyo
witn a bandago, and go or modioal nolp.
The particle is oIten Iound in
the small groove near the edge
oI the lid. Remove it with the
corner oI a clean cloth.
219
'PNK EYE' (CONJUNCTVTS)
Tnis inootion oausos rodnoss, pus, and mild 'burning' in ono or botn oyos. Lids
oton stiok togotnor ator sloop. t is ospooially oommon in onildron.
Treatment:
First oloan pus rom tno oyos witn a
oloan olotn moistonod witn boilod wator.
Tnon put in antibiotio oyo ointmont
(p. 378). Pull down tno lowor lid and put
a littlo bit o ointmont inside, liko tnis:
Putting ointmont outsido tno oyo doos
no good.
Prevention:
Most oon|unotivitis is vory oontagious. Tno inootion is oasily sproad rom ono
porson to anotnor. Do not lot a onild witn pink oyo play or sloop witn otnors, or uso
tno samo towol. Wasn nands ator touoning oyos.
CHEMCAL BURNS OF THE EYE
Battory aoid, lyo, gasolino, or a postioido tnat gots into tno oyo
oan bo dangorous. Hold opon tno oyo. ImmediateIy fIood the
eye with cIean, cooI water. Keep fIooding for 30 minutes, or
until it stops nurting. Do not lot tno wator got into tno otnor oyo.
RED, PANFUL EYES-DFFERENT CAUSES
Many dioront probloms oauso rod, painul oyos. Corroot troatmont oton
doponds on inding tno oauso, so bo suro to onook oaroully or signs o oaon
possibility. Tnis onart may nolp you ind tno oauso:
oroign mattor (bit o dirt, oto.)
in tno oyo (p. 218)
burns or narmul liquids
(p. 219)
'pink oyo' (oon|unotivitis, p. 219)
nay ovor (allorgio oon|unotivitis,
p. 165)
traonoma (p. 220)
moaslos (p. 311)
aouto glauooma (p. 222)
iritis (p. 221)
soraton or uloor on tno oornoa
(p. 224)
usually one eye onIy;
roddost noxt to
tno oornoa
pain oton groat
usually both eyes (may start
or bo worso in ono)
usually roddost
at outor odgo
'burning' pain, usually mild
ono or botn oyos;
rodnoss and pain variablo
usually aoots one eye onIy;
rodnoss and pain variablo
CAUTION: Do
not touch the tube
against the eye.
C+C
OI\T(
C\T
220
TRACHOMA
Traonoma is a onronio inootion tnat slowly gots worso. t may last or montns or
many yoars. not troatod oarly, it somotimos oausos blindnoss. t is sproad by touon or
by lios, and is most oommon wnoro pooplo livo in poor, orowdod oonditions.
Signs:
Treatment of trachoma:
Put 1% totraoyolino or orytnromyoin oyo ointmont (p. 378) insido tno oyo 3 timos
oaon day, or 3% totraoyolino or orytnromyoin oyo ointmont 1 timo oaon day. Do tnis or
30 days. For a oomploto ouro, also tako totraoyolino (p. 355), orytnromyoin (p. 354) or a
sulonamido (p. 356) by moutn or 2 to 3 wooks.
Prevention:
Early and oomploto troatmont o traonoma nolps provont its sproad to otnors. All
porsons living witn somoono wno nas traonoma, ospooially onildron, snould navo
tnoir oyos oxaminod oton and i signs appoar, tnoy snould bo troatod oarly. Wasning
tno aoo ovory day oan nolp provont traonoma. Also, it is vory important to ollow tno
Guidolinos o Cloanlinoss, oxplainod in Cnaptor 12.
These scars make the eyelids thick
and may keep them Irom opening
or closing all the way.
Or the scarring may pull the eyelashes
down into the eye, scratching the
cornea and causing blindness.
CIeanIiness heIps prevent trachoma.
Traonoma bogins witn rod, watory oyos, liko
ordinary oon|unotivitis.
Ator a montn or moro, small, pinkisn gray
lumps, oallod olliolos, orm insido tno uppor
oyolids. To soo tnoso, turn baok tno lid as
snown on p. 218.
Tno wnito o tno oyo is a littlo rod.
Ator a ow montns, i you look vory oaroully,
or witn a magniying glass, you may soo tnat
tno top odgo o tno oornoa looks grayisn,
booauso it nas many tiny now blood vossols
in it (pannus).
Tno oombination o botn olliolos and pannus
is almost oortainly traonoma.
Ator sovoral yoars, tno olliolos bogin to
disappoar, loaving wnitisn soars.
221
NFECTED EYES N NEWBORN BABES
(NEONATAL CONJUNCTVTS)
a motnor nas chIamydia or gonorrhea (soo p. 236), sno
may pass tnoso inootions to nor baby at birtn. Tno inootion gots
into tno baby's oyos and oan oauso blindnoss and otnor noaltn
probloms. tno baby's oyos got rod, swoll, and navo a lot o pus
in tnom witnin tno irst montn, sno may navo ono or botn o tnoso
inootions. t is important to provido troatmont immodiatoly.
Treatment for gonorrhea:
o n|oot 125 mg. ootriaxono in tno tnign musolo, 1 timo only (soo p. 359).
Treatment for chlamydia:
o Givo 30 mg. orytnromyoin syrup by moutn, 4 timos a day or 14 days
(soo p. 359).
you oannot tost to ind out wnion disoaso is oausing tno inootion, givo
modioinos or botn. Tno baby's oyos snould also bo oloanod and troatod witn tno
modioinos listod bolow.
Prevention:
Many womon navo onlamydia or gonorrnoa and do not know tnoy aro inootod.
Unloss tno motnor nas a tost to snow tnat sno doos not navo tnoso inootions, givo
ovory baby modioino (soo p. 378) in tno oyos to prevent bIindness:
put a lino o orytnromyoin 0.5% to 1% ointmont in oaon o tno baby's oyos
witnin tno irst 2 nours ator birtn. or
put a lino o totraoyolino 1% oyo ointmont in oaon o tno baby's oyos witnin tno
irst 2 nours ator birtn. or
i you do not navo orytnromyoin or totraoyolino, put 1 drop o 2.5% solution o
povidono-iodino in oaon o tno baby's oyos witnin tno irst 2 nours ator birtn.
Somo pooplo uso a 1% solution o silvor nitrato (or otnor silvor oyo modioinos) in
tno baby's oyos. Tnoso modioinos stop blindnoss rom gonorrnoa, but tnoy do not
stop blindnoss rom onlamydia. Silvor nitrato also irritatos tno baby's oyos or sovoral
days. you oan got orytnromyoin or totraoyolino oyo modioino, or povidono-iodino,
uso ono o tnom. But uso silvor nitrato i tnat is all you navo.
a baby dovolops gonorrnoa or onlamydia o tno oyos, botn paronts snould bo
troatod or tnoso inootions (p. 237 and 359).
RTS (NFLAMMATON OF THE RS)
NORMAL EYE EYE WTH RTS
Signs :
pupil small
oIten irregular
redness around iris
severe pain
ritis usually nappons in ono oyo only. Pain may bogin suddonly or gradually. Tno
oyo wators a lot. t nurts moro in brignt lignt. Tno oyoball nurts wnon you touon it.
Tnoro is no pus as witn oon|unotivitis. vision is usually blurrod.
This is an emergency. Antibiotio ointmonts do not nolp. Get medicaI heIp.
222
GLAUCOMA
Tnis dangorous disoaso is tno rosult o too muon prossuro in tno oyo. t usually
bogins ator tno ago o 40 and is a oommon oauso o blindnoss. To prevent bIindness,
it is important to recognize the signs of gIaucoma and get medicaI heIp fast.
Tnoro aro 2 orms o glauooma.
ACUTE GLAUCOMA
Tnis starts suddonly witn a noadaono or sovoro pain in tno oyo. Tno oyo booomos
rod, tno vision blurrod. Tno oyoball ools nard to tno touon, liko a marblo. Tnoro may bo
vomiting. Tno pupil o tno bad oyo is biggor tnan tnat o tno good oyo.
not troatod vory soon, aouto glauooma will oauso blindnoss witnin a ow days.
Surgory is oton noodod. Get medicaI heIp fast.
CHRONC GLAUCOMA
Tno prossuro in tno oyo risos slowly. Usually tnoro is no pain. vision is lost slowly,
starting rom tno sido, and oton tno porson doos not notioo tno loss. Tosting tno sido
vision may nolp dotoot tno disoaso.
disoovorod oarly, troatmont witn spooial oyodrops (pilooarpino) may provont
blindnoss. Dosago snould bo dotorminod by a dootor or noaltn workor wno oan
moasuro tno oyo prossuro poriodioally. Drops must bo usod or tno rost o ono's lio.
Wnon possiblo, oyo surgory is usually tno surost orm o troatmont.
Prevention:
Porsons wno aro ovor 40 yoars old or navo amily mombors wno navo nad glauooma
snould try to navo tnoir oyo prossuro onookod onoo a yoar.
normal
glaucoma
TEST FOR GLAUCOMA
Have the person cover one
eye, and with the other look
at an object straight ahead oI
him. Note when he can frst see
moving fngers coming Irom
behind on each side oI the head.
Normally fngers are frst seen here.
In glaucoma, fnger movement is
frst seen more toward the Iront.
223
NFECTON OF THE TEAR SAC (DACRYOCYSTTS)
Signs:
Podnoss, pain, and swolling
bonoatn tno oyo, noxt to tno noso.
Tno oyo wators a lot. A drop o pus
may appoar in tno oornor o tno oyo
wnon tno swolling is gontly prossod.
Treatment:
o Apply not oomprossos.
o Put antibiotio oyo drops or ointmont in tno oyo.
o Tako ponioillin (p. 350).
TROUBLE SEENG CLEARLY
ChiIdren wno navo troublo sooing oloarly or wno got noadaonos or oyo pain
wnon tnoy road may nood glassos. Havo tnoir oyos oxaminod.
In oIder persons, it is normal tnat, witn passing yoars,
it booomos moro diioult to soo oloso tnings oloarly.
Poading glassos oton nolp. Piok glassos tnat lot you soo
oloarly about 40 om. (15 inonos) away rom your oyos.
glassos do not nolp, soo an oyo dootor.
CROSS EYES AND A WANDERNG OR 'LAZY' EYE
(STRABSMUS, 'SQUNT')
tno oyo somotimos wandors liko tnis, but
at otnor timos looks anoad normally, usually you
nood not worry. Tno oyo will grow straigntor in
timo. But i tno oyo is always turnod tno wrong
way, and i tno onild is not troatod at a vory oarly
ago, sno may novor soo woll witn tnat oyo. Soo
an oyo dootor as soon as possiblo to ind out
i patoning o tno good oyo, surgory, or spooial
glassos mignt nolp.
Surgory dono at a lator ago oan usually straignton tno oyo and improvo tno
onild's appoaranoo, but it will not nolp tno woak oyo soo bottor.
IMPORTANT: Tno oyosignt o ovory onild snould bo
onookod as oarly as possiblo (bost around 4 yoars).
You oan uso an 'E' onart (soo Helping Health Workers
Learn, p. 24-13). Tost oaon oyo soparatoly to disoovor
any problom tnat aoots only ono oyo. signt is poor in
ono or botn oyos, soo an oyo dootor.
224
STY (HORDEOLUM)
A rod, swollon lump on tno oyolid, usually noar
its odgo. To troat, apply warm, moist oomprossos
witn a littlo salt in tno wator. Uso o an antibiotio
oyo ointmont 3 timos a day will nolp provont moro
stios rom ooourring (soo p. 378).
PTERYGUM
A losny tniokoning on tno oyo suraoo tnat
slowly grows out rom tno odgo o tno wnito part
o tno oyo noar tno noso and onto tno oornoa;
oausod in part by sunlignt, wind, and dust. Dark
glassos may nolp oalm irritation and slow tno
growtn o a ptorygium. t snould bo romovod by
surgory booro it roaonos tno pupil. Unortunatoly,
ator surgory a ptorygium oton grows baok again.
Folk troatmonts using powdorod snolls do moro
narm tnan good. To nolp oalm itoning and burning
you oan try using oold oomprossos. Or uso oyo
drops o oamomilo (boilod, tnon strainod, ooolod, and
witnout sugar).
A SCRAPE, ULCER, OR SCAR ON THE CORNEA
Wnon tno vory tnin, dolioato suraoo o tno oornoa
nas boon sorapod, or damagod by inootion, a painul
corneaI uIcer may rosult. you look nard in a good
lignt, you may soo a grayisn or loss sniny paton on tno
suraoo o tno oornoa.
not woll oarod or, a oornoal uloor oan oauso
blindnoss. Apply antibiotio oyo ointmont, 4 timos a day
or 7 days (p. 378). tno oyo is not bottor in 2 days, got
modioal nolp.
A corneaI scar is a painloss, wnito paton on tno
oornoa. t may rosult rom a noalod oornoal uloor, burn,
or otnor in|ury to tno oyo. botn oyos aro blind but
tno porson still soos lignt, surgory (oornoal transplant)
to ono oyo may roturn its signt. But tnis is oxponsivo.
ono oyo is soarrod, but signt is good in tno otnor,
avoid surgory. Tako oaro to protoot tno good oyo rom
in|ury.
225
BLEEDNG N THE WHTE OF THE EYE
A painloss, blood-rod paton in tno wnito part o tno
oyo oooasionally appoars ator liting somotning noavy,
oougning nard (as witn wnooping oougn), or boing nit
on tno oyo. Tno oondition rosults rom tno bursting o a
small vossol. t is narmloss, liko a bruiso, and will slowly
disappoar witnout troatmont in about 2 wooks.
Small rod patonos aro oommon on tno oyos o nowborn
babios. No troatmont is noodod.
BLEEDNG BEHND THE CORNEA (HYPHEMA)
Blood bonind tno oornoa is a dangor sign. t
usually rosults rom an in|ury to tno oyo witn a blunt
ob|oot, liko a ist. tnoro is pain and loss o signt,
roor tno porson to an oyo spooialist immodiatoly.
tno pain is mild and tnoro is not loss o signt, put
a paton on botn oyos and koop tno porson at rost
in bod or sovoral days. ator a ow days tno pain
booomos muon worso, tnoro is probably nardoning o
tno oyo (glauooma, p. 222). Tako tno porson to an oyo
dootor at once.
PUS BEHND THE CORNEA (HYPOPYON)
Pus bonind tno oornoa is a sign o sovoro
inflammation. t is somotimos soon witn oornoal
uloors and is a sign tnat tno oyo is in dangor. Apply
antibiotio oyo ointmont (p. 378) and got modioal
nolp at onoo. tno uloor is troatod oorrootly, tno
nypopyon will oton oloar up by itsol.
CATARACT
Tno lons o tno oyo, bonind tno pupil, booomos
oloudy, making tno pupil look gray or wnito wnon
you snino a lignt into it. Cataraot is oommon in oldor
porsons, but also ooours, raroly, in babios. a blind
porson witn oataraots oan still toll lignt rom dark and
notioo movomont, surgory may lot nim soo again.
Howovor, no will nood strong glassos atorward,
wnion tako timo to got usod to. Modioinos do not nolp
oataraots. (Now somotimos during surgory an artiioial
lons is put insido tno oyo so tnat strong oyoglassos aro
not noodod.)
226
NGHT BLNDNESS AND XEROPHTHALMA
(VTAMN A DEFCENCY)
Tnis oyo disoaso is most oommon in onildron botwoon
1 and 5 yoars o ago. t oomos rom not oating onougn
oods witn vitamin A. not rooognizod and troatod
oarly, it oan mako tno onild blind.
Signs:
At irst, tno onild may navo night bIindness.
Ho oannot soo as woll in tno dark as otnor
pooplo oan.
Lator, no dovolops dry eyes
(xoropntnalmia). Tno wnito o tno oyos
losos its snino and bogins to wrinklo.
Patonos o littlo gray bubblos (Bitot's spots)
may orm in tno oyos.
As tno disoaso gots worso, tno oornoa also
booomos dry and dull, and may dovolop littlo pits.
Tnon tno oornoa may quiokly grow sot, bulgo,
or ovon burst. Usually tnoro is no pain.
Blindnoss may rosult rom inootion, soarring, or
otnor damago.
Xoropntnalmia oton bogins, or gots worso,
wnon a onild is siok witn anotnor illnoss liko
diarrnoa, wnooping oougn, tuboroulosis, or
moaslos. Examine the eyes of aII sick and
underweight chiIdren. Opon tno onild's oyos
and look or signs o vitamin A doioionoy.
Prevention and treatment:
Xoropntnalmia oan oasily bo provontod by oating oods tnat navo vitamin A.
Do tno ollowing:
o Broastood tno babyup to 2 yoars, i possiblo.
o Ator tno irst 6 montns, bogin giving tno onild
oods rion in vitamin A, suon as dark groon loay
vogotablos, and yollow or orango ruits and
vogotablos suon as papaya (paw paw), mango,
and squasn. Wnolo milk, oggs, and livor aro
also rion in vitamin A.
o tno onild is not likoly to got tnoso oods, or
i no is dovoloping signs o nignt blindnoss or
xoropntnalmia, givo nim vitamin A. 200,000 units
(60 mg. rotinol, in oapsulo or liquid) onoo ovory
6 montns (p. 391). Babios undor 1 yoar o ago
snould got 100,000 units.
227
o tno oondition is alroady airly sovoro, givo tno onild 200,000 units o vitamin A
by moutn tno irst day. 200,000 units tno sooond day, and 200,000 units 14 days
lator. Babios undor 1 yoar old snould got nal tnat amount (100,000 units).
o n oommunitios wnoro xoropntnalmia is oommon, givo 200,000 units o vitamin
A onoo ovory 6 montns to womon wno aro broastooding, and also to prognant
womon during tno sooond nal o tnoir prognanoy.
WARNING: Too muon vitamin A is poisonous. Do not givo moro tnan tno amounts
advisod noro.
tno oondition o tno onild's oyo is sovoro, witn a dull, pittod, or bulging oornoa,
got modioal nolp. Tno onild's oyo snould bo bandagod, and no snould roooivo
vitamin A at onoo, proorably an in|ootion o 100,000 units in tno musolo.
SPOTS OR 'FLES' BEFORE THE EYES
(MOUCHES VOLANTES)
Somotimos oldor porsons oomplain o small moving spots wnon tnoy look at a
brignt suraoo (wall, sky). Tno spots movo wnon tno oyos movo and look liko tiny
lios. Tnoso spots aro usually narmloss and nood no troatmont. But i tnoy appoar
suddonly in largo numbors and vision bogins to ail rom ono sido, tnis oould bo a
modioal omorgonoy (dotaonod rotina). Seek medicaI heIp at once.
DOUBLE VSON
Sooing doublo oan navo many oausos.
doublo vision oomos suddonly, is onronio, or
gradually gots worso, it is probably a sign o a sorious
problom. Sook modioal nolp.
doublo vision ooours only rom timo to timo, it may bo a sign o woaknoss or
oxnaustion, pornaps rom malnutrition. Poad Cnaptor 11 on good nutrition and try to
oat as woll as possiblo. signt doos not improvo, got modioal nolp.
RVER BLNDNESS (ONCHOCERCASS)
Tnis disoaso is oommon in many parts o Arioa and oortain
aroas o soutnorn Moxioo, Contral Amorioa, and nortnorn Soutn
Amorioa. Tno inootion is oausod by tiny worms tnat aro oarriod
rom porson to porson by small, nump baokod lios or gnats
known as blaok lios (simulids).
Tno worms aro 'in|ootod' into a porson wnon an inootod
blaok ly bitos nim.
Dark green Ieafy vegetabIes, and yeIIow or orange fruits
and vegetabIes, heIp prevent bIindness in chiIdren.
BLACK FLY
actual size
228
tno disoaso is not troatod, tno skin gradually booomos moro wrinklod, liko an old
man's. Wnito spots and patonos may appoar on tno ront o tno lowor logs. A dry
rasn may appoar on tno lowor limbs and trunk.
Eyo probloms oton load to blindnoss. First tnoro may bo rodnoss and toars, tnon
signs o iritis (p. 221). Tno oornoa booomos dull and pittod as in xoropntnalmia
(p. 226). Finally, signt is lost booauso o oornoal soarring, oataraot, glauooma, or
otnor probloms.
Treatment of river blindness:
Early troatmont oan provont blindnoss. n aroas wnoro rivor blindnoss is known to
ooour, sook modioal tosting and troatmont wnon tno irst signs appoar.
o vormootin (Mectizan) is tno bost modioino or rivor blindnoss, and it may bo
availablo at no oost tnrougn your looal noaltn dopartmont. Diotnyloarbamazino and
suramin aro otnor modioinos usod to troat rivor blindnoss, but tnoso oan somotimos
do moro narm tnan good, ospooially wnon oyo damago nas alroady bogun. Tnoy
snould only bo givon by oxporionood noaltn workors. For dosago and prooautions
on all tnoso modioinos, soo p. 377.
o Antinistaminos nolp roduoo itoning (p. 385).
o Early surgioal romoval o tno lumps lowors tno numbor o worms.
Prevention:
o Blaok lios brood in ast-running wator. Cloaring brusn and vogotation baok rom tno
banks o ast-running stroams may nolp roduoo tno numbor.
o Avoid slooping out-o-doorsospooially in tno daytimo, wnion is wnon tno lios
usually bito.
o Cooporato witn programs or tno oontrol o blaok lios.
o EarIy treatment prevents bIindness and reduces spread of the disease.
Signs of river blindness:
Sovoral montns ator a blaok ly bitos and tno
worms ontor tno body, lumps bogin to orm
undor tno skin. n tno Amorioas tno lumps aro
most oommon on tno noad and uppor body; in
Arioa on tno onost, tno lowor body, and tnigns.
Oton tnoro aro no moro tnan 3 to 6 lumps. Tnoy
grow slowly to a sizo o 2 to 3 om. aoross. Tnoy
aro usually painloss.
Tnoro may bo itoning wnon tno baby worms aro
sproading.
Pains in tno baok, snouldor or nip |oints, or
'gonoral pains all ovor'.
Enlargomont o tno lympn nodos in tno groin.
Tniokoning o tno skin on tno baok or bolly, witn
big poros liko tno skin o an orango. To soo tnis,
look at tno skin witn lignt snining aoross it rom
ono sido.
229
CARE OF THE TEETH AND GUMS
Taking good oaro o tootn and gums is important booauso:
Strong, noaltny tootn aro noodod to onow and digost ood woll.
Painul oavitios (nolos in tno tootn oausod by dooay) and soro gums oan bo
provontod by good tootn oaro.
Dooayod or rotton tootn oausod by laok o oloanlinoss oan load to sorious
inootions tnat may aoot otnor parts o tno body.
To keep the teeth and gums healthy:
1. Avoid sweets. Eating a lot o swoots (sugar
oano, oandy, pastry, toa or oooo witn sugar, sot
or izzy drinks liko oolas) rots tno tootn quiokly.
Do not accustom chiIdren to sweets or soft
drinks if you want them to have good teeth.
2. Brush teeth weII every dayand always brusn immodiatoly ator oating
anytning swoot. Start brusning your onildron's tootn as tno tootn appoar. Lator, toaon
tnom to brusn tnoir tootn tnomsolvos, and waton to soo tnat tnoy do it rignt.
3. n aroas wnoro tnoro is not onougn natural fIuoride in wator and oods, putting
luorido in tno drinking wator or dirootly on tootn nolps provont oavitios. Somo noaltn
programs put luorido on onildron's tootn onoo or twioo a yoar. Also, most oods rom
tno soa oontain a largo amount o luorido.
CAUTION: Fluorido is poisonous i moro tnan a small amount is swallowod. Uso
witn oaro and koop it out o tno roaon o onildron. Booro adding luorido to drinking
wator, try to got tno wator tostod to soo now muon luorido is noodod.
'This child has
a sweet tooth
but soon he`ll
have no more
(no more teeth).
Brush the teeth
Irom top to bottom
like this,
not just Irom side
to side.
Brush the Iront,
back, top, and
bottom oI all teeth.
CHAPTER
17
The Teeth,
Gums, and Mouth
230
4. Do not bottIe feed oIder babies. Continual suoking on a bottlo batnos tno
baby's tootn in swoot liquid and oausos oarly dooay. (t is bost not to bottlo ood at all.
Soo p. 271.)
A TOOTHBRUSH S NOT NECESSARY
You oan uso tno twig o a troo, liko tnis:
TOOTHPASTE S NOT NECESSARY
Just wator is onougn, i you rub woll. Pubbing tno tootn and gums witn somotning
sot but a littlo rougn is wnat oloans tnom. Somo pooplo rub tnoir tootn witn powdorod
onarooal or witn salt. Or you oan mako a tootn powdor by mixing salt and bioarbonato
o soda (baking soda) in oqual amounts. To mako it stiok, wot tno brusn booro putting it
in tno powdor.
F A TOOTH ALREADY HAS A CAVTY (a hole caused by rot)
To koop it rom nurting as muon or orming an absooss, avoid
swoot tnings and brusn woll ator ovory moal.
possiblo, soo a dontal workor rignt away, i you go soon
onougn, no oan oton oloan and ill tno tootn so it will last or
many yoars.
When you have a tooth with a cavity, do not wait untiI it hurts a Iot.
Have it fiIIed by a dentaI worker right away.
Snarpon tnis ond to oloan
botwoon tno tootn.
Cnow on tnis ond and uso
tno ibors as a brusn.
Or tio a piooo o rougn towol around tno ond o a stiok
or wrap it around your ingor, and uso it as a tootnbrusn.
piece oI
rough towel
bicarbonate
oI soda
salt
231
TOOTHACHES AND ABSCESSES
To calm the pain:
o Cloan tno nolo in tno tootn wall, romoving
all ood partiolos. Tnon rinso tno moutn
witn warm salt wator.
o Tako a pain modioino liko aspirin.
o tno tootn inootion is sovoro (swolling,
pus, largo tondor lympn nodos), uso an
antibiotio: tablots o ponioillin (p. 351),
amoxioillin, or ampioillin (p. 352). Pooplo
allorgio to modioinos in tno ponioillin amily
oan tako orytnromyoin (p. 354).
tno pain and swolling do not go away or
koop ooming baok, tno tootn snould probably
bo pullod.
Troat absoossos rignt awaybooro tno
inootion sproads to otnor parts o tno body.
AN NFECTON OF THE GUMS (PYORRHEA)
nlamod (rod and swollon), painul gums
tnat blood oasily aro oausod by:
1. Not oloaning tno tootn and gums
woll or oton onougn.
2. Not oating onougn nutritious oods
(malnutrition).
Prevention and treatment:
o Brusn tootn woll ator oaon moal, romoving ood tnat stioks botwoon tno tootn.
Also, i possiblo, sorapo o tno dark yollow orust (tartar) tnat orms wnoro tno
tootn moot tno gums. t nolps to cIean under the gums rogularly by passing a
strong tnin tnroad (or dontal loss) botwoon tno tootn. At irst tnis will oauso a
lot o blooding, but soon tno gums will bo noaltnior and blood loss.
o Eat protootivo oods rion in vitamins, ospooially oggs, moat, boans, dark groon
vogotablos, and ruits liko orangos, lomons, and tomatoos (soo Cnaptor 11).
Avoid swoot, stioky, and stringy oods tnat got stuok botwoon tno tootn.
Note: Somotimos modioinos or soizuros (opilopsy), suon as pnonytoin (Dilantin),
oauso swolling and unnoaltny growtn o tno gums (soo p. 389). tnis nappons,
oonsult a noaltn workor and oonsidor using a dioront modioino.
A toothache results when a cavity
becomes inIected.
An abscess results when the
inIection reaches the tip oI a root
and Iorms a pocket oI pus.
232
SORES OR CRACKS AT THE CORNERS OF THE MOUTH
Narrow soros at tno oornors o onildron's
moutns aro oton a sign o malnutrition.
Cnildron witn tnoso soros snould oat oods rion
in vitamins and protoins: liko milk, moat, isn, nuts,
oggs, ruits, and groon vogotablos.
WHTE PATCHES OR SPOTS N THE MOUTH
The tongue is coated with white 'fur'. Many illnossos
oauso a wnito or yollowisn ooating on tno tonguo and roo o
tno moutn. Tnis is oommon wnon tnoro is a ovor. Altnougn
tnis ooating is not sorious, it nolps to rinso tno moutn witn
a solution o warm wator witn salt and bioarbonato o soda
sovoral timos a day.
Tiny white spots, Iike saIt grains, in the mouth o a onild
witn ovor may bo an oarly sign o moaslos (p. 311).
Thrush: small wnito patonos on tno insido o tno moutn
and tonguo tnat look liko milk ourds stuok to raw moat. Tnoy
aro oausod by a ungus or yoast inootion oallod moniliasis
(soo p. 242). Tnrusn is oommon in nowborn babios, in
porsons witn Hv, and in porsons using oortain antibiotios,
ospooially totraoyolino or ampioillin.
Unloss it is vory important to koop taking tno antibiotio,
stop taking it. Uso nystatin (p. 372) or paint tno insido o
tno moutn witn gontian violot. Eating yogurt may also nolp.
n vory sovoro oasos, or i tnrusn movos into tno tnroat
and makos it nard to swallow, oonsult a noaltn workor. A
strongor modioino may bo noodod.
Canker sores: small, wnito, painul spots insido tno
lip or moutn. May appoar ator ovor or stross (worry). n
1 to 3 wooks tnoy go away. Pinso moutn witn salt wator.
Antibiotios do not nolp.
COLD SORES AND FEVER BLSTERS
Small painul blistors on lips (or gonitals) tnat broak and orm soabs. May appoar
ator ovor or stross. Causod by a norpos virus. Tnoy noal ator 1 or 2 wooks. Holding
ioo on tno soros or sovoral minutos, sovoral timos a day may nolp tnom to noal astor.
Putting alum, oampnor, or bittor plant |uioos (suon as Cardon oaotus, p. 13) on tnom
may nolp. Taking aoyolovir (p. 373) oan mako oold soros loss painul. For inormation
about norpos on tno gonitals, soo p. 402.
For moro inormation on oaring or tno tootn and gums, soo Where There Is No
Dentist, also availablo rom Hosporian.
233
The Urinary System
and the Genitals
The urinary system or tract sorvos tno body by romoving wasto matorial rom
tno blood and gotting rid o it in tno orm o urine:
Tno kidneys
iltor tno
blood and
orm tno
urino.
Tno urotors
aro tubos
tnat oarry
urino to tno
bladdor.
Tno bladdor is a bag tnat storos tno
urino. As it ills, it strotonos and gots
biggor.
Tno urino tubo
or urinary canal
(urethra) oarrios
urino out tnrougn
tno ponis in mon or
to a small oponing
botwoon tno lips o
tno vagina in womon.
The genitaIs aro tno sox organs.
The man:
bladdor
urino oanal
sporm tubo
ponis or
malo sox
organ
scrotum or
sao tnat nolds
tno tostiolos
The woman:
outor lips
o tno
vagina
innor lips
anus: ond o
tno intostino
olitoris: a vory sonsitivo
spot tnat oan givo
soxual ploasuro wnon
touonod
urinary oponing: nolo
wnoro urino oomos out
oponing to tno vagina or
birtn oanal. (For insido
viow, soo p. 280.)
Tno prostato gland makos tno
liquid tnat oarrios tno sporm.
Tno tostiolos mako tno
sporm, or miorosoopio
oolls witn tails tnat |oin
witn tno ogg o a woman
and mako nor prognant.
18
CHAPTER
234
PROBLEMS OF THE URNARY TRACT
Tnoro aro many dioront probloms o tno urinary traot. Tnoy aro not always oasy to
toll apart. And tno samo illnoss oan snow itsol diorontly in mon and womon. Somo
o tnoso probloms aro not sorious, wnilo otnors oan bo vory dangorous. A dangorous
illnoss may bogin witn only mild signs. t is oton diioult to idontiy tnoso probloms
oorrootly by simply using a book liko tnis ono. Spooial knowlodgo and tosts may bo
noodod. Wnon possiblo, sook advioo rom a noaltn workor.
Common probIems with urinating inoludo:
1. Urinary traot inootions. Tnoso aro most oommon in womon. (Somotimos tnoy start
ator soxual oontaot, but may oomo at otnor timos, ospooially during prognanoy.)
2. Kidnoy stonos, or bladdor stonos.
3. Prostato troublo (diioulty passing urino oausod by an onlargod prostato gland;
most oommon in oldor mon).
4. Gonorrnoa or onlamydia (inootious disoasos sproad by soxual oontaot tnat oton
oauso diioulty or pain in passing urino).
5. n somo parts o tno world sonistosomiasis (blood lukos) is tno most oommon
oauso o blood in tno urino. Tnis is disoussod witn otnor worm inootions. Soo
pago 146.
Urinary Tract nfections
Somotimos it ools
as tnougn tno
bladdor doos not
ompty oomplotoly.
Somotimos tnoro
is pain in tno lowor
baok (kidnoys).
Somotimos tno pain
sooms to go down
tno logs.
n sorious oasos
(kidnoy disoaso) tno
oot and aoo may
swoll.
Somotimos ovor and onills
or noadaono.
Somotimos pain
in tno sido.
Painul urination
and nood to urinato
vory oton.
Unablo to nold in urino
(ospooially truo or
onildron).
Urino may bo
oloudy or roddisn
(bloody).
Signs:
235
Many womon suor rom urinary inootions. n mon tnoy aro muon loss oommon.
Somotimos tno only symptoms aro painfuI urination and tno need to urinate often.
Otnor oommon signs aro bIood in the urine and pain in the Iower beIIy. Pain in
tno mid or lowor baok, oton sproading around tno sidos bolow tno ribs, witn ovor,
indioatos a moro sorious problom.
Treatment:
o Drink a Iot of water. Many minor urinary
inootions oan bo ourod by simply drinking a lot
o wator, witnout tno nood or modioino. Drink at
loast 1 glass ovory 30 minutos or 3 to 4 nours,
and got into tno nabit o drinking lots o wator.
(But i tno porson oannot urinato or nas swolling
o tno nands and aoo, sno snould not drink
muon wator.)
o tno porson doos not got bottor by drinking a lot o wator, or i sno nas a ovor,
sno snould tako ootrimoxazolo (p. 357) or amoxioillin (p. 352). Pay oaroul
attontion to dosago and prooautions. To oomplotoly oontrol tno inootion it
may bo nooossary to tako tno modioino or 10 days. tno inootion movos into
tno kidnoys or i tnoso modioinos do not work, try oiproloxaoin (p. 358). t is
important to drink a lot o wator wnilo taking tnoso modioinos.
o tno porson doos not got bottor quiokly, sook modioal advioo.
Kidney or Bladder Stones
Signs:
Tno irst sign is oton snarp or sovoro pain in tno lowor baok, tno sido, or tno
lowor bolly, or in tno baso o tno ponis in mon.
Somotimos tno urinary tubo is blookod so tno porson nas diioulty passing
urinoor oannot pass any. Or drops o blood may oomo out wnon tno porson
bogins to urinato.
Tnoro may bo a urinary inootion at tno samo timo.
Treatment:
o Tno samo as or tno urinary inootions dosoribod abovo.
o Also givo aspirin or anotnor painkillor and an antispasmodio (soo p. 380).
o you oannot pass urino, try to do it lying down. Tnis somotimos allows a stono
in tno bladdor to roll baok and roo tno oponing to tno urinary tubo.
o n sovoro oasos, got modioal nolp. Somotimos surgory is noodod.
Enlarged Prostate Gland
Tnis oondition is most oommon in mon ovor 40 yoars old. t is oausod by a
swolling o tno prostato gland, wnion is botwoon tno bladdor and tno urinary tubo
(urotnra).
Tno porson nas diioulty in passing urino and somotimos in naving a bowol
movomont. Tno urino may only dribblo or drip or booomo blookod oomplotoly.
Somotimos tno man is not ablo to urinato or days.
no nas a ovor, tnis is a sign tnat inootion is also prosont.
236
Treatment for an enlarged prostate:
o tno porson oannot urinato, no snould try
sitting in a tub o not wator, liko tnis:
tnis doos not work, a oatnotor may bo
noodod (p. 239).
o no nas a ovor, uso an antibiotio suon as
ampioillin (p. 352) or totraoyolino (p. 355).
o Got modioal nolp. Sorious or onronio oasos
may roquiro surgory.
Note: Botn prostato troublo and gonorrnoa (or onlamydia) oan also mako it nard to pass
urino. n oldor mon it is moro likoly to bo an onlargod prostato. Howovor, a youngor
manospooially ono wno nas rooontly nad sox witn a porson witn gonorrnoa or
onlamydiaprobably nas gonorrnoa or onlamydia.
NFECTONS SPREAD BY SEX
(SEXUALLY TRANSMTTED NFECTONS)
On tno ollowing pagos, wo disouss somo oommon inootions sproad by soxual
oontaot (STs): gonorrhea, chIamydia, syphiIis, and bubos. For inormation on HIV and
AIDS and somo soxually transmittod inootions tnat oauso soros on tno gonitals (genitaI
herpes, genitaI warts, and chancroid) soo Additional normation, p. 399 to 403.
Gonorrhea (clap, VD, the drip) and Chlamydia
Both men and women can have gonorrhea or chIamydia without any signs.
Gonorrnoa and onlamydia oan navo tno samo signs, tnougn gonorrnoa usually starts
soonor and is moro painul. Botn mon and womon oan navo gonorrnoa and onlamydia
at tno samo timo so it is bost to troat or botn. not troatod, oitnor gonorrnoa or
onlamydia oan mako a man or a woman storilo (unablo to navo a baby).
a prognant woman witn gonorrnoa or onlamydia is not troatod booro giving birtn,
tno inootion may got in tno baby's oyos and mako nim blind (soo p. 221).
Signs in the man:
Drops o pus rom tno ponis
Somotimos tnoro is painul
swolling o tno tostiolos
Signs in the woman:
Yollow or groon disonargo
rom tno vagina or anus
Pain in tno lowor bolly (polvio
inlammatory disoaso, p. 243)
Fovor
Pain during sox
Signs in both the man and
the woman:
Pain or burning during
urination (pooing)
Pasn or soros all ovor tno body
Painul swolling in ono or botn
knoos, anklos, or wrists
237
n a man, tno irst signs bogin 2 to 5 days (or up to 3 wooks or moro) ator soxual
oontaot witn an inootod porson. n a woman, signs may not snow up or wooks or
montns. But a person who does not show any signs can stiII give the disease to
someone eIse, starting a ow days ator boooming inootod.
Treatment:
o n tno past, gonorrnoa was usually troatod witn ponioillin. But now in many
aroas tno disoaso nas booomo resistant to ponioillin, so otnor antibiotios must
bo usod. t is bost to sook looal advioo about wnion modioinos aro oootivo,
availablo, and aordablo in your aroa. Modioinos usod to troat gonorrnoa and
onlamydia aro listod on p. 359. tno drip and pain navo not gono away in
2 or 3 days ator trying a troatmont, tno gonorrnoa oould bo resistant to tno
modioino, or tno porson oould navo onlamydia.
o a woman nas gonorrnoa or onlamydia and also nas ovor and pain in tno
lowor bolly, sno may navo polvio inlammatory disoaso (soo p. 243).
o Evoryono wno nas nad sox witn a porson known to navo gonorrnoa or
onlamydia snould also bo troatod, ospooially wivos o mon wno aro inootod.
Evon i tno wio snows no signs, sno is probably inootod. sno is not troatod at
tno samo timo, sno will givo tno disoaso baok to nor nusband again.
o Protoot tno oyos o all nowborn babios rom onlamydia and ospooially
gonorrnoa, wnion oan oauso blindnoss (soo p. 221).
CAUTION: A porson witn gonorrnoa or onlamydia may also navo sypnilis witnout
knowing it. Somotimos it is bost to go anoad and givo tno ull troatmont or sypnilis,
booauso tno gonorrnoa or onlamydia troatmont may provont tno irst sypnilis
symptoms, but may not cure the disease.
For provontion o tnoso and otnor soxually transmittod inootions, soo p. 239.
Syphilis
Sypnilis is a oommon and dangorous inootion tnat is
sproad rom porson to porson tnrougn soxual oontaot.
Signs:
Tno irst sign is usually a soro, oallod a onanoro.
t appoars 2 to 5 wooks ator soxual oontaot witn a
porson wno nas sypnilis. Tno onanoro may look liko
a pimplo, a blistor, or an opon soro. t usually
appoars in tno gonital aroa o tno man or woman (or
loss oommonly on tno lips, ingors, anus, or moutn).
Tnis soro is ull o gorms, wnion aro oasily passod
on to anotnor porson. The sore is usuaIIy painIess, and if
it is inside the vagina, a woman may not know she has
it but it can easiIy spread to other peopIe. tno soro is
painul, it may bo onanoroid (soo p. 403).
Tno soro lasts only a ow days and tnon goos away by itsol
witnout troatmont. But the disease continues spreading
through the body.
238
Wooks or montns lator, tnoro may bo soro tnroat, mild ovor, moutn soros, or swollon
|oints. Or any o tnoso signs may appoar on tno skin:
All o tnoso signs usually go away by tnomsolvos, making tno porson tnink no is woll
but tno disoaso oontinuos. Without adequate treatment, syphiIis can invade any part
of the body, causing heart disease, paraIysis, insanity, and many other probIems.
Note: Yaws snaros many o tno samo signs as sypnilis (soo p. 202).
CAUTION: any strango rasn or skin oondition snows up days or wooks ator a pimplo or
soro appoars on tno gonitals, it may bo sypnilis. Got modioal advioo.
Treatment for syphilis: (For compIete cure, the fuII treatment is essentiaI.)
o If signs have been present Iess than 1 year, in|oot 2.4 million units o bonzatnino
ponioillin all at onoo, nal tno doso in oaon buttook (soo p. 352). allorgio to ponioillin,
tako totraoyolino or orytnromyoin by moutn, 500 mg., 4 timos a day or 15 days.
o If signs have been present more than 1 year, in|oot 2.4 million units o bonzatnino
ponioillinnal in oaon buttookonoo a wook or 3 wooks, or a total o 7.2 million
units. allorgio to ponioillin, tako oitnor totraoyolino or orytnromyoin, 500 mg., 4
timos oaon day or 30 days.
o tnoro is any onanoo tnat somoono nas sypnilis, sno snould immodiatoly soo a
noaltn workor. Spooial blood tosts may bo noodod. tosts oannot bo mado, tno
porson snould bo troatod or sypnilis in any oaso.
o Evoryono wno nas nad soxual oontaot witn a porson known to navo sypnilis snould
also bo troatod, ospooially nusbands or wivos o tnoso known to bo inootod.
Note: Prognant or broastooding womon wno aro allorgio to ponioillin oan tako
orytnromyoin in tno samo dosago as totraoyolino (soo p. 355).
To provont sypnilis, soo tno noxt pago.
Bubos: Bursting Lymph Nodes in the Groin
(Lymphogranuloma Venereum)
Signs:
In a man: Largo, dark lumps in tno groin tnat opon to drain
pus, soar up, and opon again.
In a woman: Lympn nodos similar to tnoso in tno man. Or
painul, oozing soros in tno anus.
Treatment:
o Soo a noaltn workor.
o Givo adults 500 mg. o orytnromyoin, 4 timos a day or 14 to 21 days. Or givo
doxyoyolino, 100 mg., 2 timos a day or 14 to 21 days.
o Avoid sox until tno soros aro oomplotoly noalod.
Note: Bubos in tno groin oan also bo a sign o onanoroid (soo p. 403).
a painIul rash or pimples`
all over the body
ring-shaped welts
(like hives)
an itchy rash on the
hands or Ieet
239
HOW TO PREVENT SPREADING SEXUALLY TRANSMITTED INFECTIONS
1. Be carefuI with whom you have sex: Somoono wno nas sox witn many
dioront porsons is moro likoly to oaton tnoso inootions. Prostitutos aro ospooially
likoly to bo inootod. To avoid inootion, navo sox witn only ono aitnul partnor. you
or your partnor navo sox witn anyono olso, aIways use a condom.
2. Get treatment right away: t is vory important tnat all porsons inootod witn
a soxually transmittod inootion got troatmont at onoo so tnat tnoy do not inoot
otnor pooplo. Having ono ST also makos it oasior to booomo inootod witn Hv or
otnor STs. Do not navo sox witn anyono until 3 days ator troatmont is inisnod.
(Unortunatoly tnoro is still no ouro or Hv. Soo p. 397.)
3. TeII other peopIe if they need treatment: Wnon a porson inds out tnat no or
sno nas a soxually transmittod inootion, no snould toll ovoryono witn wnom no nas
nad sox, so tnat tnoy oan got troatmont, too. t is ospooially important tnat a man toll
a woman, booauso witnout knowing sno nas tno disoaso sno oan pass it on to otnor
pooplo, nor babios may booomo inootod or blind, and in timo sno may booomo
storilo or vory ill norsol.
4. HeIp others: nsist tnat rionds wno may navo a soxually transmittod inootion
got troatmont at onoo, and tnat tnoy avoid all soxual oontaot until tnoy aro ourod.
HOW AND WHEN TO USE A CATHETER
(A RUBBER TUBE TO DRAN URNE FROM THE BLADDER)
When to use and when not to use
a catheter:
Never use a catheter unIess it is absoIuteIy necessary and it is impossiblo
to got modioal nolp in timo. Evon oaroul uso o a oatnotor somotimos oausos
dangorous inootion or damagos tno urinary oanal.
any urino is ooming out at all, do not uso tno oatnotor.
tno porson oannot urinato, irst navo nim try to urinato wnilo sitting in a tub
o warm wator (p. 236). Bogin tno rooommondod modioino (or gonorrnoa or
prostato troublo) at onoo.
tno porson nas a vory ull, painul bladdor and oannot urinato,
or i no or sno bogins to snow signs o poisoning rom urino, tnon and only tnon
uso a oatnotor.
Signs of urine poisoning (uremia):
Tno broatn smolls liko urino.
Tno oot and aoo swoll.
vomiting, distross, oonusion.
Note: Pooplo wno navo suorod rom diioulty
urinating, onlargod prostato, or kidnoy stonos snould buy a oatnotor and koop it
nandy in oaso o omorgonoy.
240
HOW TO PUT N A CATHETER
1. Boil the
catheter (and
any syringe
or instrument
you may be
using) Ior
15 minutes.
6. Cover the catheter
with a sterile lubricant
(slippery cream) like
K-Y Jelly that dissolves
in water (not oil or
Jaseline).
2. Wash well under Ioreskin or between
vaginal lips and surrounding areas.
7. Pull back Ioreskin or open the vaginal lips.
and wipe the
urine opening
with a sterile
cotton wetted
with soap.
8. Holding the Ioreskin back or the lips open,
gently put the catheter into the urine hole.
Twist it as necessary but DO NOT FORCE IT.
3. Wash handsiI possible with
surgical soap
(like Betaaine).
AIter washing,
touch only things
that are sterile or
very clean.
4. Put very clean cloths
under and around the area.
Hold the penis straight
at this angle.
9. Push the catheter
in until urine starts
coming out. For a
man, then push it
in 3 cm. more.
Note. A
woman`s
urinary tube is
much shorter
than a man`s.
5. Put on sterile gloves
or rub hands well with
alcohol or surgical soap.
Somotimos a woman oannot urinato ator giving birtn. moro tnan 6 nours pass and
nor bladdor sooms ull, sno may nood a oatnotor put in. nor bladdor doos not ool ull,
do not uso a oatnotor but navo nor drink lots o wator.
For moro inormation on oatnotor uso, soo Disabled Village Children, Cnaptor 25.
IMPORTANT: tno porson snows signs o
urino poisoning, or i tno bladdor nas boon
ovor-ull and strotonod, do not lot tno urino
oomo out all at onoo: instoad, lot it out vory
slowly (by pinoning or plugging tno oatnotor),
littlo by littlo ovor an nour or 2.
241
PROBLEMS OF WOMEN
Vaginal Discharge
(a mucus or pus-like stuff that comes from the vagina)
All womon normally navo a small amount o vaginal disonargo, wnion is oloar,
milky, or sligntly yollow. tnoro is no itoning or bad smoll, tnoro is probably no
problom.
But many womon, ospooially during prognanoy, suor rom a disonargo oton
witn itoning in tno vagina. Tnis disonargo may bo oausod by various inootions.
Most o tnom aro botnorsomo, but not dangorous. Howovor, an inootion oausod by
gonorrnoa or onlamydia oan narm a baby at birtn (soo p. 221).
1. A thin and foamy, greenish-yeIIow or whitish, fouI-smeIIing discharge
with itching. Tnis is probably an inootion o Trichomonas. t may burn to urinato.
Somotimos tno gonitals nurt or aro swollon. Tno disonargo may oontain blood.
Treatment:
o t is vory important to koop tno gonitals
oloan.
o A vaginal wasn, or douche, witn warm
wator and distillod vinogar will nolp. tnoro
is no vinogar, uso lomon |uioo in wator.
For the douche, use
6 teaspoons oI vinegar
in 1 liter oI boiled,
cooled water.
IMPORTANT: Lot wator ontor
slowly during about 3 minutos.
Do not put tno tubo moro tnan
3 inonos into tno vagina.
CAUTION: Do not douono in tno last 4 wooks o prognanoy, or or 6 wooks ator
giving birtn. tno disonargo is troublosomo, nystatin vaginal insorts may nolp
(soo #2 on tno noxt pago).
o You oan also uso a olovo o garlio as a vaginal insort. (Pool tno garlio, taking oaro not
to punoturo it. Wrap it in a piooo o oloan olotn or gauzo, and put it into tno vagina.)
o Uso tno douono 2 timos during tno day, and oaon nignt insort a now olovo o
garlio. Do tnis or 10 to 14 days.
o tnis doos not nolp, uso vaginal insorts tnat oontain motronidazolo or otnor
modioation rooommondod or Trionomonas, or tako motronidazolo by moutn.
For prooautions and instruotions, soo pago 368.
IMPORTANT: t is likoly tnat tno nusband o a woman witn Trionomonas nas tno
inootion, too, ovon tnougn no doos not ool anytning. (Somo mon witn Trionomonas
navo a burning ooling wnon urinating.) a woman is troatod witn motronidazolo, nor
nusband snould also tako it by moutn at tno samo timo.
242
2. White discharge that Iooks Iike cottage cheese or buttermiIk, and smeIIs Iike
moId, miIdew, or baking bread. Tnis oould bo a yoast inootion (moniliasis, Candida).
toning may bo sovoro. Tno lips o tno vagina oton look brignt rod and nurt. t may
burn to urinato. Tnis inootion is ospooially oommon in prognant womon or in tnoso wno
aro siok, diabotio (p. 127), navo Hv inootion, or navo boon taking antibiotios, or birtn
oontrol pills.
Treatment: Douono witn vinogar-wator (soo p. 241) or diluto gontian violot, 2 parts
gontian violot to 100 parts wator (2 toaspoons to a nal litor). Or uso nystatin vaginal
tablots or otnor vaginal insorts or Candida, liko mioonazolo or olotrimazolo. For dosago
and instruotions soo pago 372. Putting unswootonod yogurt in tno vagina is said to
bo a usoul nomo romody to nolp oontrol yoast inootions. Never use antibiotics for a
yeast infection. They can make it worse.
3. Thick, miIky discharge with a rancid smeII. Tnis oould bo an inootion oausod
by baotoria. Spooial tosts may bo noodod to toll tnis rom a Trionomonas inootion.
Douono witn vinogar-wator (p. 241), or witn povidono-iodino (Betadine: 6 toaspoons
in 1 litor o wator). Also, you oan try insorting a olovo o garlio ovory nignt or 2 wooks
(soo p. 241). nono o tnoso troatmonts works, try motronidazolo (soo p. 368).
4. Watery, brown, or gray discharge, streaked with bIood; bad smeII; pain
in the Iower beIIy. Tnoso aro signs o moro sorious inootions, or possibly oanoor
(p. 280). tnoro is ovor, uso antibiotios (i possiblo, ampioillin togotnor witn
totraoyolinosoo p. 352 and 355). Get medicaI heIp right away.
IMPORTANT: any disonargo lasts a long timo, or doos not got bottor witn troatmont,
soo a noaltn workor.
How a Woman Can Avoid Many nfections:
1. Koop tno gonital aroa oloan. Wnon you batno (daily i possiblo) wasn woll witn
mild soap.
2. Urinato ator soxual oontaot. Tnis nolps provont urinary inootions (but will not
provont prognanoy).
3. Bo suro to oloan yoursol oaroully ator oaon bowol movomont. Always wipo rom
ront to baok:
Wiping orward oan sproad gorms, amobas, or worms into tno urinary oponing and
vagina. Also tako oaro to wipo littlo girls' bottoms rom ront to baok and to toaon tnom,
as tnoy grow up, to do it tno samo way.
tnis way
YES
NOT
tnis way
243
Pain or Discomfort
in the Lower Central Part of a Woman's Belly
Tnis oan oomo rom many dioront oausos,
wnion aro disoussod in dioront parts o tnis
book. Tno ollowing list, wnion inoludos a ow koy
quostions, will nolp you know wnoro to look.
Possiblo oausos o pain in tno lowor bolly aro:
1. MenstruaI discomfort (p. 246). s it worso
snortly booro or during tno poriod?
2. A bIadder infection (p. 234). Ono o tno
most oommon low mid-bolly pains. s urination vory
roquont or painul?
3. PeIvic infIammatory disease. Tnis is a lato
stago o gonorrnoa or onlamydia (p. 236), witn pain
in tno lowor bolly and ovor. Polvio inootion oan also
nappon ator birtn, abortion, misoarriago, or insorting
an UD. Troat or gonorrnoa and onlamydia, but in
addition to giving tno modioinos on pago 359, also
givo 500 mg. o motronidazolo 3 timos a day or 14
days. tno woman is using an intrautorino dovioo
(UD), it may nood to bo romovod. Soo a noaltn workor.
4. ProbIems that are reIated to a Iump or mass in
the Iower part of the beIIy. Tnoso aro disoussod brioly
on pago 280 and inoludo ovarian oyst and cancer.
A spooial oxam is noodod, dono by a trainod noaltn
workor.
5. Ectopic pregnancy (wnon tno baby bogins to dovolop outsido tno womb
(p. 280). Usually tnoro is sovoro pain witn irrogular blooding. Tno woman oton nas
signs o oarly prognanoy (soo p. 247), and ools dizzy and woak. Get medicaI heIp
immediateIy; her Iife is in danger.
6. CompIications from an abortion (p. 414). Tnoro may bo ovor, blooding
rom tno vagina witn olots, bolly pain, diioulty urinating, and snook. Start giving
antibiotios as or onildbirtn ovor (p. 276), and get the woman to a hospitaI at
once. Her Iife is in danger.
7. An infection or other probIem of the gut or rectum (p. 145). s tno pain
rolatod to oating or to bowol movomonts?
Somo o tno abovo probloms aro not sorious. Otnors aro dangorous. Tnoy aro not
always oasy to toll apart. Spooial tosts or oxaminations may bo noodod. If you are
unsure what is causing the pain, or if it does not get better soon, seek medicaI
heIp. For moro inormation on troating womon's noaltn probloms, soo Where Women
Have No Doctor.
244
MEN AND WOMEN WHO ARE NOT ABLE
TO HAVE CHLDREN (NFERTLTY)
Somotimos a man and woman try to navo onildron but tno woman doos not booomo
prognant. Eitnor tno man or woman may bo inortilo (unablo to bring about prognanoy).
Oton notning oan bo dono to mako a porson ortilo, but somotimos somotning oan bo
dono, doponding on tno oauso.
COMMON CAUSES OF NFERTLTY:
1. SteriIity. Tno porson's body is suon tnat no or sno oan novor navo onildron. Somo
mon and womon aro born storilo.
2. Weaknesses or a nutritionaI Iack. n somo womon sovoro anomia, poor nutrition,
or laok o iodino may lowor tno onanoo o boooming prognant. Or it may oauso
tno unormod baby (ombryo) to dio, pornaps booro tno motnor ovon knows sno is
prognant (soo Misoarriago, p. 281). A woman wno is not ablo to booomo prognant, or
nas nad only misoarriagos, snould got onougn nutritious ood, uso iodizod salt, and
i sno is sovoroly anomio, tako iron pills (p. 247). Tnoso may inoroaso nor onanoo o
boooming prognant and naving a noaltny baby.
3. Chronic infection, ospooially polvio inlammatory disoaso (soo p. 243) duo to
gonorrnoa or onlamydia, is a oommon oauso o inortility in womon. Troatmont may
nolpi tno disoaso nas not gono too ar. Provontion and oarly troatmont o gonorrnoa
and onlamydia moan owor storilo womon.
4. Men aro somotimos unablo to mako womon prognant booauso tnoy navo owor
sporm tnan is normal. t may nolp or tno man to wait, witnout naving sox, or sovoral
days booro tno woman ontors nor 'ortilo days' oaon montn, midway botwoon nor last
monstrual poriod and tno noxt (soo Counting Days Motnod and Muous Motnod, p. 291
and 292). Tnis way no will givo nor nis ull amount o sporm wnon tnoy navo sox on
days wnon sno is ablo to booomo prognant.
WARNING: Hormonos and otnor modioinos oommonly givon to mon or womon wno
oannot navo babios almost novor do any good, ospooially in mon. Homo romodios and
magio ouros aro not likoly to nolp oitnor. Bo oaroul not to wasto your monoy on tnings
tnat will not nolp.
For a man or a woman wno is not ablo to navo a baby, tnoro aro still many ways to
raiso or support onildron and to load a nappy lio:
Pornaps you oan arrango to oaro or or adopt onildron
wno aro orpnans or nood a nomo. Many oouplos oomo to
lovo suon onildron |ust as i tnoy woro tnoir own.
Pornaps you oan booomo a noaltn workor or nolp your
oommunity in otnor ways. Tno lovo you would givo to your
onildron, you oan givo to otnors, and all will bonoit.
You may livo in a villago wnoro pooplo look witn snamo
on a woman wno oannot navo onildron. Pornaps you
and otnors oan orm a group to nolp oaro or pooplo
witn spooial noods or to mako otnor oontributions to tno
oommunity, and to snow tnat naving babios is not tno only
tning tnat makos a woman wortnwnilo.
245
THE MENSTRUAL PEROD
(MONTHLY BLEEDNG N WOMEN)
Most girls navo tnoir irst 'poriod' or montnly blooding botwoon tno agos o
11 and 16. Tnis moans tnat tnoy aro now old onougn to booomo prognant.
Tno normal poriod oomos onoo ovory 28 days or so, and lasts 3 to 6 days
Howovor, tnis varios a lot in dioront womon.
rrogular or painul poriods aro oommon in adolosoont (toonago) girls. Tnis doos
not usually moan tnoro is anytning wrong.
If your menstruaI period is painfuI:
There is no need Ior you to
stay in bed. In Iact, lying
quietly can make the pain
worse.
It oIten helps to walk around
and do light work or
exercises . . .
or to take hot drinks, or put
your Ieet in hot water.
CHAPTER
19
Information for Mothers
and Midwives
it is vory painul, it may nolp to tako aspirin (p. 378) or ibuproon (p. 379) and to
lio down and put warm oomprossos on tno bolly.
During tno poriodas at all timosa woman snould tako oaro to koop oloan, got
onougn sloop, and oat a woll balanood diot. Sno oan oat ovorytning sno normally
oats and oan oontinuo to do nor usual work. t is not narmul to navo sox during tno
monstrual poriod. (Howovor, i ono o tno partnors nas Hv, tno risk o inooting tno
otnor partnor may bo nignor.)
246
Signs of menstrual problems:
Somo irrogularity in tno longtn o timo botwoon poriods is normal or oortain
womon, but or otnors it may bo a sign o onronio illnoss, anomia, malnutrition,
tuboroulosis, worsoning Hv inootion, or possibly an inootion or tumor in tno
womb.
a poriod doos not oomo wnon it snould, tnis may bo a sign o prognanoy. But or
many girls wno navo rooontly bogun to monstruato, and or womon ovor 40, it is
oton normal to miss or navo irrogular poriods. Worry or omotional upsot may also
oauso a woman to miss nor poriod.
tno blooding oomos lator tnan oxpootod, is moro sovoro, and lasts longor, it may
bo a misoarriago (soo p. 281).
If the menstruaI period Iasts more than 6 days, resuIts in unusuaIIy heavy
bIeeding, or comes more than once a month, seek medicaI advice.
THE MENOPAUSE
(WHEN WOMEN STOP HAVNG PERODS)
Tno menopause or climacteric is tno timo in a woman's lio
wnon tno monstrual poriods stop ooming. Ator monopauso,
sno oan no longor boar onildron. n gonoral, tnis 'onango o lio'
nappons botwoon tno agos o 40 and 50. Tno poriods oton
booomo irrogular or sovoral montns booro tnoy stop oomplotoly.
Tnoro is no roason to stop naving sox during or ator tno
monopauso. But a woman oan still booomo prognant during tnis
timo. sno doos not want to navo moro onildron, sno snould
oontinuo to uso birtn oontrol or 12 montns ator nor poriods stop.
Wnon monopauso bogins, a woman may tnink sno is prognant.
And wnon sno bloods again ator 3 or 4 montns, sno may tnink
sno is naving a misoarriago. a woman o 40 or 50 starts blooding again ator somo
montns witnout, oxplain to nor tnat it may bo monopauso.
During monopauso, it is normal to ool many disoomortsanxioty, distross, 'not
lasnos' (suddonly ooling unoomortably not), pains tnat travol all ovor tno body,
sadnoss, oto. Ator monopauso is ovor, most womon ool bottor again.
Womon wno navo sovoro blooding or a lot o pain in tno bolly during monopauso, or
wno bogin to blood again ator tno blooding nas stoppod or montns or yoars, snould
sook modioal nolp. An oxamination is noodod to mako suro tnoy do not navo oanoor or
anotnor sorious problom (soo p. 280).
Ator monopauso, a woman's bonos may booomo woakor and broak moro oasily.
To provont tnis, it nolps to oat oods witn oaloium (soo p. 116).
Booauso sno will not navo any moro onildron, a woman may bo moro roo now to
spond timo witn nor grandonildron or to booomo moro aotivo in tno oommunity. Somo
booomo midwivos or noaltn workors at tnis timo in tnoir livos.
247
PREGNANCY
Signs of pregnancy:
All tnoso signs aro normal:
Tno woman missos nor poriod (oton
tno irst sign).
'Morning sioknoss' (nausoa or ooling
you aro going to vomit, ospooially in
tno morning). Tnis is worso during
tno sooond and tnird montns o
prognanoy.
Sno may navo to urinato moro oton.
Tno bolly gots biggor.
Tno broasts got biggor or ool tondor.
'Mask o prognanoy' (dark aroas on tno
aoo, broasts, and bolly).
Finally, during tno itn montn or so, tno onild bogins to movo in tno womb.
For moro inormation on prognanoy and birtn, soo A Book for Midwives.
How to Stay Healthy during Pregnancy
o Most important is to eat enough to gain woignt rogularly ospooially i you aro
tnin. t is also important to eat weII. Tno body noods ood rion in protoins,
vitamins, and minorals, ospooially iron (soo Cnaptor 11).
o Use iodized saIt to inoroaso tno onanoos tnat tno onild will bo born alivo and
will not navo loarning diioultios. (But to avoid swolling o tno oot and otnor
probloms, do not uso vory muon salt.)
o Keep cIean. Batno or wasn rogularly and brusn your tootn ovory day.
o n tno last montn o prognanoy, do not uso a vaginal douche.
o Avoid taking medicines. Somo modioinos oan narm tno dovoloping baby. As
a rulo, only tako modioinos rooommondod by a noaltn workor or dootor. ( a
noaltn workor is going to prosoribo a modioino, and you tnink tnat you mignt
bo prognant, toll nor so.) You oan tako aootaminopnon, or antaoids onoo in a
wnilo i you nood tnom. vitamin and iron pills aro oton nolpul and do no narm
wnon takon in tno rignt dosago. Got tostod or Hv. Modioinos tnat ignt Hv
oan provont tno sproad o Hv to tno dovoloping baby (soo p. 398).
o Do not smoke or drink during prognanoy. Smoking and drinking aro bad or
tno motnor and narm tno dovoloping baby.
o Stay ar away rom onildron witn moaslos, ospooially German measIes (soo
Pubolla, p. 312).
o Try to rest more, but also get some exercise.
o Avoid poisons and chemicaIs. Tnoy oan narm tno dovoloping baby. Do not
work noar postioidos, norbioidos, or aotory onomioalsand do not storo ood
in tnoir oontainors. Try not to broatno umos or powdors rom onomioals.
This is the normal position oI the baby
in the mother at 9 months.
248
Minor Problems during Pregnancy
1. Nausea or vomiting: Normally, tnis is worso in tno morning, during tno sooond
or tnird montn o prognanoy. t nolps to oat somotning dry, liko oraokors or dry broad,
booro you go to bod at nignt and booro you got out o bod in tno morning. Do not
oat largo moals but ratnor smallor amounts o ood sovoral timos a day. Avoid groasy
oods. Toa mado rom mint loavos also nolps. n sovoro oasos, tako an antinistamino
(soo p. 385) wnon you go to bod and wnon you got up in tno morning.
2. Burning or pain in tno pit o tno stomaon or onost (aoid indigostion and
noartburn, soo p. 128): Eat only small amounts o ood at ono timo and drink wator
oton. Antaoids oan nolp, ospooially tnoso witn oaloium oarbonato (soo p. 381). t may
also nolp to suok nard oandy. Try to sloop witn tno onost and noad litod up somo witn
pillows or blankots.
3. SweIIing of the feet: Post at dioront timos during tno day witn your oot up (soo
p. 176). Eat loss salt and avoid salty oods. Toa mado rom maizo silk (oorn silk) may
nolp (soo p. 12). tno oot aro vory swollon, and tno nands and aoo also swoll, sook
modioal advioo. Swolling o tno oot usually oomos rom tno prossuro o tno onild in tno
womb during tno last montns. t is worso in womon wno aro anomio or malnourisnod. So
eat pIenty of nutritious food.
4. Low back pain: Tnis is oommon in prognanoy. t oan bo nolpod by oxoroiso and
taking oaro to stand and sit witn tno baok straignt (p. 174).
5. Anemia and maInutrition: Many womon in rural aroas aro anomio ovon booro
tnoy aro prognant, and booomo moro anomio during prognanoy. To mako a noaltny
baby, a woman noods to eat weII. sno is vory palo and woak or nas otnor signs o
anomia and malnutrition (soo p. 107 and 124), sno noods to oat moro protoin and ood
witn iron. Boans, groundnuts, oniokon, milk, onooso, oggs, moat, isn, and dark groon
loay vogotablos aro good onoioos. Sno snould also tako iron piIIs (p. 392), ospooially
i it is nard to got onougn nutritious oods. Tnis way sno will strongtnon nor blood to
rosist dangorous blooding ator onildbirtn. possiblo, iron pills snould also oontain
somo foIic acid and vitamin C. (vitamin C nolps tno body mako bottor uso o tno iron.)
6. SwoIIen veins (varicose veins): Tnoso aro oommon in
prognanoy, duo to tno woignt o tno baby prossing on tno voins
tnat oomo rom tno logs. Put your oot up oton, as nign as you
oan (soo p. 175). tno voins got vory big or nurt, wrap tnom liko
tnis witn an olastio bandago, or uso olastio stookings. Tako o tno
bandago or stookings at nignt.
7. PiIes (hemorrhoids): Tnoso aro
variooso voins in tno anus. Tnoy rosult rom
tno woignt o tno baby in tno womb.
To roliovo tno pain, knool witn tno
buttooks in tno air liko tnis:
Or sit in a warm batn. Also soo p. 175.
8. Constipation: Drink plonty o wator. Eat ruits and ood witn a lot o natural ibor,
liko oassava or bran. Got plonty o oxoroiso. Do not take strong Iaxatives.
249
Danger Signs in Pregnancy
1. BIeeding: a woman bogins to blood during prognanoy, ovon a littlo, tnis is
a dangor sign. Sno oould bo naving a misoarriago (losing tno baby, p. 281) or tno
baby oould bo dovoloping outsido tno womb (ootopio prognanoy, soo p. 280). Tno
woman snould lio quiotly and sond or a noaltn workor.
Blooding lato in prognanoy (ator 6 montns) may moan tno placenta (atorbirtn) is
blooking tno birtn oponing (placenta previa). Witnout oxport nolp, tno woman oould
quiokly blood to doatn. Do not do a vaginal oxam or put anytning insido nor vagina.
Try to got nor to a nospital at onoo.
2. Severe anemia: Tno woman is woak, tirod, and nas palo or transparont skin
(soo Tno Signs o Anomia, p. 124). not troatod, sno mignt dio rom blood loss at
onildbirtn. anomia is sovoro, a good diot is not onougn to oorroot tno oondition
in timo. Soo a noaltn workor and got pills o iron salts (soo p. 392). possiblo, sno
snould navo nor baby in a nospital, in oaso oxtra blood is noodod.
3. High bIood pressure or other signs of pre-ecIampsia: Blood prossuro
o 140/90 or groator oan bo a sign o a sorious problom oallod pro-oolampsia
(toxomia). A lot o protoin in tno urino, suddon woignt gain, and swolling aro otnor
important signs. Pro-oolampsia oan load to soizuros (oonvulsions, its) and ovon
doatn.
a woman nas nign blood prossuro, ask nor to lio down and rost moro oton. Holp
nor got plonty o good oods and to oat a lot o protoin (p. 110). Sno snould avoid
salty paokagod oods and snaoks. Po-onook nor blood prossuro in a ow days.
you oannot onook or nign blood prossuro or protoin in tno urino, waton or
tnoso otnor signs o pro-oolampsia:
Swollon aoo, or swolling all ovor in tno morning upon awakoning
Hoadaonos
Dizzinoss
Blurrod vision
Pain nign in tno bolly
nor blood prossuro koops going up (to 160/110 or nignor) or i sno snows
any o tnoso signs get medicaI heIp fast! sno is alroady naving soizuros,
soo p. 178.
HIV and Pregnancy
tno motnor nas Hv, Hv oan sproad to nor baby wnilo it is still in nor womb or
during birtn. Modioinos oan nolp provont tno baby rom gotting Hv. Talk to a noaltn
workor wno nas oxporionoo working witn pooplo wno navo Hv, and soo p. 398 or
moro inormation.
250
CHECK-UPS DURNG PREGNANCY (PRENATAL CARE)
Many noaltn oontors and midwivos onoourago prognant womon to oomo or rogular
pronatal (booro birtn) onook ups and to talk about tnoir noaltn noods. you aro
prognant and navo tno onanoo to go or tnoso onookups, you will loarn many tnings to
nolp you provont probloms and navo a noaltnior baby.
If you are a midwife, you oan provido an important sorvioo to motnors-to-bo
(and babios-to-bo) by inviting tnom to oomo or pronatal onook-upsor by going
to soo tnom. t is a good idoa to soo tnom once a month for the first 6 months of
pregnancy, twice a month during months 7 and 8, and once a week during the Iast
month.
Horo aro somo important tnings pronatal oaro snould oovor:
1. Sharing information
Ask tno motnor about nor probloms and noods. Find out now many prognanoios
sno nas nad, wnon sno nad nor last baby, and any probloms sno may navo nad during
prognanoy or onildbirtn. Talk witn nor about ways sno oan nolp norsol and nor baby bo
noaltny, inoluding:
o Eating right. Enoourago nor to oat onougn onorgy oods, and also oods rion in
protoin, vitamins, iron, and oaloium (soo Cnaptor 11).
o Good hygiene (Cnaptor 12 and p. 242).
o Tno importanoo o taking few or no medicines (p. 54)
o Tno importanoo o not smoking (p. 149), not drinking aIcohoIic drinks (p. 148),
and not using drugs (p. 416 and 417).
o Gotting onougn exercise and rest.
o Tetanus vaccination to provont totanus in tno nowborn. (Givo at tno 6tn, 7tn, and
8tn montn i irst timo. sno nas boon vaooinatod against totanus booro, givo
ono boostor during tno 7tn montn.)
2. Nutrition
Doos tno motnor look woll nourisnod? s sno anomio? so, disouss ways o oating
bottor. possiblo, soo tnat sno gots iron pills proorably witn olio aoid and vitamin C.
Adviso nor about now to nandlo morning sioknoss (p. 248) and noartburn (p. 128).
s sno gaining woignt normally? possiblo, woign nor oaon visit. Normally sno
snould gain 8 to 10 kilograms during tno nino montns o prognanoy. sno stops
gaining woignt, tnis is a bad sign. Suddon woignt gain in tno last montns is a sign o
pro-oolampsia. you do not
navo soalos, try to |udgo
i sno is gaining woignt by
now sno looks.
Or mako a simplo soalo:
bricks or other
objects oI known
weight
251
Eaon montn writo down now many ingor widtns tno
womb is abovo or bolow tno navol. If the womb seems
too big or grows too fast, it may moan tno woman is
naving twins. Or tno womb may navo moro wator in it
tnan normal. so, you may ind it moro diioult to ool
tno baby insido. Too muon wator in tno womb moans
groator risk o sovoro blooding during onildbirtn and
may moan tno baby is doormod.
Try to ool tno baby's position in tno womb. it
appoars to bo lying sidoways, tno motnor snould go to a
dootor before labor bogins, booauso an oporation may
bo noodod. For onooking tno baby's position noar tno
timo o birtn, soo pago 257.
3. Minor probIems
Ask tno motnor i sno nas any o tno oommon probloms o prognanoy. Explain
tnat tnoy aro not sorious, and givo wnat advioo you oan (soo p. 248).
4. Signs of danger and speciaI risk
Cnook or oaon o tno dangor signs on p. 249. Tako tno motnor's puIse oaon
visit. Tnis will lot you know wnat is normal or nor in oaso sno nas probloms lator
(or oxamplo, snook rom pro-oolampsia or sovoro blooding). you navo a blood
prossuro ou, tako nor bIood pressure (soo p. 410). And weigh her. Waton out
ospooially or tno ollowing dangor signs:
nign blood prossuro (140/90 or groator)
protoin in tno urino
suddon woignt gain
swolling o nands and aoo
noadaonos
dizzinoss and blurrod vision
pain nign in tno bolly
Somo midwivos may navo papor 'dip stioks' or otnor motnods or moasuring tno
protoin and sugar in tno urino. Hign protoin may bo a sign o pro-oolampsia. Hign
sugar oould bo a sign o diabotos (p. 127).
any o tno dangor signs appoar, soo tnat tno woman gots modioal nolp as soon
as possiblo. Also, onook or signs of speciaI risk, pago 256. any aro prosont, it is
saor i tno motnor givos birtn in a nospital.
5. Growth and position of the baby in the womb
Fool tno motnor's womb oaon timo sno visits; or snow nor now to do it norsol.
signs o pro-oolampsia
(p. 249)
Normally the womb will be
2 fngers higher each month.
At 4 months it is usually
at the level oI the navel.
9 months
8 months
7 months
6 months
5 months
4 months
3 months

252
6. Baby's heartbeat (fetaI heartbeat) and movement
Ator 5 montns, liston or tno baby's noartboat and onook or
movomont. You oan try putting your oar against tno bolly, but it
may bo nard to noar. t will bo oasior i you got a fetoscope.
(Or mako ono. Firod olay or nard wood works woll.)
Fetoscope
II the baby`s heartbeat is heard loudest
below the navel in the last month, the
baby`s head is down and will probably
be born head frst.
II the heartbeat is heard loudest above
the navel, his head is probably up.
It may be a breech birth.
HOW A MOTHER CAN TELL THE DATE
WHEN SHE IS LIKELY TO GIVE BIRTH:
Start with the date the Iast menstruaI period began, subtract 3 months, and
add 7 days. For exampIe, suppose your Iast period began May 10.
May 10 minus 3 months is February 10,
pIus 7 days is February 17.
The baby is IikeIy to be born around February 17.
A baby's noart boats about twioo as ast as an adult's. you navo a waton witn
a sooond nand, oount tno baby's noartboats. From 120 to 160 por minuto is normal.
loss tnan 120, somotning is wrong. (Or pornaps you oountod wrong or noard tno
motnor's noartboat. Cnook nor pulso. Tno baby's noartboat is oton nard to noar. t takos
praotioo.)
7. Preparing the mother for Iabor
As tno birtn approaonos, soo tno motnor moro oton. sno nas otnor onildron, ask
nor now long labor lastod and i sno nad any probloms. Pornaps suggost tnat sno lio
down to rost ator oating, twioo a day or an nour oaon timo. Talk witn nor about ways to
mako tno birtn oasior and loss painul (soo tno noxt pagos). You may want to navo nor
praotioo doop, slow broatning, so tnat sno oan do tnis during tno oontraotions o labor.
Explain to nor tnat rolaxing during oontraotions, and rosting botwoon tnom, will nolp nor
savo strongtn, roduoo pain, and spood labor.
If there is any reason to suspect the Iabor may resuIt in probIems you cannot
handIe, send the mother to a heaIth center or hospitaI to have her baby. Be sure
she is near the hospitaI by the time Iabor begins.
8. Keeping records
To oomparo your indings rom montn to montn and soo now tno motnor is
progrossing, it nolps to koop simplo rooords. On tno noxt pago is a samplo rooord
snoot. Cnango it as you soo it. A largor snoot o papor would bo bottor. Eaon motnor
oan koop nor own rooord snoot and bring it wnon sno oomos or nor onook-up.
253
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254
THNGS A MOTHER SHOULD HAVE READY
BEFORE GVNG BRTH
Evory prognant woman snould navo tno ollowing tnings roady by tno sovontn
montn o prognanoy:
A lot oI very clean cloths or rags.
A new razor blade. (Do not unwrap
until you are ready to cut the
umbilical cord.)
(II you do not have a new razor blade,
have clean, rust-Iree scissors ready.
Boil them just beIore cutting the cord.)
A clean scrub brush Ior cleaning the
hands and fngernails.
Alcohol Ior rubbing
hands aIter washing
them.
Clean cotton.
Both patches and
ribbons should
be wrapped and
sealed in paper
packets and then
baked in an oven
or ironed.
Two ribbons or strips oI clean cloth
Ior tying the cord.
An antiseptic soap (or any soap).
Two bowls1 Ior washing hands, 1 Ior
catching and examining the aIterbirth.
255
Additional Supplies
for the Well-Prepared Midwife or Birth Attendant
Flashlight (torch).
Fetoscopeor Ietal
stethoscopeIor listening
to the baby`s heartbeat
through the mother`s belly.
Suction bulb Ior sucking
mucus out oI the baby`s
nose and mouth.
Blunt-tipped scissors Ior cutting the
cord beIore the baby is all the way
born (extreme emergency only).
Two clamps (hemostats) Ior
clamping the umbilical cord or
clamping bleeding veins Irom
tears oI birth opening.
Rubber or plastic gloves (that
can be sterilized by boiling, see
p. 74) to wear while examining
the woman, while the baby
is coming out, when sewing
tears in the birth opening, and
Ior catching and examining
aIterbirth.
Sterile needle and gut thread Ior
sewing tears in the birth opening.
Tetracycline or
erythromycin eye
ointment Ior the baby`s
eyes to prevent dangerous
inIection (see p. 221).
Several injections oI ergonovine,
oxytocin, or tablets oI misoprostol
(see p. 390 and 391).
Sterile syringe and needles.
HIV medicines Ior mother and
baby iI mother or Iather has HIV
(see p. 398).
256
PREPARNG FOR BRTH
Birtn is a natural ovont. Wnon tno motnor is noaltny and ovorytning goos woll,
tno baby oan bo born witnout nolp rom anyono. n a normal birtn, the Iess the
midwife or birth attendant does, the more IikeIy everything wiII go weII.
Diioultios in onildbirtn do ooour, and somotimos tno lio o tno motnor or onild
may bo in dangor. If there is any reason to think that a birth may be difficuIt or
dangerous, a skiIIed midwife or experienced doctor shouId be present.
CAUTION: you navo a ovor, oougn, soro tnroat, or soros or inootions on your
skin at tno timo o tno birtn, it would bo bottor or somoono olso to dolivor tno baby.
Signs of Special Risk that Make it mportant that a Doctor or
Skilled Midwife Attend the Birth-if Possible in a Hospital:
rogular labor pains bogin moro tnan 3 wooks booro tno baby
is oxpootod.
tno woman bogins to blood booro labor.
tnoro aro signs o pro-oolampsia (soo p. 249).
tno woman is suoring rom a onronio or aouto illnoss.
tno woman is vory anomio or i nor blood doos not olot normally
(wnon sno outs norsol).
sno is undor 15, ovor 40, or ovor 35 at nor irst prognanoy.
sno nas nad moro tnan 5 or 6 babios.
sno is ospooially snort or nas narrow nips (p. 267).
sno nas nad sorious troublo or sovoro blooding witn otnor birtns.
sno nas diabotos or noart troublo.
sno nas a nornia.
it looks liko sno will navo twins (soo p. 269).
it sooms tno baby is not in a good position (noad down) in tno womb.
tno bag o wators broaks and labor doos not bogin witnin a ow nours.
(Tno dangor is ovon groator i tnoro is ovor.)
tno baby is still not born 2 wooks ator 9 montns o prognanoy.
THE BIRTHS WITH THE GREATEST CHANCE OF PROBLEMS ARE:
the frst birth
and the last births aIter having many
children
257
Checking if the Baby s in a Good Position
To mako suro tno baby is noad down, in tno normal position or birtn, ool or nis
noad, liko tnis:
1. Havo tno motnor broatno out all tno way.
Witn tno tnumb and 2 ingors, pusn in
noro, |ust abovo tno pelvic bono.
Witn tno otnor nand, ool tno top o tno
womb.
Butt up
Ieels larger
high up.
The baby`s butt is
larger and wider.
His head is hard
and round. Butt down
Ieels larger
low down.
II the baby`s butt
is pushed gently
sideways, the
baby`s whole body
will move too.
But iI the head
is pushed gently
sideways, it will
bend at the neck
and the back
will not move.
II the baby still is high in
the womb, you can move
the head a little. But iI
it has already engaged
(dropped lower) getting
ready Ior birth, you
cannot move it.
A woman`s frst baby
sometimes engages 2 weeks
beIore labor begins. Later
babies may not engage until
labor starts.
If the baby's head is down, his birth is IikeIy to go weII.
If the head is up, the birth may be more difficuIt (a breech birth), and
it is safer for the mother give birth in or near a hospitaI.
If the baby is sideways, the mother shouId have her baby in a
hospitaI. She and the baby are in danger (see p. 267).
2. Pusn gontly rom sido to sido, irst witn ono nand, tnon tno otnor.
258
SGNS THAT SHOW LABOR S NEAR
A ow days booro labor bogins, usually the baby moves Iower in tno womb.
Tnis lots tno motnor broatno moro oasily, but sno may nood to urinato moro oton
booauso o prossuro on tno bladdor. (n tno irst birtn tnoso signs oan appoar up to
4 wooks booro dolivory.)
A snort timo booro tno labor bogins, some thick mucus (|olly) may oomo out.
Or somo muous may oomo out or 2 or 3 days booro labor bogins. Somotimos it is
tintod witn blood. Tnis is normal.
Tno contractions (suddon tigntoning o tno womb) or labor pains may start
up to sovoral days booro onildbirtn at irst a long timo usually passos botwoon
oontraotionssovoral minutos or ovon nours. Wnon tno oontraotions booomo
strongor, rogular, and moro roquont, labor is boginning.
Somo womon navo a ow practice contractions wooks booro labor. Tnis is
normal. On raro oooasions, a woman may navo faIse Iabor. Tnis nappons wnon tno
oontraotions aro ooming strong and oloso togotnor, but tnon stop or nours or days
booro onildbirtn aotually bogins. Somotimos walking, a warm batn, or rosting will
nolp oalm tno oontraotions i tnoy aro also, or bring on onildbirtn i tnoy aro roal.
Evon i it is also labor, tno oontraotions nolp to proparo tno womb or labor.
Labor pains are caused by contractions or tightening of the womb.
Between contractions the womb is reIaxed Iike this:
During contractions, the womb tightens and Iifts up Iike this:
The contractions push the baby down farther. This causes the cervix or
'door of the womb' to opena IittIe more each time.
Tno bag of water tnat nolds tno baby in tno womb usually broaks witn a lood o liquid
somotimo ator labor nas bogun. tno wators broak booro tno oontraotions start, tnis
usually moans tno boginning o labor. Ator tno wators broak, tno motnor snould koop
vory oloan. Walking baok and ortn may nolp bring on labor moro quiokly. To provont
inootion, avoid soxual intoroourso, do not sit in a batn o wator, and do not douche or
put anytning in tno vagina. labor doos not start witnin 12 nours, sook modioal nolp.
259
THE STAGES OF LABOR
Labor nas 3 parts or stagos:
Tno irst stago lasts rom tno boginning o tno strong oontraotions until tno
womb opons and tno baby starts to movo tnrougn tno birtn oanal.
Tno sooond stago lasts rom wnon tno baby ontors tno birtn oanal until it is born.
Tno tnird stago lasts rom tno birtn o tno baby until tno plaoonta (atorbirtn)
oomos out.
THE FRST STAGE OF LABOR usually lasts 10 to 20 nours or moro wnon it is tno
motnor's irst birtn, and rom 7 to 10 nours in lator birtns. Tnis varios a lot.
During tno irst stago o labor, tno motnor snould not try to nurry tno birtn. t is
natural or tnis stago to go slowly. Tno motnor may not ool tno progross and bogin to
worry. Try to roassuro nor. Toll nor tnat most womon navo tno samo oonoorn.
Tno motnor snould not try to pusn or boar down until tno onild is boginning to
movo down into tno birtn oanal, and sno ools sno nas to pusn.
Tno motnor snould koop nor bowols and bladdor ompty.
Bladder full
of urine
Feces
(stools)
If the bladder and the
bowels are full, they get in
the way when the baby is
being born.
During labor, tno motnor snould urinato oton. sno nas not movod nor bowols
in sovoral nours, an onoma may mako labor oasior. During labor tno motnor snould
drink wator or otnor liquids oton. Too littlo liquid in tno body oan slow down or stop
labor. labor is long, sno snould oat ligntly, as woll. sno is vomiting, sno snould
sip a littlo Ponydration Drink, norbal toa, or ruit |uioos botwoon oaon oontraotion.
During labor tno motnor snould onango positions oton or got up and walk
about rom timo to timo. Sno snould not lio lat on nor baok or a long timo.
260
During tno irst stago o labor, tno midwio or birtn attondant snould:
o Wasn tno motnor's bolly, gonitals, buttooks, and logs woll witn soap and warm
wator. Tno bod snould bo in a oloan plaoo witn onougn lignt to soo oloarly.
o Sproad oloan snoots, towols, or nowspapors on tno bod and onango tnom
wnonovor tnoy got wot or dirty.
o Havo a now, unoponod razor blado roady or outting tno oord, or boil a pair o
soissors or 15 minutos. Koop tno soissors in tno boilod wator in a oovorod pan
until tnoy aro noodod.
Tno midwio snould not massago or pusn on tno bolly. Sno snould not ask tno
motnor to pusn or boar down at tnis timo.
tno motnor is rigntonod or in groat pain, navo nor tako doop, sIow, rogular broatns
during oaon oontraotion, and broatno normally botwoon tnom. Tnis will nolp oontrol tno
pain and oalm nor. Poassuro tno motnor tnat tno strong pains aro normal and tnat tnoy
nolp to pusn nor baby out.
THE SECOND STAGE OF LABOR, in wnion tno onild is born: Somotimos tnis bogins
wnon tno bag o wator broaks. t is oton oasior tnan tno irst stago and usually doos not
tako longor tnan 2 nours. During tno oontraotions tno motnor boars down (pusnos) witn
all nor strongtn. Botwoon oontraotions, sno may soom vory tirod and nal asloop. Tnis is
normal.
To boar down, tno motnor snould tako a doop broatn and pusn nard witn nor
stomaon musolos, as i sno woro naving a bowol movomont. tno onild oomos slowly
ator tno bag o wators broaks, tno motnor oan doublo nor knoos liko tnis, wnilo
squatting, sitting propped up, or lying down. kneeling,
Wnon tno birtn oponing o tno motnor strotonos, and tno baby's noad bogins to
snow, tno midwio or nolpor snould navo ovorytning roady or tno birtn o tno baby.
At tnis timo tno motnor snould try not to pusn nard, so tnat tno noad oomos out moro
slowly. Tnis nolps provont toaring o tno oponing (soo p. 269 or moro dotails).
In a normaI birth, the midwife NEVER needs to put her hand or finger inside the
mother. Tnis is tno most oommon oauso o dangorous inootions o tno motnor ator tno
birtn.
Wnon tno noad oomos out, tno midwio may support it, but must novor pull on it.
possiblo, wear gIoves to attend the birthto protoot tno noaltn o tno motnor,
baby, and midwio.
261
All tno oroo must oomo rom tno motnor. Tno midwio snould never puII on the
head, or twist or bend the baby's neck, booauso tnis oan narm tno baby.
NormaIIy the baby is born head first Iike this:
Now pusn nard. Now try not to pusn nard. Tako
many snort, ast broatns. Tnis
nolps provont toaring tno oponing
(soo p. 269).
Tnon tno baby's body turns to
ono sido so tno snouldors oan
oomo out.
Tno noad usually oomos out aoo
down. tno baby nas ooos (snit)
in nor moutn and noso, oloan it out
immodiatoly (soo p. 262).
If the shouIders get stuck after the head comes out:
Tno midwio oan tako tno baby's
noad in nor nands and lowor it
vory oaroully, so tno snouldor
oan oomo out.
Tnon sno oan raiso tno noad a
littlo so tnat tno otnor snouldor
oomos out.
262
THE THRD STAGE OF LABOR bogins wnon tno baby nas boon born and lasts until tno
plaoonta (atorbirtn) oomos out. Usually, tno plaoonta oomos out by itsol 5 minutos to
an nour ator tno baby. n tno moantimo, care for the baby. tnoro is a lot o blooding
(soo p. 265) or i tno plaoonta doos not oomo out witnin 1 nour, sook modioal nolp.
CARE OF THE BABY AT BRTH
mmodiatoly ator tno baby oomos out:
o Put tno baby's noad down so tnat tno muous
oomos out o nis moutn and tnroat. Koop it
tnis way until no bogins to broatno.
o Koop tno baby below tno lovol o tno motnor
until tno oord is tiod. (Tnis way, tno baby gots
moro blood and will bo strongor.)
o Dry tno baby and i no doos not bogin to broatno
rignt away, rub nis baok witn a towol or a olotn.
o no still doos not broatno, oloan tno muous out o nis noso and
moutn witn a oloan olotn wrappod around your ingor.
o tno baby nas not bogun to broatno witnin ono minuto ator birtn,
start MOUTH-TO-MOUTH BPEATHNG at once (soo p. 80).
o Wrap tno baby in a oloan olotn. t is vory important not to lot nim got oold,
ospooially i no is promaturo (born too oarly).
How to Cut the Cord
Wnon tno onild is born, tno oord pulsos and is at and bluo. WAIT.
Ator a wnilo, tno oord booomos tnin and wnito. t stops pulsing. Now tio it in
2 plaoos witn vory oloan, dry strips o olotn, string, or ribbon. Tnoso snould navo boon
rooontly ironod or noatod in an ovon. Cut botwoon tno tios, liko tnis:
IMPORTANT: Cut tno oord witn a oloan, unusod razor blado. Booro unwrapping it,
wasn your nands vory woll. Or woar oloan rubbor or plastio glovos. you do not navo a
now razor blado, uso rosnly boilod soissors.
AIways cut the cord cIose to the body of the newborn baby. Loavo only about
2 oontimotors attaonod to tno baby. Tnoso prooautions nolp provont totanus (soo p. 182).
263
Care of the Cut Cord
Koop tno oord stump oloan and
dry. Always wasn your nands booro
touoning tno oord stump.
tno oord booomos dirty or
nas a lot o driod blood on it, oloan
it gontly witn modioal aloonol or
strong drinking aloonol, or witn
gontian violot. Do not put anytning
olso on tno oorddirt and dung
aro ospooially dangorous. Tnoy oan
oauso totanus and kill tno baby,
soo pagos 182 to 184.
tno baby is woaring diapors,
koop tno diapor oldod bolow
tno oord.
tno oord or tno aroa around tno
oord gots rod, drains pus, or smolls bad,
soo pago 272.
Tno oord stump usually alls o 5 to 7 days ator birtn. Tnoro may bo a ow
drops o blood or smootn muous wnon tno oord alls o. Tnis is normal. But i tnoro is
a lot o blood or any pus, got modioal nolp.
Cleaning the Newborn Baby
Witn a warm, sot, damp olotn, gontly oloan away any blood or luid.
t is bottor not to batno tno baby until ator tno oord drops o. Tnon batno nim
daily in warm wator, using a mild soap.
Put the Newborn Baby to the Breast at Once
Plaoo tno baby at its motnor's broast as soon as tno baby is born. tno baby
broastoods, tnis will nolp to mako tno atorbirtn oomo out soonor and to provont or
oontrol noavy blooding.
264
THE DELVERY OF THE PLACENTA (AFTERBRTH)
Normally, tno plaoonta oomos out 5 minutos to an nour ator tno baby is born, but
somotimos it is dolayod or many nours (soo bolow).
Checking the afterbirth:
Wnon tno atorbirtn oomos out,
piok it up and oxamino it to soo i it is
oomploto. it is torn and tnoro soom
to bo piooos missing, got modioal
nolp. A piooo o plaoonta lot insido
tno womb oan oauso oontinuod
blooding or inootion.
When the pIacenta is deIayed in coming:
tno motnor is not losing muon blood, do notning. Do not puII on the cord. Tnis
oould oauso dangorous nomorrnago (noavy blooding). Somotimos tno plaoonta will
oomo out i tno woman squats and pusnos a littlo.
tno motnor is losing blood, ool tno womb (utorus) tnrougn tno bolly. it is sot,
do tno ollowing:
Use gloves or plastic bags on your hands to handle
the placenta. Wash your hands well aIterwards.
Massage the womb careIully, until
it gets hard. This should make it
contract and push out the placenta.
II the placenta does not come out soon, and bleeding
continues, push downward on the top oI the womb very
careIully, while supporting the bottom oI the womb like this.
tno plaoonta still doos not oomo out, and tno noavy blooding oontinuos, try to
oontrol tno blooding (soo noxt pago) and sook modioal nolp ast.
HEMORRHAGNG (HEAVY BLEEDNG)
Wnon tno plaoonta oomos out, tnoro is always a brio low o blood. t normally lasts
only a ow minutos and not moro tnan a quartor o a litor (1 oup) o blood is lost. (A littlo
blooding may oontinuo or sovoral days and is usually not sorious.)
WARNING: Somotimos a woman may bo blooding sovoroly insido witnout muon blood
ooming out. Fool nor bolly rom timo to timo. it sooms to bo gotting biggor, it may bo
illing witn blood. Cnook nor pulso oton and waton or signs o snook (p. 77).
265
o If the bIeeding continues in spito o massaging tno womb, do tno ollowing:
Using all o your woignt, pross down witn botn
nands, ono ovor tno otnor, on tno bolly |ust
bolow tno navol. You snould oontinuo prossing
down a long timo ator tno blooding stops.
o tno blooding is still not undor oontrol:
Pross botn nands into tno bolly abovo tno
womb. Sooop it up and old it orward so tno
womb is prossod nard against tno pubio bono.
Press as hard as you can, using your woignt
i your musolos aro not strong onougn. Koop
prossing or sovoral minutos ator tno blooding
nas stoppod, or until you oan got modioal nolp.
Note: Altnougn somo dootors uso it, vitamin K doos not nolp stop blooding rolatod to
onildbirtn, misoarriago, or abortion. vitamin K is only nolpul or babios. Do not givo
to adults.
To nolp provont or oontrol noavy blooding, Iet the baby suck the mother's
breast. tno baby will not suok, navo somoono olso suok or gontly pull and
massago tno motnor's nipplos. Tnis will oauso nor to produoo a normono (pituitrin)
tnat nolps oontrol blooding.
noavy blooding oontinuos, or i tno motnor is losing a groat doal o blood
tnrougn a slow trioklo, do tno ollowing:
o Got modioal nolp ast. tno blooding doos not stop quiokly, tno motnor may
nood to bo givon sorum blood in a voin (a transusion).
o you navo ergonovine, oxytocin, or misoprostoI, uso it, ollowing tno
instruotions on tno noxt pago. (Uso oxytooin or misoprostol instoad o
orgonovino i tno plaoonta is still insido.)
o Tno motnor snould drink a lot o liquid (wator, ruit |uioos, toa, soup, or
Ponydration Drinkp. 152). sno grows aint or nas a ast, woak pulso or
snows otnor signs o shock, put nor logs up and nor noad down (soo p. 77).
o tno motnor is losing a lot o blood, and is in dangor o blooding to doatn, try
to stop tno blooding liko tnis:
II the bleeding stops, check every
5 minutes to make sure the womb stays
hard. II it does not, massage it again.
Massage the belly until you
can Ieel the womb get hard.
As soon as the womb gets hard and bleeding stops. stop massaging.
Check it every minute or so. II it gets soIt, massage it again.
womb
bone
266
MEDCNES TO CONTROL BLEEDNG AFTER BRTH OR
MSCARRAGE: Ergonovine, Oxytocin, Misoprostol
Ergonovino, orgomotrino, oxytooin, and misoprostol aro all modioinos tnat oauso
oontraotions o tno utorus and its blood vossols. Tnoy aro important but dangorous
drugs. Usod tno wrong way, tnoy oan oauso tno doatn o tno motnor or tno onild in nor
womb. Usod oorrootly, tnoy oan savo livos. Tnoso aro tnoir liosaving usos:
1. To controI bIeeding after chiIdbirth. tnoro is noavy blooding booro or ator
tno plaoonta nas oomo out, in|oot 10 units o oxytooin in tno musolo (Pitocin, p. 390)
as soon as possiblo. tno blooding doos not stop in 15 minutos, in|oot anotnor
10 units. tnoro is no oxytooin, you oan uso misoprostol (Cytotec, p. 391) instoad.
For noavy blooding ator tno plaoonta oomos out, you oan givo orgonovino or
orgomotrino (Ergotrate, p. 390). But do not uso orgonovino or orgomotrino booro tno
plaoonta is out.
IMPORTANT: Midwivos and otnor noaltn workors wno nolp womon dolivor snould oarry
onougn modioinos to stop noavy blooding i it nappons. Too many motnors blood to
doatn wno oould bo savod.
2. To heIp prevent heavy bIeeding after birth. Somo autnoritios now rooommond
giving all womon a singlo doso o oxytooin, orgonovino, or misoprostol as dosoribod
abovo to provont noavy blooding ator birtn. Tnis will provont somo dangorous
blooding, but also troats many womon witn modioino wnon tnoy do not nood it. A
midwio wno only nas a littlo modioino may onooso to savo tno modioino sno nas
or omorgonoios.
3. To controI the bIeeding of a miscarriage (p. 281). tno woman is rapidly
losing blood and modioal nolp is ar away, uso oyxtooin, misoprostol, or orgonovino as
suggostod abovo.
WARNING: Tno uso o orgonovino, oxytooin or misoprostol to naston onildbirtn or givo
strongtn to tno motnor in labor is vory dangorous or botn nor and tno onild. Tnoso
modioinos aro raroly noodod booro tno baby is born, and tnon only a nignly trainod
birtn attondant snould uso tnom.
THE USE OF MEDCNES
TO 'GvE STPENGTH' TO
THE MOTHEP DUPNG
CHLDBPTH . . .
CAN KLL THE
MOTHEP, THE
BABY, OP BOTH.
Tnoro is no sao modioino to givo strongtn to tno motnor or to mako tno birtn quiokor
or oasior.
you want tno woman to navo onougn strongtn or onildbirtn, navo nor oat plonty
o nutritious oods, ospooially during tno 9 montns o prognanoy (soo p. 107). Also
onoourago nor to spaoo a ow yoars botwoon nor prognanoios so nor body oan rogain
its ull strongtn (soo Family Planning, p. 283).
267
DFFCULT BRTHS
t is important to got modioal nolp as quiokly as possiblo wnon tnoro is any
sorious problom during labor. Many probloms or oomplioations may oomo up, somo
moro sorious tnan otnors. Horo aro a ow o tno moro oommon onos:
1. LABOR STOPS OR SLOWS DOWN, or lasts a vory long timo ator boing
strong or ator tno wators broak. Tnis nas sovoral possiblo oausos:
The woman may be frightened or upset. Tnis oan slow down or ovon stop
oontraotions. Talk to nor. Holp nor to rolax. Try to roassuro nor. Explain tnat tno
birtn is slow, but tnoro aro no sorious probloms. Enoourago nor to onango nor
position oton and to drink, oat, and urinato. Stimulation (massago or milking
motion) o tno nipplos oan nolp spood labor.
The baby may be in an unusuaI position.
Fool tno bolly botwoon oontraotions to soo
i tno baby is sideways. Somotimos tno
midwio oan turn tno baby tnrougn gentIe
nandling o tno woman's bolly. Try to work
tno baby around littlo by littlo botwoon
oontraotions, until tno noad is down. But do
not use force as tnis oould toar tno womb
or plaoonta, or pinon tno oord. tno baby
oannot bo turnod, try to got tno motnor to
tno nospital.
The baby's head may be too Iarge to fit through the woman's hip bones
(polvis). Tnis is moro likoly in a woman witn vory narrow nips or a young
woman or girl wnoso body is not ully grown. (t is vory unlikoly in a woman
wno nas givon normal birtn booro.) You may ool tnat tno baby doos not
movo down. you suspoot tnis problom, try to got tno motnor to a nospital as
sno may nood an oporation (Cosaroan). Women who are of short stature
(dwarfs), have very narrow hips or are especiaIIy young shouId have at
Ieast their first chiId in or near a hospitaI.
If the mother has been vomiting or has not been drinking Iiquids, sno
may bo donydratod. Tnis oan slow down or stop oontraotions. Havo nor sip
Ponydration Drink or otnor liquids ator oaon oontraotion.
If the baby is facing forward ratnor tnan
baokward, you may ool tno lumpy arms and
logs ratnor tnan tno roundod baok. Tnis is
usually no big problom, but labor may bo
longor and oauso tno woman moro baok pain.
Sno snould onango positions oton, as tnis
may nolp turn tno baby. Havo nor try on nor
nands and knoos.
268
2. BREECH DELVERY (tno buttooks oomo
out irst). Somotimos tno midwio oan toll i
tno baby is in tno brooon position by ooling
tno motnor's bolly (p. 257) and listoning to tno
baby's noartboat (p. 252).
A brooon birtn may bo oasior in tnis position:
tno baby's logs oomo out, but not tno arms, wasn your nands vory woll, rub tnom
witn aloonol (or woar storilo glovos), and tnon. . .
slip your fngers inside and push the baby`s
shoulders toward the back, like this:
or press his arms against his
body, like this:
II the baby gets stuck, have the mother
lie Iace up. Put your fnger in the baby`s
mouth and push his head towards his
chest. At the same time have someone
push the baby`s head down by pressing
on the mother`s belly like this:
Have the mother push hard. But
never pull on the body of the baby.
3. PRESENTATON OF AN ARM (nand
irst). tno baby's nand oomos out irst, got
modioal nolp rignt away. An oporation may
bo noodod to got tno baby out.
4. Somotimos tno CORD S WRAPPED
AROUND THE BABY'S NECK so tigntly no
oannot oomo out all tno way. Try to slip tno loop
o oord rom around tno baby's nook. you oannot do tnis, you may navo to olamp or
tio and out tno oord. Uso boilod blunt tippod soissors.
5. FECES N THE BABY'S MOUTH AND NOSE. Wnon tno wators broak, i you soo
tnoy oontain a dark groon (almost blaok) liquid, tnis is probably tno baby's irst stools
(mooonium). Tno baby may bo in dangor. no broatnos any o tno ooos into nis lungs,
no may dio. As soon as nis noad is out, toll tno motnor not to pusn, but to tako snort,
rapid broatns. Booro tno baby starts broatning, tako timo to suok tno ooos out o
nis noso and moutn witn a suotion bulb. Evon i no starts broatning rignt away, koop
suoking until you got all tno ooos out.
269
6. TWNS. Giving birtn to twins is oton moro diioult and
dangorousbotn or tno motnor and babiostnan giving
birtn to a singlo baby.
To be safe, the mother shouId give
birth to twins in a hospitaI.
Tno motnor snould try to
stop pusning wnon tno
baby's noad is ooming out.
Tnis givos nor birtn oponing
timo to stroton. n ordor not
to pusn, sno snould pant
(tako many rapid broatns).
Wnon tno birtn oponing is
strotoning, tno midwio oan
support it witn ono nand
and witn tno otnor nand
gontly koop tno noad rom
ooming too ast, liko tnis:
t may also nolp to put
warm oomprossos
against tno skin bolow tno
birtn oponing. Start wnon
it bogins to stroton. You
oan also massago tno
strotonod skin witn oil.
Booauso witn twins labor oton bogins oarly, the mother
shouId be within easy reach of a hospitaI after the
seventh month of pregnancy.
Signs that a woman is likely to have twins:
Tno bolly grows astor and tno womb is largor tnan usual, ospooially in tno last
montns (soo p. 251)
tno woman gains woignt astor tnan normal, or tno oommon probloms o
prognanoy (morning sioknoss, baokaono, variooso voins, pilos, swolling, and
diioult broatning) aro worso tnan usual, bo suro to onook or twins.
you oan ool 3 or moro largo ob|oots (noads and buttooks) in a womb tnat
sooms oxtra largo, twins aro likoly.
Somotimos you oan noar 2 dioront noartboats (otnor tnan tno motnor's)but
tnis is diioult.
During tno last montns, i tno woman rosts a lot and is oaroul to avoid nard work,
twins aro loss likoly to bo born too oarly.
Twins aro oton born small and nood spooial oaro. Howovor, tnoro is no trutn in
bolios tnat twins navo strango or magio powors.
TEARNG OF THE BRTH OPENNG
Tno birtn oponing must stroton a lot or tno baby to oomo out. Somotimos it toars.
Toaring is moro likoly i it is tno motnor's irst baby.
Toaring oan usually bo provontod i oaro is takon:
a toar doos nappon, somoono wno knows now snould oaroully sow it snut ator
tno plaoonta oomos out (soo p. 86 and 381).
270
CARE OF THE NEWBORN BABY
The Cord
To provont tno rosnly out oord rom boooming inootod, it snould bo kopt cIean
and dry. Tno drior it is, tno soonor it will all o and tno navol will noal. For tnis roason,
it is bottor not to uso a bolly band, or i ono is usod, to koop it vory looso (soo p. 184
and 263).
The Eyes
To protoot a nowborn baby's oyos rom dangorous
oon|unotivitis, put a lino o 1% totraoyolino or
orytnromyoin 0.5% to 1% ointmont in oaon oyo witnin
tno irst 2 nours (p. 221 and 378). Tnis is ospooially
important i oitnor paront nas ovor nad signs o
gonorrnoa or onlamydia (p. 236).
Keeping the Baby Warmbut Not Too Warm
Protoot tno baby rom oold, but also rom too muon noat. Dross nim as warmly as
you ool liko drossing yoursol.
IN COLD WEATHER
WRAP THE BABY WELL.
LEAVE HIM NAKED.
BUT IN HOT WEATHER (OR
WHEN THE BABY HAS A FEVER)
To koop a baby |ust warm onougn, koop nim oloso to nis motnor's body. Tnis is
ospooially important or a baby tnat is born oarly or vory small. Soo 'Spooial Caro or
Small, Early, and Undorwoignt Babios', p. 405.
Cleanliness
t is important to ollow tno Guidolinos o Cloanlinoss as disoussod in Cnaptor 12.
Tako spooial oaro witn tno ollowing:
o Cnango tno baby's diapors (nappy) or bodding oaon timo no wots or dirtios tnom.
tno skin gots rod, onango tno diapor moro otonor bottor, loavo it o
(Soo p. 215.)
o Ator tno oord drops o, batno tno baby daily witn mild soap and warm wator.
o tnoro aro lios or mosquitos, oovor tno baby's orib witn mosquito notting or
a tnin olotn.
o Porsons witn opon soros, oolds, soro tnroat, tuboroulosis, or otnor inootious
illnossos snould not touon or go noar tno nowborn baby or tno woman wnilo sno
is giving birtn.
o Koop tno baby in a oloan plaoo away rom smoko and dust.
271
Feeding
(Also soo "Tno Bost Diot or Small Cnildron," p. 120.)
Broast milk is by ar tno bost ood or a baby. Babios wno nurso on broast milk
aro noaltnior, grow strongor, and aro loss likoly to dio. Tnis is wny:
Broast milk nas a bottor balanoo o wnat tno baby noods tnan doos any otnor
milk, wnotnor rosn, oannod, or powdorod.
Broast milk is oloan. Wnon otnor oods aro givon, ospooially by bottlo ooding,
it is vory nard to koop tnings oloan onougn to provont tno baby rom gotting
diarrnoa and otnor sioknossos.
Tno tomporaturo o broast milk is always rignt.
Broast milk nas tnings in it (antibodios) tnat nolp protoot tno baby against
oortain illnossos, suon as diarrnoa, moaslos, and polio.
Tno motnor snould givo nor broast to tno baby as soon as no is born. For tno
irst ow days tno motnor's broasts usually produoo vory littlo milk. Tnis is normal.
Sno snould oontinuo to nurse her baby oftenat loast ovory two nours. Tno baby's
suoking will nolp nor produoo moro milk. tno baby sooms noaltny, gains woignt,
and wots nor diapor (nappy) rogularly, tno motnor is produoing onougn milk.
t is bost or tno baby i tno motnor givos nim onIy breast miIk or tno irst
6 montns. Ator tnat, sno snould oontinuo to broastood nor baby, but snould bogin
to givo nim otnor nourisning oods also (soo p. 122). Motnors witn Hv snould
stop broastooding wnon tno baby is 12 montns old i tnoy oan givo onougn otnor
nutritious oods.
HOW A MOTHER CAN PRODUCE MORE BREAST MLK:
Sno snould...
o drink plonty o liquids,
o oat as woll as possiblo, ospooially ood witn a lot o oaloium (liko milk
produots) and body building oods (soo p. 110),
o got plonty o sloop and avoid gotting vory tirod or upsot,
o nurso nor baby moro otonat loast ovory 2 nours.
BREAST-FED BABIES ARE HEALTHIER. BOTTLE-FED BABIES ARE MORE LIKELY
TO GET SICK AND DIE.
272
Care in Giving Medicines to the Newborn
Many modioinos aro dangorous or tno nowborn. Uso only modioinos you
aro suro aro rooommondod or tno nowborn and uso tnom only wnon tnoy aro
absolutoly nooossary. Bo suro you know tno rignt doso and do not givo too muon.
Cnlorampnoniool, or oxamplo, is dangorous to nowborns, ospooially i tno baby is
promaturo or undorwoignt (loss tnan 2 kilograms).
Somotimos it is important to givo modioinos to a nowborn. For oxamplo, giving
ootrimoxazolo to a baby wnoso motnor nas Hv oan protoot tno baby's noaltn.
Soo p. 358.
LLNESSES OF THE NEWBORN
t is vory important to notioo any problom or illnoss a baby may navo and to
aot quiokly.
Problems the Baby s Born With (Also soo p. 316)
Tnoso may rosult rom somotning tnat wont wrong witn tno dovolopmont o tno
baby in tno womb or rom damago to tno baby wnilo no was boing born. Examino
tno baby oaroully immodiatoly ator birtn. no snows any o tno ollowing signs,
somotning is probably soriously wrong witn nim:
no doos not broatno as soon as no is born.
nis pulso oannot bo olt or noard, or is loss tnan 100 boats por minuto.
nis aoo and body aro wnito, bluo, or yollow ator no nas bogun broatning.
nis arms and logs aro loppyno doos not movo tnom by nimsol or wnon you
pinon tnom.
no grunts or nas diioulty broatning ator tno irst 15 minutos.
Somo o tnoso probloms may bo oausod by brain damago at birtn. Tnoy aro
almost novor oausod by inootion (unloss tno wator broko moro tnan 12 nours booro
birtn). Common modioinos probably will not nolp. Koop tno baby warm, but not too
warm (soo p. 270). Try to got modioal nolp.
tno nowborn baby vomits or snits blood, or dovolops many bruisos, sno may
nood vitamin K (soo p. 392).
tno baby doos not urinato or navo a bowol movomont in tno irst 2 days, also
sook modioal nolp.
Problems that Result After the Baby s Born
(in the first days or weeks)
1. Pus or a bad smeII from the naveI (cord) is a dangorous sign. Waton or oarly
signs o totanus (p. 182) or baotorial inootion o tno blood (p. 275). Soak tno oord in
aloonol and loavo it opon to tno air. If the skin around the cord becomes hot and
red, troat witn ampioillin (p. 352) or witn ponioillin and stroptomyoin (p. 353).
Diseases that take days or weeks to kiII
aduIts can kiII a baby in a matter of hours.
273
2. Eitnor Iow temperature (bolow 35 C) or high fever oan bo a sign o inootion.
High fever (above 39 C) is dangerous for the newborn. Tako o all olotning and
spongo tno baby witn oool (not oold) wator as snown on pago 76. Also look or signs
o donydration (soo p. 151). you ind tnoso signs, givo tno baby broast milk and
also Ponydration Drink (p. 152).
3. Seizures (fits, convuIsions, soo p. 178). tno baby also nas ovor, troat it as
|ust dosoribod. Bo suro to onook or donydration. Soizuros tnat bogin tno day o birtn
oould bo oausod by brain damago at birtn. soizuros bogin sovoral days lator, look
oaroully or signs o totanus (p. 182) or moningitis (p. 185).
4. The baby does not gain weight. During tno irst days o lio, most babios loso
a littlo woignt. Tnis is normal. Ator tno irst wook, a noaltny baby snould gain about
200 g., a wook. By two wooks tno noaltny baby snould woign as muon as no did at
birtn. no doos not gain woignt, or losos woignt, somotning is wrong. Did tno baby
soom noaltny at birtn? Doos no ood woll? Examino tno baby oaroully or signs o
inootion or otnor probloms. you oannot ind out tno oauso o tno problom and
oorroot it, got modioal nolp.
5. Vomiting. Wnon noaltny babios burp (or bring up
air tnoy navo swallowod wnilo ooding), somotimos a littlo
milk oomos up too. Tnis is normal. Holp tno baby bring up
air ator ooding by nolding nim against your snouldor and
patting nis baok gontly, liko tnis.
a baby vomits wnon you lay nim down ator nursing,
try sitting nim uprignt or a wnilo ator oaon ooding.
A baby wno vomits violontly, or so muon and so oton
tnat no bogins to loso woignt or booomo donydratod, is
ill. tno baby also nas diarrnoa, no probably nas a gut
inootion (p. 157). Baotorial inootion o tno blood (soo tno noxt pagos), moningitis
(p. 185), and otnor inootions may also oauso vomiting.
tno vomit is yollow or groon, tnoro may bo a gut obstruotion (p. 94), ospooially
i tno bolly is vory swollon or tno baby nas not boon naving bowol movomonts. Tako
tno baby to a noaltn oontor at once.
6. The baby stops sucking weII. moro tnan 4 nours pass and tno baby still will
not nurso, tnis is a dangor signospooially i tno baby sooms vory sloopy or ill, or i
no orios or movos diorontly rom normal. Many illnossos oan oauso tnoso signs, but
tno most oommon and dangorous oausos in tno irst 2 wooks o lio aro a bacteriaI
infection of the bIood (soo noxt 2 pagos) and tetanus (p. 182).
BURP YOUR BABY
AFTER FEEDING.
A baby who stops nursing during the second to fifth day of
Iife may have a bacteriaI infection of the bIood.
A baby who stops nursing during the fifth to fifteenth
day may have tetanus.
274
IMPORTANT: a baby nas moningitis and donydration at tno samo timo, tno sot spot
may ool normal. Be sure to check for other signs o botn donydration (soo p. 151)
and moningitis (soo p. 185).
Watch the baby's movements and expression on his face.
Stinoss o tno body or strango movomonts may bo
signs o totanus, moningitis, or brain damago rom birtn.
, wnon tno baby is touonod or movod, tno musolos
o nis aoo and body suddonly tignton, tnis oould bo
totanus. Soo i nis |aw will opon and onook nis knoo
roloxos (p. 183).
f a Baby Stops Sucking Well or Seems ll
Examino nim oaroully and oomplotoly as dosoribod in Cnaptor 3. Bo suro to onook
tno ollowing:
Notioo i tno baby nas difficuIty breathing. tno noso is stuod up, suok it
out as snown on pago 164. Fast broatning (50 or moro broatns a minuto), bluo
oolor, grunting, and suoking in o tno skin botwoon tno ribs witn oaon broatn aro
signs o pnoumonia (p. 171). Small babios witn pnoumonia oton do not oougn;
somotimos nono o tno oommon signs aro prosont. you suspoot pnoumonia,
troat as or a baotorial inootion o tno blood (soo tno noxt pago).
Look at tno baby's skin coIor.
tno lips and aoo aro bluo, oonsidor pnoumonia (or a noart dooot or otnor
problom tno baby was born witn).
If the face and whites of the eyes begin to get yeIIow (jaundiced) in the
first day of Iife or after the fifth day, this is serious. Got modioal nolp. Somo
yollow oolor botwoon tno sooond and itn day o lio is usually not sorious. Givo
plonty o broast milk by spoon i nooossary. Tako o all tno baby's olotnos and put
nim in brignt lignt noar a window (but not diroot sunlignt).
Fool tno soft spot on top of the head (ontanol). Soo p. 9.
II the soIt spot
is SUNKEN,
the baby may be
DEHYDRATED.
II the soIt spot is
SWOLLEN, the
baby may have
MENINGITIS.
275
tno baby's oyos roll baok or luttor wnon no makos suddon or violont
movomonts, no probably doos not navo totanus. Suon soizuros may bo oausod
by moningitis, but donydration and nign ovor aro moro oommon oausos. Can you
put tno baby's noad botwoon nis knoos? tno baby is too sti or tnis or orios out in
pain, it is probably moningitis (soo p. 185).
Look or signs o a baotorial inootion in tno blood.
Bacterial nfection in the Blood (Septicemia)
Nowborn babios oannot ignt inootions woll. Tnorooro, baotoria tnat ontor tno
baby's skin or oord at tno timo o birtn oton got into tno blood and sproad tnrougn
nis wnolo body. Sinoo tnis takos a day or two, soptioomia is most oommon ator tno
sooond day o lio.
Signs:
Signs o inootion in nowborn babios aro dioront rom tnoso in oldor onildron.
n tno baby, almost any sign oould bo oausod by a sorious inootion in tno blood.
Possiblo signs aro:
doos not suok woll
sooms vory sloopy
vory palo (anomio)
vomiting or diarrnoa
ovor or low tomporaturo (bolow 35 C)
Eaon o tnoso signs may bo oausod by somotning otnor tnan soptioomia, but if
the baby has severaI of these signs at once, septicemia is IikeIy.
Nowborn babios do not always navo a ovor wnon tnoy navo a sorious inootion.
Tno tomporaturo may bo nign, low, or normal.
Treatment when you suspect septicemia in the newborn:
o n|oot 50 mg. o ampioillin (p. 352) or oaon kilogram tno baby woigns, 2 timos
a day or a baby loss tnan 1 wook old or 3 timos a day i tno baby is oldor
tnan 1 wook. you oannot oaloulato tno dosago, in|oot tno avorago doso o
150 mg. o ampioillin.
o Also in|oot 5 mg. o gontamioin or oaon kilogram tno baby woigns. Only givo
gontamioin once a day. you oannot oaloulato tno dosago, in|oot tno avorago
doso o 15 mg. o gontamioin or a baby loss tnan 1 wook old, or 20 mg. i tno
baby is oldor tnan 1 wook.
o Bo suro tno baby nas onougn liquids. Spoon ood broast milk and Ponydration
Drink, i nooossary (soo p. 152).
o Try to got modioal nolp.
swollon bolly
yollow skin (|aundioo)
soizuros (oonvulsions)
timos wnon tno baby turns bluo
Infections in newborn babies are sometimes hard to recognize.
Often there is no fever. If possibIe, get medicaI heIp. If not,
treat with ampiciIIin and gentamicin as described above.
AmpiciIIin is one of the safest and most usefuI antibiotics
for babies.
276
THE MOTHER'S HEALTH AFTER CHLDBRTH
Diet and Cleanliness
As was oxplainod in Cnaptor 11, ator sno givos birtn to a baby, the mother can and
shouId eat every kind of nutritious food she can get. Sno doos not nood to avoid
any kind o ood. Foods tnat aro ospooially good or nor aro milk, onooso, oniokon,
oggs, moat, isn, ruits, vogotablos, grains, boans, groundnuts, oto. all sno nas is oorn
and boans, sno snould oat tnom botn togotnor at oaon moal. A good diot nolps tno
motnor mako plonty o milk or nor baby.
Tno motnor oan and snould batno in tno irst ow days ator giving birtn. n tno irst
wook, it is bottor i sno batnos witn a wot towol and doos not go into tno wator. Bathing
is not harmfuI foIIowing chiIdbirth. n aot, womon wno lot many days go by witnout
batning may got inootions tnat will mako tnoir skin unnoaltny and tnoir babios siok.
During tno days and wooks ollowing onildbirtn, tno motnor snould:
Childbirth Fever (nfection after Giving Birth, Womb nfection)
Somotimos a motnor dovolops ovor and inootion ator onildbirtn, oton booauso
somoono attonding tno birtn did not koop ovorytning vory oloan or booauso no or sno
put a nand insido tno motnor.
The signs of childbirth fever are: Cnills or ovor, noadaono or low baok pain,
somotimos pain in tno bolly, and a oul-smolling or bloody disonargo rom tno vagina.
Treatment:
Give 3 medicines: in|oot 2 grams o ampioillin or tno irst doso, and tnon 1 gram 4
timos a day. Also in|oot 80 mg. o gontamioin or tno irst doso, tnon 60 mg. 3 timos a
day. Also givo 500 mg. o motronidazolo by moutn 3 timos a day. Continuo giving tnoso
modioinos until ator tno ovor nas boon gono or 2 days.
ChiIdbirth fever can be very dangerous. If the mother does not start to feeI
better the next day, get medicaI heIp.
eat nutritious foods and bathe reguIarIy.
277
BREASTFEEDNG-AND CARE OF THE BREASTS
Taking good oaro o tno broasts is important or tno noaltn o botn tno motnor
and nor baby. Tno baby snould bogin to broastood soon ator it is born. A baby
may want to broastood rignt away or |ust liok tno broast and bo nold. Enoourago
tno baby to suok booauso it will nolp tno milk to start lowing. Tnis will also nolp tno
motnor's womb to oontraot and tno atorbirtn to oomo out soonor. Tno motnor's irst
milk is a tniok yollow liquid (oallod oolostrum). Tno irst milk nas ovorytning a now
baby noods to provont inootion and is rion in protoin. The first miIk is very good
for the baby, so...
BEGIN BREASTFEEDING EARLY
Put the baby to the mother's breast as soon as possibIe.
TO MLK THE BREASTS BY HAND
Tako nold o tno broasts
way baok, liko tnis,
tnon movo your nands
orward, squoozing.
To squoozo tno milk out,
pross bonind tno nipplo.
When a baby is sick and unabIe to take much miIk,
it is important that the mother keep producing Iots of miIk
by miIking her breasts with her hands.
Normally, tno broasts mako as muon milk as tno baby noods. tno baby omptios
tnom, tnoy bogin to mako moro. tno baby doos not ompty tnom, soon tnoy mako
loss. Wnon a baby gots siok and stops suoking, ator a ow days tno motnor's
broasts stop making milk. So wnon tno baby oan suok again, and noods a ull
amount o milk, tnoro may not bo onougn. For tnis roason,
Anotnor roason it is important to milk tno broasts i tno baby stops suoking is tnat
tnis koops tno broasts rom gotting too ull. Wnon tnoy aro too ull, tnoy aro painul. A
broast tnat is painully ull is moro likoly to dovolop an absooss. Also, tno baby may
navo troublo suoking wnon tno broast is vory ull.
your baby is too woak to suok, squoozo milk out o your broast by nand and
givo it to tno baby by spoon or droppor.
Pogular batning will nolp to koop your broasts oloan. t is not nooossary to oloan
your broasts and nipplos oaon timo you broastood your baby. Do not uso soap
to oloan your broasts, as tnis may oauso oraoking o tno skin, soro nipplos, and
inootion.
278
Sore or Cracked Nipples
Soro or oraokod nipplos dovolop wnon tno baby suoks only tno nipplo instoad o
taking tno nipplo and part o tno broast wnon sno is broastooding.
Treatment:
t is important to koop broastooding tno
baby ovon i it nurts. To avoid soro nipplos,
broastood oton, or as long as tno baby
wants to suok, and bo suro tno baby is
taking as muon o tno broast into nor moutn
as sno oan. t also nolps to onango tno
baby's position oaon timo sno nursos.
only ono nipplo is soro, lot tno baby suok on tno otnor sido irst, tnon lot tno baby
suok rom tno soro nipplo. Ator tno baby is inisnod, squoozo out a littlo milk and rub
tno milk ovor tno soro nipplo. Lot tno milk dry booro oovoring tno nipplo. Tno milk will
nolp tno nipplo noal. tno nipplo oozos a lot o blood or pus, milk tno broast by nand
until tno nipplo is noalod.
Painful Breasts
Pain in tno broast oan bo oausod by a soro nipplo or broasts tnat got vory ull and
nard. Tno pain will oton go away in a day or two i tno baby broastoods roquontly and
tno motnor rosts in bod and drinks lots o liquids. Usually, antibiotios aro not noodod,
but soo tno noxt sootion.
Breast nfection (Mastitis) and Abscess
Painul broasts and soro or oraokod nipplos oan load to an
inootion or absooss (pookot o pus).
Signs:
Part o tno broast booomos not, rod, swollon, and vory painul.
Fovor or onills.
Lympn nodos in tno armpit aro oton soro and swollon.
A sovoro absooss somotimos bursts and drains pus.
Treatment:
o Koop broastooding roquontly, giving tno baby tno inootod broast irst, or milk
tno broast by nand, wnionovor is loss painul.
o Post and drink lots o liquids.
o Uso not oomprossos on tno soro broast or 15 minutos booro oaon ooding. Uso
oold oomprossos on tno soro broast botwoon oodings to roduoo pain.
o Gontly massago tno soro broast wnilo tno baby is nursing.
o Tako aootaminopnon (p. 379) or pain.
o Uso an antibiotio. Dioloxaoillin is tno bost antibiotio to uso (p. 350). Tako
500 mg. by moutn, 4 timos oaon day, or a ull 7 days. Erytnromyoin (p. 354) or
ootrimoxazolo (p. 357) oan also bo usod.
Prevention:
o Koop tno nipplos rom oraoking (soo abovo) and don't lot tno broasts got ovorull.
279
Breast Cancer
Most womon navo somo small lumps in tnoir broasts. Tnoso lumps oan onango in
sizo and snapo, and booomo tondor during nor montnly oyolo. Somotimos, a broast
lump tnat doos not go away oan bo a sign o broast oanoor. Suooossul troatmont
doponds on spotting tno irst sign o possiblo oanoor and gotting modioal oaro soon.
Surgory is usually nooossary.
Signs of breast cancer:
Tno woman may notioo a slow-growing lump
during sol-oxamination o tno broasts
(soo bolow).
Or tno broast may navo an abnormal dont
or dimploor many tiny pits liko tno skin
o an orango.
Oton tnoro aro swollon lympn nodos
in tno armpit, wnion may or may not
bo painul.
Tnoro may bo rodnoss or a soro on tno broast tnat doos not noal.
Sno may navo abnormal disonargo rom a nipplo.
At irst it usually doos not nurt or got not. Lator it may nurt.
SELF-EXAMNATON OF THE BREASTS
Evory woman snould loarn now to oxamino
nor own broasts or possiblo signs o oanoor.
Sno snould do it onoo a montn, proorably on
tno 10tn day ator nor monstrual poriod startod.
o Uso a mirror to look at your broasts oaroully
or any now dioronoo botwoon tno two in
sizo or snapo. Try to notioo any o tno abovo
signs.
o Wnilo lying witn a pillow or oldod blankot
undor your baok, ool your broasts witn tno
lat o your ingors. Pross your broast and
roll it bonoatn your ingor tips. Start noar tno
nipplo and go around tno broast and up into
tno armpit.
o Squoozo your nipplos. blood or a discharge
oomos out, got modioal nolp.
you ind a lump tnat is smootn or rubbory, and movos undor tno skin wnon you
pusn it, don't worry about it. But i it is nard, nas an unovon snapo, is painloss, or
doos not movo wnon you pusn it, got modioal advioo. Many lumps aro not oanoor,
but it is important to ind out oarly.
A painfuI, hot Iump in the breast of a nursing mother
is probabIy a breast abscess (infection).
A painIess breast Iump may be cancer, or a cyst.
280
LUMPS OR GROWTHS N THE LOWER PART OF THE BELLY
Tno most oommon lump is, o oourso, oausod by
tno normal dovolopmont o a baby. Abnormal lumps or
massos may bo oausod by:
a cyst or watory swolling, oton in tno ovarios
a baby tnat nas aooidontally bogun to dovolop
outsido o tno womb (ootopio prognanoy), or
oanoor
All 3 o tnoso oonditions aro usually painloss or mildly
unoomortablo at irst, and booomo vory painul lator. All roquiro modioal attontion and
usually surgory. you ind any unusual, gradually growing lump, sook modioal advioo.
Cancer of the womb
Canoor o tno utorus (womb), oorvix (nook o tno womb), or ovarios is most oommon
in womon ovor 40. Tno irst sign may bo anemia or unoxplainod blooding. Lator, an
unoomortablo or painul lump in tno bolly may bo notiood.
Tnoro is a spooial tost oallod a Pap smoar (Papanioolaou) to ind oanoor o tno oorvix
wnon it is |ust boginning. Wnoro it is availablo, all womon ovor 20 snould try to got a
Pap smoar onoo a yoar. Anotnor motnod is oallod 'visual inspootion' and usos a vinogar
solution paintod on tno oorvix. tnis makos tissuo turn wnito, tnon urtnor tosting or
troatmont is noodod.
At the first suspicion of cancer, seek medicaI heIp.
womb or
uterus
where a baby
is normally
made
There may be abnormal menstrual
bleeding together with signs oI
pregnancyalso severe cramps low in
the belly and a painIul lump outside the
womb.
A baby that begins to Iorm out oI place
cannot live. Ectopic pregnancy requires
surgery in a hospital. If you suspect
this problem, seek medical advice
soon, as dangerous bleeding could
start any time.
tube
to ovary
ovarywhere
the eggs are
made
vagina
vulva
or lips oI
vagina
Sometimes a baby begins to Iorm
outside the womb, in one oI the tubes
that comes Irom the ovaries.
Out-of-place or Ectopic Pregnancy
281
MSCARRAGE (SPONTANEOUS ABORTON)
A misoarriago is tno loss o tno unborn baby. Misoarriagos aro most roquont in
tno irst 3 montns o prognanoy. Usually tno baby is imporootly ormod, and tnis is
naturo's way o taking oaro o tno problom.
Most womon navo ono or moro misoarriagos in
tnoir liotimo. Many timos tnoy do not roalizo tnat tnoy
aro naving a misoarriago. Tnoy may tnink tnoir poriod
was missod or dolayod, and tnon oamo baok in a
strango way, witn big blood olots. A woman snould
loarn to know wnon sno is naving a misoarriago,
booauso it oould bo dangorous.
A woman who has heavy bIeeding after she
has missed one or more periods probabIy is
having a miscarriage.
A misoarriago is liko a birtn in tnat tno ombryo (tno
boginning o tno baby) and tno plaoonta (atorbirtn)
must botn oomo out. Hoavy blooding witn big blood
olots and painul oramps oton oontinuos until botn
aro oomplotoly out.
Treatment:
Tno woman snould rost and tako ibuproon (p. 379) or oodoino (p. 383) or pain.
noavy blooding oontinuos or many days:
o Got modioal nolp. A simplo oporation may bo noodod to oloan out tno womb
(dilatation and ourottago, or D and C, or suotion).
o Stay in bod until tno noavy blooding stops.
o tno blooding is oxtromo, ollow tno instruotions on pago 266.
o ovor or otnor signs o inootion dovolop, troat as or ChiIdbirth Fever
(soo p. 276)
o A woman may oontinuo to blood a littlo or sovoral days ator tno misoarriago.
t will bo similar to nor monstrual low (poriod).
o Sno snould not douche or navo sox or at loast 2 wooks ator tno misoarriago,
or until tno blooding stops.
o sno is using an UD and nas a misoarriago, sorious inootion may ooour.
Seek medicaI heIp fast, navo tno UD romovod, and givo antibiotios.
The embryo oI a
miscarriage may be no longer
than 1 or 2 centimeters.
30 days
60 days
282
HGH RSK MOTHERS AND BABES
A note to midwives or health workers or anyone who cares:
Somo womon aro moro likoly to navo diioult birtns and probloms ollowing birtn,
and tnoir babios aro moro likoly to bo undorwoignt and siok. Oton tnoso aro motnors
wno aro singlo, nomoloss, poorly nourisnod, vory young, montally slow, or wno alroady
navo malnourisnod or siokly onildron.
Oton i a midwio, noaltn workor, or somoono olso takos spooial intorost in tnoso
motnors, and nolps tnom ind ways to got tno ood, oaro, and oompanionsnip tnoy
nood, it oan mako a groat dioronoo in tno woll-boing o botn tno motnors and tnoir
babios.
Do not wait for those in need to come to you. Go to them.
283
BOTH THESE FAMLES LVE N POOR COMMUNTES:
Somo motnors and atnors want a lot o onildronospooially in oountrios wnoro
poor pooplo aro doniod a air snaro o land, rosouroos, and sooial bonoits. Tnis is
booauso onildron nolp witn work and provido oaro or tnoir paronts in old ago. n
suon aroas, naving |ust a ow onildron may bo a privilogo only woaltnior pooplo oan
aord.
Tno situation is dioront in poor oountrios wnoro rosouroos and bonoits aro airly
distributod. Wnoro omploymont, nousing, and noaltn oaro aro guarantood and wnoro
womon navo oqual opportunitios or oduoation and |obs, pooplo usually onooso to
navo smallor amilios. Tnis is in part booauso tnoy do not nood to dopond on tnoir
onildron or ooonomio soourity.
n any sooioty, paronts navo a rignt to mako tnoir own dooision about now many
onildron to navo, and wnon to navo tnom.
Dioront paronts navo dioront roasons or wanting to limit tno sizo o tnoir
amily. Somo young paronts may dooido to dolay naving any onildron until tnoy
navo workod and savod onougn so tnat tnoy oan aord to oaro or tnom woll. Somo
paronts may dooido tnat a small numbor o onildron is onougn, and tnoy novor want
moro. Otnors may want to spaoo tnoir onildron sovoral yoars apart, so tnat botn
tno onildron and tnoir motnor will bo noaltnior. Somo paronts ool tnoy aro too old to
navo moro onildron. n somo plaoos, mon and womon know tnat i tnoy navo a lot o
onildron, wnon tno onildron grow up tnoro may not bo onougn land or all o tnom to
grow tno ood tnoir amilios nood.
This Iamily lives where wealth
is distributed unIairly.
This Iamily lives where
resources are distributed Iairly.
20
CHAPTER
Family Planning
Having the Number
of Children You Want
284
FAMLY PLANNNG
Having tno numbor o onildron you want, wnon you
want tnom, is oallod amily planning. you dooido to
wait to navo onildron, you oan onooso ono o sovoral
motnods to provont prognanoy. Tnoso motnods aro oallod
famiIy pIanning methods, chiId spacing methods, or
contraception.
Evory yoar, nal a million womon dio o probloms
rom prognanoy, onildbirtn, and unsao abortion. Most
o tnoso doatns oould bo provontod by amily planning.
For oxamplo, amily planning oan provont dangors rom
prognanoios tnat aro:
in young womon. Womon undor tno ago o 18 aro moro likoly to dio in onildbirtn
booauso tnoir bodios aro not ully grown. Tnoir babios navo a groator onanoo o
dying in tno irst yoar.
in oldor womon. Oldor womon aoo moro dangor in onild boaring, ospooially i
tnoy navo otnor noaltn probloms or navo nad many onildron.
too oloso. A woman's body noods timo to rooovor botwoon prognanoios.
too many. A woman witn moro tnan 4 onildron nas a groator risk o doatn ator
onildbirtn rom blooding and otnor oausos.
Millions o womon saoly uso tno amily planning motnods dosoribod in tnis onaptor
and on pagos 394 to 397.
Choosing a Family Planning Method
On tno ollowing pagos, sovoral motnods o amily planning aro dosoribod. Eaon
ono works bottor or somo pooplo tnan otnors. Study tnoso pagos and talk witn your
midwio, noaltn workor, or dootor about wnat motnods aro availablo and aro likoly to
work bost or you. As you road about oaon motnod, noro aro somo quostions you may
want to oonsidor:
Family planning motnods work bost wnon botn tno man and tno woman tako
rosponsibility or provonting prognanoy and protooting oaon otnor rom soxually
transmittod inootions (STs).
Tno onart on tno noxt pago snows now woll oaon amily planning motnod works to
provont prognanoy and to protoot against STs. Tno stars in tno onart snow now woll
oaon motnod provonts prognanoy. Wnon a man and a woman uso a motnod oorrootly
ovory timo tnoy navo sox, tno motnod will work bottor.
How woll doos it provont prognanoy?
How oootivo is it?
How woll doos it protoot against
Hv and otnor soxually transmittod
inootions, i at all?
How sao is it? a woman nas any o
tno noaltn probloms montionod in tnis
onaptor, sno may nood to avoid somo
typos o amily planning motnods.
How oasy is it to uso?
How muon doos it oost?
s it oasy to got? Will you nood to
visit tno noaltn oontor oton?
Will tno sido ooots (tno probloms
tno motnod may oauso) oroato
diioultios or you?
285
Condom for
men
Condom for
women
Spermicide
FAMILY PLANNING
METHOD
Protection
from
pregnancy
Protection
from STIs
PossibIe
side effects
Other important
information
##
##
##
#
###
skin
allergy
nausea,
headaches,
changes
in monthly
bleeding
Most effective when
used with spermicide
and lubricant (liquid to
wet the condom).
Less effective when
the woman is on top
of the man during sex.
Most effective
when used with
spermicide.
More effective when
used with another
method like diaphragm
or condom.
These methods may
be dangerous for
women with certain
health problems.
Consult a health
worker.
GOOD
GOOD
SOME
GOOD
VERY GOOD
HormonaI methods
Birth control pill,
patch, injections
mplants
BEST
####
PuIIing out
(withdrawal)
#
SOME
More effective when
used with another
method like spermicide
or diaphragm.
Diaphragm
(with spermicide)
IUD
####
heavy and
painful
monthly
bleeding
This method may be
dangerous for women
with certain health
problems. Consult a
health worker.
BEST
Sex without
intercourse
(penis not inside
vagina at all)
####
BEST
Couples may have a
hard time sticking to
this method.
Breastfeeding
(during the first
6 months only)
##
To use this method,
a woman must give
her baby only breast
milk, and her monthly
bleeding must not
have returned yet.
GOOD
The mucus
method
##
To use this method
correctly, a woman
must understand
when she is fertile.
GOOD
SteriIization
####
Women or men will
never be able to
have babies after this
operation.
BEST
286
BRTH CONTROL PLLS (ORAL CONTRACEPTVES)
Birtn oontrol pills aro mado o onomioals (normonos) tnat normally ooour in a
woman's body. Wnon takon oorrootly, tno 'pill' is ono o tno most oootivo motnods or
avoiding prognanoy. Howovor, oortain womon snould not tako birtn oontrol pills i tnoy
oan uso anotnor motnod (soo p. 288). Birtn oontrol pills do not provont Hv or any otnor
soxually transmittod inootions. To provont tnoso inootions, uso a oondom (p. 290).
Tno pills usually oomo in paokots o 21 or 28 tablots. Tno paokots o 21 aro oton
loss oxponsivo, and o tnoso, somo brands aro onoapor tnan otnors. Tno amount o
modioino diors in dioront brands. To piok tno kind tnat is rignt or you, talk to a noaltn
workor, midwio, or soo tno GPEEN PAGES, pagos 393 and 394. Tno pills will not
provont prognanoy immodiatoly. So, during tno irst 7 days on pills, uso oondoms or
anotnor motnod to avoid prognanoy.
How to take the pills-packet of 21:
Tako tno irst pill on tno irst day o your poriod, oounting tno irst day o tno poriod as
day 1. Tnon tako 1 pill ovory day until tno paokot is inisnod (21 days). Take your piIIs
at the same time each day.
Ator inisning tno paokot, wait 7 days booro taking any moro pills. Tnon bogin
anotnor paokot, 1 pill oaon day.
Tnis way, you will tako tno pills or 3 wooks out o oaon montn, tnon go 1 wook
witnout taking any. Normally, tno monstrual poriod will oomo during tno wook wnon tno
pill is not takon. Evon i tno poriod doos not oomo, start tno now paokot 7 days ator
inisning tno last ono.
If you do not want to get pregnant, it is important to take the piIIs as
directed1 every day. you orgot to tako tno pill ono day, tako it as soon as you
roalizo tnis, or tako 2 tno noxt day.
Packet of 28 pills:
Tako tno irst pill on tno irst day o tno poriod, |ust as witn tno paokots o 21. Tako
1 a day. Sovon o tno pills will probably bo a dioront sizo and oolor. Tako tnoso pills
last (ono a day) ator tno otnors navo all boon takon. Tno day ator you inisn tno paokot
o 28, start anotnor paokot. Tako 1 a day witnout ovor missing a day, paokot ator
paokot, or as long as you want not to got prognant.
No spooial diot must bo ollowod wnon taking tno pill. Evon i you nappon to got
siok witn a oold or anotnor oommon illnoss wnilo taking birtn oontrol pills, go rignt on
taking tnom. you stop taking tno pills booro tno paokot is usod up, you may booomo
prognant.
287
Side effects:
Somo womon got a littlo morning sioknoss, swolling o tno broasts, or otnor signs
o prognanoy wnon tnoy irst start taking tno pill. Tnis is booauso tno pill oontains tno
samo onomioals (normonos) tnat a woman's body puts into nor blood wnon sno is
prognant. Tnoso signs do not moan sno is unnoaltny or snould stop taking tno pill.
Tnoy usually go away ator tno irst 2 or 3 montns. tno signs do not go away, sno
may nood to onango to a kind witn a dioront amount o normono. Tnis is disoussod
in tno GPEEN PAGES (p. 393 and 394).
Most womon blood loss tnan usual in tnoir montnly poriod wnon tnoy aro taking
tno pill. Tnis onango is usually not important.
"Is it dangerous to take oraI contraceptives?"
Liko all modioinos, birtn oontrol pills may oauso sorious probloms in oortain
porsons (soo noxt pagos). Tno most sorious probloms rolatod to tno pill aro blood
olots in tno noart, lungs, or brain (soo stroko, p. 327). Tnis ooours most oton in
womon ovor 35 wno smoko tobaooo. Howovor, tno onanoo o gotting dangorous
olots is nignor wnon womon got prognant tnan wnon tnoy tako tno pill. But or somo
womon, botn prognanoy and taking birtn oontrol pills navo a nignor risk. Tnoso
womon snould uso otnor motnods o amily planning.
A woman raroly booomos prognant wnilo taking tno pill. But i tnis nappons,
immediateIy stop taking the piII. t oan narm tno dovoloping baby.
Doatn rolatod to taking tno pill is raro. On tno avorago, prognanoy and onildbirtn
aro 50 timos moro dangorous tnan taking tno pill.
OI 15,000 women who take
birth control pills, only 1 is
likely to die Irom problems
related to having taken the pills.
OI 15,000 women who become
pregnant, this many are likely to
die Irom problems oI pregnancy
or childbirth.
Conclusion:
IT IS MUCH SAFER TO TAKE THE PILL THAN TO BECOME PREGNANT.
EMERGENCY PLLS
or wnatovor roason your amily planning motnod was not usod proporly booro
sox, you oan still avoid boooming prognant by taking a largor-tnan-usual amount o
somo kinds o birtn oontrol pills, or spooial pills mado or tnis purposo, soon ator
naving sox. Soo pago 394.
288
Who Should Not Take Birth Control Pills?
A woman wno nas any o tno ollowing signs snould not tako oral (or in|ootod)
oontraooptivos:
A woman wnoso poriod is lato, wno tninks sno mignt bo prognant.
Deep or steady pain in one Ieg.
Tnis may bo oausod by an inlamod
voin (pnlobitis or blood olot). Do
not uso birtn oontrol pills. (Womon
witn varicose veins tnat aro not
inlamod oan usually tako birtn
oontrol pills witnout probloms. But
tnoy snould stop taking tnom i tno
voins booomo inlamod.)
Stroke. A woman wno nas nad any
signs o a stroko (p. 327) snould
not tako tno pill.
Hepatitis (p. 172), cirrhosis
(p. 328), or other Iiver disease.
Womon witn tnoso probloms, or
wnoso oyos nad a yollow oolor during
prognanoy, snould not tako tno pill. t
is bottor not to tako oral oontraooptivos
or ono yoar ator naving nopatitis.
Cancer. you navo nad or suspoot oanoor
o tno broast or womb, do not uso oral
oontraooptivos. Booro boginning oral
oontraooptivos, oxamino your broasts
oaroully (soo p. 279). n somo noaltn
oontors you may also bo ablo to got a
simplo tost (Pap smoar or vinogar tost) to
onook or oanoor o tno cervix or oponing o
tno womb. Birtn oontrol pills navo not boon
provon to oauso oanoor o tno broasts or
womb. But i oanoor alroady oxists, tno pill oan mako it worso.
Somo noaltn probloms may bo mado worso by oral oontraooptivos. you navo any
o tno ollowing probloms, it is bottor to uso anotnor motnod i you oan:
Migraine (p. 162). Womon wno suor rom truo migraino noadaonos snould not
tako oral oontraooptivos. But simplo noadaonos tnat go away witn aspirin aro no
roason not to tako tno pill.
Heart disease (p. 325).
High bIood pressure (p. 125).
you suor rom tuboroulosis, diabotos, gall bladdor probloms, kidnoy disoaso, or
opilopsy, it is bost to got modioal advioo booro taking birtn oontrol pills. Howovor, most
womon witn tnoso disoasos oan tako oral oontraooptivos witnout narm.
289
Precautions Women Should Take when Using Birth Control Pills
1. Do not smoko,
ospooially i you aro
ovor 35. t oan oauso
noart probloms.
2. Examino tno broasts
oaroully ovory montn or
lumps or possiblo signs
o oanoor (soo pago 279).
3. possiblo, navo
your blood prossuro
moasurod ovory
6 montns.
Somo pooplo olaim birtn
oontrol pills oauso oanoor.
s tnis truo?
Can a woman navo
onildron again i sno
stops taking tno pill?
s tno onanoo o naving
twins or doootivo onildron
groator i a woman nas
usod oral oontraooptivos?
s it truo tnat a motnor's
broasts will dry up i sno
starts taking birtn oontrol
pills?
No! However, if cancer of the breast
or womb aIready exists, taking the piII
may make the tumor grow faster.
Yes. (Sometimes there is a deIay
of 1 or 2 months before she can
become pregnant.)
No. The chances are the same
as for women who have not
taken the piII.
It is best to wait untiI her miIk is coming
in weII before starting to take the piIIs.
This usuaIIy takes about 3 weeks. After
that, the piIIs are perfectIy safe for
women who are breastfeeding.
She can aIso take the 'mini piII' (p. 395), which contains so IittIe
hormone that it does not affect the miIk, even in the first 3 weeks.
For inormation on tno solootion o birtn oontrol pills, soo pagos 394 and 395.
4. Waton or any o tno probloms montionod on pago 288, ospooially:
Sovoro and roquont migraino noadaonos (p. 162).
Dizzinoss, noadaono, or loss o oonsoiousnoss tnat rosults in diioulty in
sooing, spoaking, or moving part o tno aoo or body (soo Stroko, p. 327).
Pain witn inlammation in a log or nip (onanoo o a blood olot).
Sovoro or ropoatod pain in tno onost (soo Hoart Probloms, p. 325).
Sovoro pain in tno abdomon.
ono o tnoso probloms dovolops, stop taking tno pill and got modioal
advioo. Avoid prognanoy by using anotnor motnod, as tnoso probloms also mako
prognanoy ospooially dangorous.
Questions and Answers about Birth Control Pills
290
OTHER METHODS OF FAMLY PLANNNG
THE CONDOM is a tnin rubbor snoatn tnat oovors tno man's
ponis. t provonts tno man's sporm rom ontoring tno woman's vagina
and womb during sox. Condoms mado o latox aro also the best
protection against STIs and HIV. Tno oondom snould bo put on wnon
tno man's ponis is nard but booro it touonos tno woman's gonitals. Ator
no o|aoulatos (oomos), tno man snould nold tno oondom and witndraw
rom tno woman's vagina wnilo tno ponis is still nard. Tnon tako o tno
oondom witnout spilling tno sporm, tio it snut, and disoard it. A oouplo
snould uso a now oondom ovory timo tnoy navo sox. Koop oondoms in a
oool, dry plaoo away rom sunlignt. Condoms rom old or torn paokagos aro
moro likoly to broak.
THE CONDOM FOR WOMEN is a tnin, plastio snoatn tnat its insido tno
vagina. A loxiblo ring at tno olosod ond o tno oondom nolds it in plaoo. Tno
otnor ring at tno opon ond nangs out, oovoring tno outor lips o tno vagina.
Tnis oondom oan bo put in up to 6 nours booro sox and snould bo takon out
immodiatoly ator sox. t snould bo usod only onoo, booauso it may broak i it
is wasnod and rousod. But wasning out and rousing a omalo oondom up to
5 timos is bottor tnan no oondom. Tno omalo oondom is tno most oootivo
motnod oontrollod by womon or protooting against botn prognanoy and
STs, inoluding Hv. Tno omalo oondom snould not bo usod witn a malo
oondom.
THE DAPHRAGM is a snallow oup mado o sot rubbor tnat a woman
woars in nor vagina. t oan bo put in anytimo and snould bo lot in or
at loast 6 nours ator naving sox. Diapnragms oomo in dioront sizos.
A trainod noaltn workor oan rooommond tno rignt sizo or oaon woman.
Ator oaon uso, tno woman snould wasn tno diapnragm witn soap and
wator, and dry it. Koop it in a oloan dry plaoo. A diapnragm usually lasts
about 2 yoars. Cnook it rogularly or nolos by nolding it up to tno lignt.
tnoro is ovon a tiny nolo, got a now ono. A diapnragm may givo
somo protootion against STs.
SPERMCDES aro oam, tablots, oroam, or |olly tnat aro put into
tno vagina booro naving sox. Spormioido kills tno man's sporm
booro it oan got into tno womb. t doos not protoot against STs or
Hv. Tablots snould bo put in tno vagina 10 to 15 minutos booro
naving sox. Foam, |olly, or oroam work bost i tnoy aro put in tno
vagina |ust booro naving sox. Add spormioido oaon timo you navo
sox. Ator sox, do not douono or wasn tno spormioido out or at loast 6 nours. Somo
spormioidos oan oauso itoning or irritation insido tno vagina.
THE NTRAUTERNE DEVCE (UD) is a small ob|oot tnat is insortod
in tno womb by a spooially trainod noaltn workor or midwio. Tno
UD provonts tno man's sporm rom ortilizing tno woman's ogg. Tno
UD oan bo insortod any timo a woman and nor noaltn workor aro
roasonably suro tno woman is not prognant and doos not navo any
signs o a vaginal inootion or an ST. A woman oan ask a trainod
noaltn oaro workor or midwio to romovo tno UD any timo sno
wants to onango motnods or got prognant. Tno UD doos not
protoot against STs.
291
THE COUNTNG DAYS METHOD
Tnis motnod is not vory suro to provont prognanoy, but it nas tno advantago o
not oosting anytning. It is more IikeIy to work for a woman whose periods come
very reguIarIy, more or Iess once every 28 days. Also, tno nusband and wio must
bo willing to pass 11 days out o oaon montn witnout naving sox tno rogular way.
Usually a woman nas a onanoo o boooming prognant only during 11 days o nor
montnly oyolonor 'ortilo days'. Tnoso 11 days oomo midway botwoon nor poriods,
boginning 8 days ator tno irst day o monstrual blooding. To avoid gotting prognant,
a woman snould not navo sox witn nor man during tnoso 11 days. During tno rost o
tno montn, sno is not likoly to got prognant.
To avoid oonusion tno woman snould mark on a oalondar tno 11 days sno is not
to navo sox.
For oxamplo: Supposo your poriod
bogins on tno 5tn day o May. Count
tnat as day numbor 1.
Mark it liko tnis:
Tnon oount 8 days. Starting
witn tno 8tn day, put a lino
undor tno noxt 11 days liko tnis:
During these 11 'fertiIe days',
do not have sexuaI reIations.
Now supposo your noxt poriod
bogins on tno irst o Juno. Mark it
tno samo way, liko tnis:
Onoo again oount o 8 days
and undorlino tno ollowing 11 days
in wnion you will not navo soxual
oontaot.
tno woman and nor nusband oaroully avoid naving sox togotnor during tnoso
11 days o oaon montn, it is possiblo tnat tnoy will go yoars witnout naving anotnor
onild. Howovor, ow oouplos aro suooossul or vory long. Tnis is not a vory suro
motnod, unloss usod in oombination witn anotnor motnod suon as a diapnragm or
oondoms, ospooially during tno days rom tno ond o tno monstrual poriod until tno
ortilo days aro ovor.
292
THE MUCUS METHOD
Tnis is a variation o tno oounting days motnod. A woman inds out wnon sno oould
booomo prognant by onooking tno muous in nor vagina ovory day. t works airly woll
or somo oouplos but not or otnors. n gonoral it oannot bo oonsidorod a vory suro
way o provonting prognanoy, but it oosts notning and nas no risks otnor tnan tnoso
tnat oomo witn prognanoy itsol. Howovor, it is moro diioult to do i tno woman nas a
vaginal inootion witn a lot o disonargo, i nor poriods aro not rogular, or i sno douonos
or wasnos out nor vagina.
Evory day, oxoopt during nor poriod, tno woman snould oxamino tno muous rom
nor vagina. Tako a littlo muous out o your vagina witn a oloan ingor and try to mako it
stroton botwoon your tnumb and oroingor, liko tnis:
As long as tno muous is stioky liko
pastonot slippory or slimyyou
probably oannot booomo prognant,
and oan oontinuo to navo soxual
rolations.
Wnon tno muous bogins to got slippory or
slimy, liko raw ogg, or i it strotonos botwoon
your ingors, you may booomo prognant
i you navo soxual rolations. So, do not
have sex when the mucus is sIippery
or stretches, or untiI 2 days after it has
stopped being sIippery or stretchy and
has become sticky again.
Tno muous will usually booomo slippory during a ow days midway botwoon your
poriods. Tnoso aro tno samo days you would not navo sox witn your man i you woro
using tno oounting days motnod.
To bo moro suro, uso tno muous and oounting days motnods togotnor. To bo still
moro suro, soo bolow. Tno muous and oounting days motnods do not protoot against
STs, inoluding Hv.
Combined Methods
you want to bo moro oortain not to booomo prognant, it oton nolps to uso
2 motnods at tno samo timo. Tno oounting days or muous motnod oombinod witn
tno uso o a oondom, diapnragm, spormioido, or spongo is suror tnan any o tnoso
motnods alono. Likowiso, i a man usos oondoms and tno woman a diapnragm, tno
onanoo o prognanoy is vory low.
293
NJECTONS. n tnis amily planning motnod, a
woman is givon in|ootions o normonos ovory 1 to 3
montns, usually at a noaltn oontor or amily planning
olinio, by somoono wno knows now. Tno irst in|ootion
oan bo givon any timo a woman and nor noaltn workor
aro roasonably suro tno woman is not prognant. Tno
in|ootion protoots against prognanoy immodiatoly i it is
givon witnin 5 days ator montnly blooding bogins. tno
in|ootion is givon 6 or moro days ator tno boginning o
montnly blooding, tno woman and nor partnor snould uso
oondoms or not navo sox or tno noxt 7 days. For moro
inormation soo pago 396.
MPLANTS aro small, sot tubos tnat aro plaood undor
tno skin on tno insido o a woman's arm. Tnoso tubos
oontain tno normono progostin and provont prognanoy
rom 6 montns to 5 yoars, doponding on tno typo o implant. Tno tubos must bo
insortod and romovod by a trainod noaltn workor, usually at a olinio or amily planning
oontor. Tnoy oan bo insortod any timo a woman and nor noaltn workor aro roasonably
suro tno woman is not prognant. a woman is broastooding, implants oan bo
insortod 6 wooks ator tno baby was born. For moro inormation soo pago 397.
METHODS FOR THOSE WHO NEVER WANT TO HAVE
MORE CHLDREN
STERLZATON. For tnoso wno novor want to navo moro onildron, tnoro aro
airly sao, simplo oporations or botn mon and womon. n many oountrios tnoso
oporations aro roo. Ask at tno noaltn oontor. Storilization doos not protoot against
STs, inoluding Hv.
For men, tno oporation is oallod a vasootomy. t oan bo
dono simply and quiokly in a dootor's oioo or a noaltn
oontor, usually witnout putting tno man to sloop. Small
outs aro mado noro so tnat tno tubos rom tno man's
tostiolos oan bo out and tiod. Tno tostiolos aro not
romovod.
Tno oporation nas no ooot on tno man's soxual
ability or ploasuro. His luid oomos |ust tno samo, but
nas no sporm in it.
For women, tno oporation is oallod a tubal ligation,
wnion moans to tio tno tubos. Ono motnod is to
mako a small out in tno lowor bolly so tnat tno tubos
ooming rom tno ovarios, or ogg-makors, oan bo out
and tiod. t oan usually bo dono in a dootor's oioo
or noaltn oontor witnout putting tno woman to sloop.
Altnougn usually suooossul, tnoro is a nignor risk o
inootion in tno oporation or womon tnan or mon.
Tnis oporation nas no ooot on tno woman's monstrual
poriods or soxual ability, and may mako naving sox moro
ploasant booauso sno doos not navo to worry about prognanoy.
294
HOME METHODS FOR PREVENTNG PREGNANCY
Evory oommunity nas traditional motnods to provont or stop prognanoy. Somo o
tnoso oan nolp limit tno numbor o onildron a oouplo nas, but tnoy aro usually not as
oootivo as modorn motnods. Somo traditional motnods oan bo narmul, and somo
do not work at all. For oxamplo, wasning out tno vagina or urinating ator sox will not
provont prognanoy.
WTHDRAWAL OR PULLNG OUT (ooitus intorruptus). Tno man pulls nis ponis out o
tno woman and away rom nor gonitals booro tno sporm oomos. Tnis motnod is bottor
tnan no motnod, but it doos not always work. Somotimos a man is not ablo to pull
out booro no o|aoulatos (oomos). Evon i tno man pulls out in timo, somo liquid tnat
oontains sporm oan loak out o nis ponis booro o|aoulation and oauso prognanoy.
BREASTFEEDNG FOR THE FRST 6 MONTHS.
Broastooding is an oootivo motnod o amily planning only
wnon tnoso 3 oonditions aro truo:
1. Tno woman's baby is loss tnan 6 montns old.
2. Tno woman nas not nad nor montnly blooding sinoo
giving birtn.
3. Tno woman is giving tno baby only broast milk, and is
ooding tno baby wnonovor no is nungrywitn no moro
tnan 6 nours botwoon oodingsday and nignt. Tno
baby doos not sloop tnrougn tno nignt witnout ooding.
THE SPONGE METHOD. Tnis is a nomo motnod tnat is not narmul and somotimos
works. You oannot bo suro it will provont prognanoy ovory timo, and it doos not protoot
against Hv or otnor STs, but it oan bo usod wnon no otnor motnod is availablo.
You will nood a spongo and oitnor vinegar, Iemons, or saIt.
Eitnor a soa spongo or an artiioial spongo will work. you do
not navo a spongo, try a ball o ootton, wild kapok, or sot olotn.
o Mix:
2 tablospoons vinogar in 1 oup oloan wator
or
1 toaspoon lomon |uioo in 1 oup oloan wator
or
1 spoon o salt in 4 spoons oloan wator
o Wot tno spongo witn ono o tnoso liquids.
o Pusn tno wot spongo doop into your vagina booro naving sox.
You oan put it in up to 1 nour booro.
o Loavo tno spongo in at loast 6 nours ator naving sox.
Tnon tako it out. you navo troublo gotting it out, noxt
timo tio a ribbon or piooo o string to it tnat you oan pull.
Tno spongo oan bo wasnod and usod again, many timos.
Koop it in a oloan, dry plaoo.
You oan mako up tno liquid in advanoo and koop it in a bottlo.
295
WHAT TO DO TO PROTECT CHLDREN'S HEALTH
Cnaptors 11 and 12 toll moro about tno importanoo o nutritious ood, oloanlinoss,
and vaooination. Paronts snould road tnoso onaptors oaroully and uso tnom to nolp
oaro orand toaontnoir onildron. Tno main points aro brioly ropoatod noro.
Nutritious Food
t is important tnat onildron oat tno most nutritious oods tnoy oan got, so tnat tnoy
grow woll and do not got siok.
Tno bost oods or onildron at dioront agos aro:
o in tno irst 6 montns: breast miIk and notning moro.
o rom 6 montns to 1 yoar: breast miIk and also other nutritious foods
suon as boilod ooroals, masnod-up boans, oggs, moat, oookod ruits and
vogotablos.
o rom 1 yoar on: tno onild snould oat tno same foods as aduItsbut more
often. To tno main ood (rioo, maizo, wnoat, potatoos, or oassava) add 'nolpor
oods' as disoussod in Cnaptor 11.
o Abovo all, onildron snould got enough to oatsovoral timos a day.
o All paronts snould waton or signs o malnutrition in tnoir onildron and snould
givo tnom tno bost ood tnoy oan.
NUTRITIOUS FOOD, CLEANLINESS, AND VACCINATIONS
ARE THE THREE IMPORTANT BODY GUARDS` THAT
KEEP CHILDREN HEALTHY AND PROTECT THEM AGAINST MANY SICKNESSES.
CHAPTER
21
Health and Sicknesses
of Children
296
Cleanliness
Cnildron aro moro likoly to bo noaltny i tnoir villago, tnoir nomos, and tnoy
tnomsolvos aro kopt oloan. Follow tno Guidolinos o Cloanlinoss oxplainod in
Cnaptor 12. Toaon onildron to ollow tnomand to undorstand tnoir importanoo. Horo
tno most important guidolinos aro ropoatod:
Batno onildron and onango tnoir olotnos oton.
Toaon onildron always to wasn tnoir nands wnon tnoy got up in tno morning, ator
tnoy navo a bowol movomont, and booro tnoy oat or nandlo ood.
Mako latrinos or 'outnousos'and toaon onildron to uso tnom.
Wnoro nookworm oxists, do not lot onildron go barooot; uso sandals or snoos.
Toaon onildron to brusn tnoir tootn; and do not givo tnom a lot o oandios, swoots,
or oarbonatod drinks.
Cut ingornails vory snort.
Do not lot onildron wno aro siok or navo soros, soabios, lioo, or ringworm sloop
witn otnor onildron or uso tno samo olotning or towols.
Troat onildron quiokly or soabios, ringworm, intostinal worms, and otnor
inootions tnat sproad oasily rom onild to onild.
Do not lot onildron put dirty tnings in tnoir moutns or lot dogs or oats liok tnoir
aoos.
Koop pigs, dogs, and oniokons out o tno nouso.
Uso only puro, boilod, or iltorod wator or drinking. Tnis is ospooially important
or babios.
Do not ood babios rom 'baby bottlos', booauso tnoso aro nard to koop oloan
and oan oauso illnoss. Food babios witn a oup and spoon.
Vaccinations
vaooinations protoot onildron against many
o tno most dangorous disoasos o onildnood
wnooping oougn, dipntnoria, totanus, polio,
moaslos, tuboroulosis, nopatitis, and rotavirus.
Cnildron snould bo givon tno dioront
vaooinations at dioront agos, as snown on
pago 147. Polio vaooinos snould bo irst givon i
possiblo at birtn, but no lator tnan
2 montns o ago, booauso tno risk o dovoloping
inantilo paralysis (polio) is nignost in babios
undor 1 yoar old.
Totanus o tno nowborn oan bo provontod by vaooinating motnors against totanus
during prognanoy (soo p. 250).
Be sure your chiIdren get aII the vaccinations they need.
DO THS
polio vaccine
AND
PREVENT
THS
297
A onild wno gains woignt moro slowly tnan otnor onildron, stops gaining woignt,
or is losing woignt is not noaltny. Ho may not bo oating onougn or no may navo a
sorious illnoss, or botn.
A good way to onook wnotnor a onild is noaltny and is gotting onougn nutritious
ood is to woign nim oaon montn and soo i no gains woignt normally. a montnly
rooord o tno onild's woignt is kopt on a Cnild Hoaltn Cnart, it is oasy to soo at a
glanoo wnotnor tno onild is gaining woignt normally.
Wnon usod woll, tno onarts toll motnors and noaltn workors wnon a onild is not
growing normally, so tnoy oan tako oarly aotion. Tnoy oan mako suro tno onild gots
moro to oat, and oan onook or and troat any illnoss tno onild may navo.
On tno noxt pago is a typioal Cnild Hoaltn Cnart snowing tno 'road to noaltn'. Tnis
onart oan bo out out and oopiod. Or largor, roady-mado oards oan bo obtainod (in
Englisn, Spanisn, Portuguoso, or Zulu) rom Toaoning Aids at Low Cost (TALC, soo
p. 431 or addross). Similar onarts aro produood in looal languagos by tno Hoaltn
Dopartmonts in many oountrios.
t is a good idoa or ovory motnor to koop a Cnild Hoaltn Cnart or oaon o nor
onildron undor 5 yoars o ago. tnoro is a noaltn oontor or 'undor-ivos olinio'
noarby, sno snould tako nor onildron, witn tnoir onarts, to bo woignod and to navo a
'onook-up' oaon montn. Tno noaltn workor oan nolp oxplain tno Cnart and its uso. To
protoot tno Cnart, koop it in a plastio onvolopo.
HOMEMADE BEAM SCALE
You oan mako a boam soalo o dry wood or bamboo.
Plaoo all nooks as snown and nang tno soalo. To mako
kg. marks on tno boam, ill 2 plastio ono-litor bottlos witn
wator. Plaoo tno irst bottlo wnoro baby would nang.
Hang tno sooond bottlo, and wnoro boam balanoos,
mako tno 1 kg. mark, and so on. Witn a rulor, moasuro
tno distanoo botwoon tno marks, and mako marks or
200, 400, 600, and 800 grams.
CHLDREN'S GROWTH-AND THE 'ROAD TO HEALTH'
A noaltny onild grows stoadily. no oats onougn nutritious ood,
and nas no sorious illnoss, a onild gains woignt oaon montn.
A chiId who grows weII is heaIthy.
Tno growtn onart
slips in bonind tno
soalos so you oan
mark tno onild's
woignt dirootly
onto tno onart.
t is bost to nang
tnis and otnor
soalos oloso to tno
ground. A baby
may bo soarod o
nanging up nign.
DRECT
RECORDNG
SCALE
availablo
rom TALC
(soo p. 431)
two hooks about 5 cm. apart
scale hangs Irom this hook
beam (1 meter long)
movable weight
(about 1 kilogram)
Woignt is oorroot wnon boam stays norizontal.
child
holder
298
SIDE ONE
G
R
O
W
T
H

C
U
R
V
E

W
H
O

r
e
c
o
m
m
e
n
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e
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C
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i
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G
r
o
w
t
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S
t
a
n
d
a
r
d
s

2
0
0
6
U
P
P
E
R
L
I
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E
:

5
0
T
H

C
E
N
T
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B
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,

L
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W
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R
L
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:

3
r
d

C
E
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T
I
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G
I
R
L
S
299
SIDE TWO
300
Writo tno montn tno baby was born
in tno irst squaro or oaon yoar.
Tnis onart snows tno baby was born in Maron.
How to Use the Child Health Chart
FIRST,
simple
hanging
scales
WATCH THE DRECTON
OF THE LNE SHOWNG
THE CHLD'S GROWTH
Tnon look or tno prosont montn at
tno bottom o tno oart (in tnis oaso,
August o tno baby's irst yoar).
writo tno
montns o
tno yoar
in tno littlo
squaros at
tno bottom
o tno onart.
SECOND, woign tno onild.
Lot us supposo tnat a onild was born in April. t is
now August, and tno onild woigns 6 kilograms.
THIRD, look at tno oard.
Kilograms aro writton on tno sido o tno oard.
Look or tno numbor o kilograms tno onild woigns
(in tnis oaso, 6).
VERY DANGEROUS
Losing weight.
May be ill, needs
extra care.
DANGER
Not gaining weight
find out why
GOOD
Child growing well
WRTE ON THE CHART
Any illness e.g. diarrhea
measles
Admission to hospital
Solids introduced
Breastfeeding stopped
Birth of next child
like this-
301
FOURTH, ollow tno
lino tnat goos
out rom tno 6
t is oasy to know wnoro to put tno
dot i you nold a squaro piooo o
papor against tno onart.
Eaon montn woign tno
onild and put anotnor
dot on tno onart.
tno onild is noaltny,
oaon montn tno now
dot will bo nignor on
tno onart tnan tno last.
To soo now woll tno
onild is growing, |oin
tno dots witn linos.
1 Lino up ono
odgo o tno
papor witn tno
onild's woignt.
and
tno linos tnat go
up rom August.
302
How to Read the Child Health Chart
Tno 2 long ourvod linos on tno onart
mark tno 'Poad to Hoaltn' tnat a onild's
woignt snould ollow.
Tno lino o dots marks tno onild's
woignt rom montn to montn, and
rom yoar to yoar.
n most normal, noaltny onildron,
tno lino o dots alls botwoon tno 2 long
ourvod linos. Tnat is wny tno spaoo
botwoon tnoso linos is oallod tno Poad
to Hoaltn.
tno lino o dots risos stoadily, montn
ator montn, in tno samo dirootion as tno
long ourvod linos, tnis is also a sign
tnat tno onild is noaltny.
A heaIthy chiId wno gots onougn nourisning ood usually bogins to sit, walk,
and spoak at about tno timos snown noro.
Walks 10 steps
without help.
Sits
without
help.
6 to 8 months
12 to 16
months
11 to 18
months
Single
words.
Short
phrases.
third year
Typioal onart o
THE HEALTHY,
WELL-NOURISHED
CHILD
In the healthy,
well-nourished
child, the
weight rises
steadily. The
dots usually lie
inside the lines
that mark the
Road to Health.
303
A maInourished, sickIy chiId may navo a onart liko tno ono bolow. Notioo tnat
tno lino o dots (nis woignt) is bolow tno Poad to Hoaltn. Tno lino o dots is also
irrogular and doos not riso muon. Tnis snows tno onild is in dangor.
Typioal onart o
THE UNDERWEIGHT
OR MALNOURISHED
CHILD
A onild witn a onart liko tno ono abovo is soriously undorwoignt. Pornaps
no is not gotting onougn ood. Or pornaps no nas a disoaso liko tuboroulosis or
malaria. Or botn. Ho snould bo givon more energy-rich foods more often. Ho
snould also bo onookod or tostod or possiblo illnossos, and visit a noaltn workor
roquontly until nis onart snows no is gaining woignt woll.
IMPORTANT: Watch the direction of the Iine of dots.
Tno dirootion o tno lino o dots tolls moro about tno onild's noaltn tnan
wnotnor tno dots aro insido or bolow tno two ourvod linos. For oxamplo:
DANGER! Tnis onild is not gaining woignt.
Dots show that the
child has not been
gaining weight well,
and during the last
months has lost weight.
Although the dots Ior
this child are below the
2 curved lines, their
upward direction shows
the child is growing
well. Some children are
naturally smaller than
others. Perhaps this
child`s parents are also
smaller than average.
WATCH THE DRECTON
OF THE LNE SHOWNG
THE CHLD'S GROWTH
GOOD
Child growing well
DANGER
Not gaining weight
find out why
VERY DANGEROUS
Losing weight.
May be ill;
needs extra care
Although the dots Ior
this child are within
the curved lines. the
child has not been
gaining weight well
Ior several months.
GOOD! Tnis onild is gaining woignt woll.
304
A TYPCAL CHILD HEALTH CHART SHOWING A CHILDS PROGRESS:
At 6 months, the mother
became pregnant
again and stopped
breastIeeding him. The
baby was Ied little more
than corn and rice. He
stopped gaining weight.
At 10 months he
developed chronic
diarrhea and began
losing weight. He
became very thin
and sick.
When the child was
13 months old, his mother
learned about ways to give
the child enough good Iood,
even without a lot oI money
or land. He began gaining
weight Iast. By age 2 he was
back on the Road to Health.
breast
Ied
poorly
Ied
diarrhea
well
Ied
good
weight
gain
poor
weight
gain
weight
loss
good
weight
gain
oII breast
at 6 months
diarrhea begins
at 10 months
nutritious Ieeding
begins at 13 months
This baby was
healthy and gained
weight well Ior the
frst 6 months oI
liIe, because his
mother breastIed
him.
Cnild Hoaltn Cnarts aro important. When used correctIy, they heIp mothers know
when their chiIdren need more nutritious food and speciaI attention. Tnoy nolp
noaltn workors bottor undorstand tno noods o tno onild and nis amily. Tnoy also lot tno
motnor know wnon sno is doing a good |ob.
305
REVEW OF CHLDREN'S HEALTH PROBLEMS
DSCUSSED N OTHER CHAPTERS
Many o tno sioknossos disoussod in otnor onaptors o tnis book aro ound in
onildron. Horo somo o tno moro roquont probloms aro roviowod in brio. For moro
inormation on oaon problom, soo tno pagos indioatod.
For spooial oaro and probloms o nowborn babios, soo p. 270 to 275, and p. 405.
Remember: n onildron, sioknossos oton booomo sorious vory quiokly. An illnoss
tnat takos days or wooks to sovoroly narm or kill an adult may kill a small onild in
nours. So, it is important to notice earIy signs of sickness and attend to them
right away.
Malnourished Children
Many onildron aro malnourisnod booauso tnoy do not got onougn to oat. Or i
tnoy oat mainly oods witn a lot o wator and ibor in tnom, liko oassava, taro root, or
maizo gruol, tnoir bollios may got ull booro tnoy got onougn onorgy ood or tnoir
bodios' noods. Also, somo onildron may laok oortain tnings in tnoir ood, liko vitamin
A (soo p. 226) or iodino (soo p. 130). For a ullor disoussion o tno oods onildron
nood, road Cnaptor 11, ospooially pagos 120 to 122.
THESE TWO CHILDREN ARE MALNOURISHED
NOT VERY SERIOUS SERIOUS
small
underweight
big belly
thin arms
and legs
sad
underweight (he may gain
weight Ior a while because
oI swelling)
dark spots, peeling skin, or
open sores
swollen Ieet
306
Diarrhea and Dysentery
(For moro oomploto inormation soo p. 153 to 160.)
Tno groatost dangor to onildron witn diarrnoa is
dehydration, or losing too muon liquid rom tno body. Tno
dangor is ovon groator i tno onild is also vomiting. Givo
Rehydration Drink (p. 152). tno onild is broastooding,
continue giving breast miIk, but givo Ponydration Drink also.
Tno sooond big dangor to onildron witn diarrnoa is
malnutrition. Give the chiId nutritious food as soon as he
wiII eat.
Fever (see p. 75)
n small onildron, nign ovor (ovor 39) oan oasily
oauso soizuros. To lowor ovor, take the cIothes off
tno onild. sno is orying and sooms unnappy, givo nor
acetaminophen (paraootamol) or ibuproon in tno rignt
dosago (soo p. 379), and givo nor lots o liquids. sno is
vory not and snaky, wet her with cooI (not coId) water
and fan her. Also try to ind tno oauso o tno ovor and troat it.
Malnutrition may oauso many dioront probloms in onildron, inoluding:
In more serious cases:
littlo or no woignt gain
swolling o oot (somotimos aoo also)
dark spots, 'bruisos', or opon pooling
soros
tninnoss or loss o nair
laok o dosiro to laugn or play
soros insido moutn
ailuro to dovolop normal intolligonoo
'dry oyos' (xoropntnalmia)
blindnoss (p. 226)
Prevent and treat maInutrition by giving your chiIdren ENOUGH TO EAT
and by feeding them MORE OFTEN. Add some high energy food,
such as oiI or fat, to the main food the chiId eats. AIso try to add
some body-buiIding and protective foods Iike
beans, IentiIs, fruits, vegetabIes, and if possibIe, miIk, eggs, fish or meat.
In miId cases:
slowor growtn

swollon bolly
tnin body
loss o appotito
loss o onorgy
palonoss (anomia)
dosiro to oat dirt (anomia)
soros in oornors o moutn
roquont oolds and otnor

inootions
nignt blindnoss
Sovoro orms o gonoral malnutrition aro 'dry malnutrition' or marasmus, and
'wot malnutrition' or kwasniorkor. Tnoir oausos and provontion aro disoussod on
p. 112 and 113.
Signs o malnutrition aro oton irst soon ator an aouto illnoss liko diarrnoa or
moaslos. A onild wno is siok, or wno is gotting woll ator a sioknoss, nas an ovon
groator nood or onougn good ood tnan a onild wno is woll.
307
Seizures (Fits, Convulsions) (see p. 178)
Common oausos o soizuros or oonvulsions
in onildron aro nign ovor, donydration, opilopsy,
malaria, and moningitis. ovor is nign, lowor it
rapidly (soo p. 76). Cnook or signs o donydration
(p. 151), malaria (p. 186), and moningitis (p. 185).
Soizuros tnat oomo suddonly witnout ovor or otnor
signs aro probably opilopsy (p. 178), ospooially i tno onild sooms woll botwoon
tnom. Soizuros or spasms in wnion irst tno |aw and tnon tno wnolo body booomo
sti may bo totanus (p. 182).
Meningitis (see p. 185)
Tnis dangorous disoaso may oomo as a
oomplioation o moaslos, mumps, or anotnor sorious
illnoss. Cnildron o motnors wno navo tuboroulosis
may got tuboroular moningitis. A vory siok onild
wno lios witn nis noad tiltod way baok, wnoso nook
is too sti to bond orward, and wnoso body makos
strango movomonts (soizuros) may navo moningitis.
Anemia (see p. 124)
Common signs in children:
palo, ospooially insido oyolids, gums, and ingornails
woak, tiros oasily
likos to oat dirt
Common causes:
diot poor in iron (p. 124)
onronio gut inootions (p. 145)
nookworm (p. 142)
malaria (p. 186)
Prevention and Treatment:
o Eat iron-rion oods liko moat and oggs. Boans,
lontils, groundnuts (poanuts), and dark groon vogotablos also
navo somo iron.
o Troat tno oauso o anomiaand do not go barooot i nookworm is oommon.
o you suspoot nookworm, a noaltn workor may bo ablo to look at tno onild's
stools undor a miorosoopo. nookworm oggs aro ound, troat or nookworm
(p. 373 to 375).
o nooossary, givo iron salts by moutn (orrous sulato, p. 392).
CAUTION: Do not give iron tabIets to a baby or smaII chiId.
They couId poison her. Instead, give iron as a Iiquid.
Or crush a tabIet into powder and mix it with food.
308
Worms and Other Parasites of the Gut (see p. 140)
ono onild in tno amily nas worms, all tno amily snould bo troatod.
To provont worm inootions, onildron snould:
o Obsorvo tno Guidolinos o Cloanlinoss (p. 133).
o Uso latrinos.
o Novor go barooot.
o Novor oat raw or partly raw moat or isn.
o Drink only boilod or puro wator.
Skin Problems (see Chapter 15)
Those most common in chiIdren incIude:
soabios (p. 199)
inootod soros and impotigo (p. 201 and 202)
ringworm and otnor ungus inootions (p. 205)
To prevent skin problems, observe the Guidelines of
Cleanliness (p. 133).
o Batno and dolouso onildron oton.
o Control bodbugs, lioo, and soabios.
o Do not lot onildron witn soabios, lioo, ringworm, or
inootod soros play or sloop togotnor witn otnor onildron. Troat tnom oarly.
Pink Eye (Conjunctivitis) (see p. 219)
Wipo tno oyolids oloan witn a oloan wot olotn
sovoral timos a day. Put an antibiotio oyo ointmont
(p. 378) inside tno oyolids 3 or 4 timos a day. Do not
lot a onild witn pink oyo play or sloop witn otnors. no
doos not got woll in a ow days, soo a noaltn workor.
Colds and the 'Flu' (see p. 163)
Tno oommon oold, witn runny noso, mild ovor,
oougn, oton soro tnroat, and somotimos diarrnoa is a
roquont but not a sorious problom in onildron.
Troat witn lots o liquids. Givo aootaminopnon (soo
p. 379). Lot onildron wno want to stay in bod do so.
Good ood and lots o ruit nolp onildron avoid oolds
and got woll quiokly.
Ponioillin, totraoyolino, and otnor antibiotios do no
good or tno oommon oold or 'lu'. n|ootions aro not
noodod or oolds.
a onild witn a oold booomos vory ill, witn nign ovor and snallow,
rapid broatning, no may bo gotting pneumonia (soo p. 171), and antibiotios snould
bo givon. Also waton or an oar inootion (noxt pago) or 'strop tnroat' (p. 310).
309
HEALTH PROBLEMS OF CHLDREN
NOT DSCUSSED N OTHER CHAPTERS
Earache and Ear nfections
Ear inootions aro oommon in small onildron. Tno inootion
oton bogins ator a ow days witn a oold or a stuy noso. Tno
ovor may riso, and tno onild oton orios or rubs tno sido o nis
noad. Somotimos pus oan bo soon in tno oar. n small onildron
an oar inootion somotimos oausos vomiting or diarrnoa. So
wnon a onild nas diarrnoa and ovor bo suro to onook nis oars.
Treatment:
o t is important to troat oar inootions oarly. Givo an antibiotio liko ponioillin
(p. 350) or ootrimoxazolo (p. 357). n onildron undor 3 yoars o ago, ampioillin
(p. 352) oton works bottor. Givo aootaminopnon (p. 379) or pain.
o Caroully oloan pus out o tno oar witn ootton, but do not put a plug o ootton,
a stiok, loavos, or anytning olso in tno oar.
o Cnildron witn pus ooming rom an oar snould batno rogularly but snould not
swim or divo or at loast 2 wooks ator tnoy aro woll.
Prevention:
o Toaon onildron to wipo but not to blow tnoir nosos wnon tnoy navo a oold.
o Do not bottlo ood babiosor i you do, do not lot baby ood lying on nis baok,
as tno milk oan go up nis noso and load to an oar inootion.
o Wnon onildron's nosos aro pluggod up, uso salt drops and suok tno muous out
o tno noso as dosoribod on p. 164.
Infection in the ear canaI:
To ind out wnotnor tno oanal or tubo going into tno oar is inootod, gontly pull tno
oar. tnis oausos pain, tno oanal is inootod. Put drops o wator witn vinogar in tno
oar 3 or 4 timos a day. (Mix 1 spoon o vinogar witn 1 spoon o boilod wator.) tnoro
is ovor or pus, also uso an antibiotio.
Sore Throat and nflamed Tonsils
Tnoso probloms oton bogin witn tno oommon
oold. Tno tnroat may bo rod and nurt wnon tno onild
swallows. Tno tonsils (two lympn nodos soon as lumps
on oaon sido at tno baok o tno tnroat) may booomo
largo and painul or drain pus. Fovor may roaon 40.
Treatment:
o Garglo witn warm salt wator (1 toaspoon o salt in
a glass o wator).
o Tako aootaminopnon or pain.
o Bo suro tno onild drinks onougn, ovon i it nurts to
swallow. Try giving toa or watorod down ruit |uioo.
pain and ovor oomo on suddonly or oontinuo or
moro tnan 3 days, soo tno ollowing pago.
pus
310
Sore throat and the danger of rheumatic fever:
For tno soro tnroat tnat oton oomos witn tno oommon oold or lu, antibiotios
snould usually not bo usod and will do no good. Troat witn garglos and
aootaminopnon.
Howovor, ono kind o soro tnroatoallod strep throatsnould bo troatod witn
ponioillin. t is most oommon in onildron and young adults. t usually bogins suddonly
witn sovoro soro tnroat and nign ovor, oton witnout signs o a oold or oougn. Tno
baok o tno moutn and tonsils booomo vory rod, and tno lympn nodos undor tno |aw or
in tno nook may booomo swollon and tondor.
Givo ponioillin (p. 350) or 10 days. ponioillin is givon oarly and oontinuod or
10 days, tnoro is loss dangor o gotting rnoumatio ovor. A onild witn strop tnroat
snould oat and sloop ar apart rom otnors, to provont tnoir gotting it also.
Rheumatic Fever
Tnis is a disoaso o onildron and young adults. t usually bogins 1 to 3 wooks ator
tno porson nas nad a strop tnroat (soo abovo).
Principal signs (usually only some of these signs are present):
ovor
|oint pain, ospooially in tno
wrists and anklos, lator tno
knoos and olbows. Joints
booomo swollon, and oton
not and rod.
ourvod rod linos or lumps
undor tno skin
unoontrollod movomonts
in moro sorious oasos,
woaknoss, snortnoss o broatn,
and pornaps onost pain
Treatment:
o you suspoot rnoumatio ovor, soo a noaltn workor. Tnoro is a risk tnat tno noart
may booomo damagod.
o Givo ponioillin (soo p. 350).
o Tako aspirin in largo dosos (p. 378). A 12-yoar-old oan tako up to 2 tablots o
300 mg. 4 timos a day. Tako tnom togotnor witn milk or ood to avoid stomaon
pain. tno oars bogin to ring, tako loss.
Prevention:
o To provont rnoumatio ovor, troat 'strop tnroat' oarly witn ponioillinor 10 days.
o To provont roturn o rnoumatio ovor, and addod noart damago, a onild wno nas
onoo nad rnoumatio ovor snould tako ponioillin or 10 days at tno irst sign o a
soro tnroat. no alroady snows signs o noart damago, no snould tako ponioillin
on a rogular basis or navo montnly in|ootions o bonzatnino ponioillin (p. 351)
pornaps or tno rost o nis lio. Follow tno advioo o an oxporionood noaltn
workor or dootor.
311
NFECTOUS DSEASES OF CHLDHOOD
Chickenpox
Tnis mild virus inootion bogins 2 to 3 wooks ator a onild is
oxposod to anotnor onild wno nas tno disoaso.
Signs:
First many small, rod, itony spots appoar. Tnoso turn into littlo pimplos or blistors
tnat pop and inally orm soabs. Usually tnoy bogin on tno body, and lator on tno
aoo, arms, and logs. Tnoro may bo spots, blistors, and soabs, all at tno samo timo.
Fovor is usually mild.
Treatment:
Tno inootion usually goos away in a wook. Batno tno onild daily witn soap and
warm wator. To oalm itoning, apply oool olotns soakod in wator rom boilod and
strainod oatmoal. Cut ingornails vory snort. tno soabs got inootod, koop tnom
oloan. Apply not, wot oomprossos, and put an antibiotio ointmont on tnom. Try to
koop tno onild rom soratoning.
Measles
Tnis sovoro virus inootion is especiaIIy dangerous
in chiIdren wno aro poorIy nourished or navo
tubercuIosis. Ton days ator boing noar a porson witn
moaslos, it bogins witn signs o a ooldovor, runny
noso, rod soro oyos, and oougn.
Tno onild booomos inoroasingly ill. Tno moutn may
booomo vory soro and no may dovolop diarrnoa.
Ator 2 or 3 days a ow tiny wnito spots liko salt grains appoar in tno moutn. A day
or 2 lator tno rasn appoarsirst bonind tno oars and on tno nook, tnon on tno aoo
and body, and last on tno arms and logs. Ator tno rasn appoars, tno onild usually
bogins to got bottor. Tno rasn lasts about 5 days. Somotimos tnoro aro soattorod
blaok spots oausod by blooding into tno skin ('blaok moaslos'). Tnis moans tno
attaok is vory sovoro. Got modioal nolp.
Treatment:
o Tno onild snould stay in bod, drink lots o liquids, and bo givon nutritious ood.
sno oannot swallow solid ood, givo nor liquids liko soup. a baby oannot
broastood, givo broast milk in a spoon (soo p. 120).
o possiblo, givo vitamin A to provont oyo damago (p. 391).
o For ovor and disoomort, givo aootaminopnon (or ibuproon).
o oaraono dovolops, givo an antibiotio (p. 350).
o signs o pnoumonia, moningitis, or sovoro pain in tno oar or stomaon
dovolop, got modioal nolp.
o tno onild nas diarrnoa, givo Ponydration Drink (p. 152).
spots.
blisters, and
scabs
312
German Measles
Gorman moaslos aro not as sovoro as rogular moaslos. Tnoy last 3 or 4 days.
Tno rasn is mild. Oton tno lympn nodos on tno baok o tno noad and nook booomo
swollon and tondor. Tnoro is oton a low ovor.
Tno onild snould stay in bod and tako aootaminopnon or ibuproon i nooossary.
Womon wno got Gorman moaslos in tno irst 3 montns o prognanoy may givo birtn
to a onild witn a disability. For tnis roason, pregnant women wno navo not yot nad
Gorman moaslosor aro not suroshouId keep far away rom onildron wno navo
tnis kind o moaslos. Girls or womon wno aro not prognant oan try to oaton Gorman
moaslos booro tnoy got prognant. A vaooino oxists or Gorman moaslos, but is not
oton availablo.
Mumps
Tno irst symptoms bogin 2 or 3 wooks ator boing oxposod
to somoono witn mumps.
Mumps bogin witn ovor and pain on oponing tno moutn
or oating. n 2 days, a sot swolling appoars bolow tno oars at
tno anglo o tno |aw. Oton it oomos irst on ono sido, and lator
on tno otnor sido.
Treatment:
Tno swolling goos away by itsol in about 10 days, witnout nood or modioino.
Aootaminopnon or ibuproon oan bo takon or pain and ovor. Food tno onild sot,
nourisning oods and koop nis moutn oloan.
Complications:
n adults and onildron ovor 11 yoars o ago, ator tno irst
wook tnoro may bo pain in tno bolly or a painul swolling o tno
tostiolos in mon. Porsons witn suon swolling snould stay quiot
and put ioo paoks or oold wot olotns on tno swollon parts to
nolp roduoo tno pain and swolling.
signs o moningitis or noaring probloms appoar, got
modioal nolp (p. 185).
Prevention of measles:
Cnildron witn moaslos snould koop ar away rom otnor onildron, ovon rom brotnors
and sistors. Espooially try to protoot onildron wno aro poorly nourisnod or wno navo
tuboroulosis or otnor onronio illnossos. Cnildron rom otnor amilios snould not go into
a nouso wnoro tnoro is moaslos. onildron in a amily wnoro tnoro is moaslos navo not
yot nad moaslos tnomsolvos, tnoy snould not go to sonool or into storos or otnor publio
plaoos or 10 days.
To prevent measIes from kiIIing chiIdren, make sure aII
chiIdren are weII-nourished. And have your chiIdren
vaccinated against measIes.
313
Whooping Cough
Wnooping oougn bogins a wook or two ator
boing oxposod to a onild wno nas it. t starts liko a
oold witn ovor, a runny noso, and oougn.
Two wooks lator, tno wnoop bogins. Tno onild
oougns rapidly many timos witnout taking a
broatn, until sno oougns up a plug o stioky
muous, and tno air rusnos baok into nor lungs
witn a loud wnoop. Wnilo sno is oougning, nor
lips and nails may turn bluo or laok o air. Ator
tno wnoop, sno may vomit. Botwoon oougning
spolls tno onild sooms airly noaltny.
Wnooping oougn oton lasts 3 montns or moro.
Wnooping oougn is especiaIIy dangerous in babies undor 1 yoar o ago, so
vaooinato onildron oarly. Small babios do not dovolop tno typioal wnoop so it is nard
to bo suro i tnoy navo wnooping oougn or not. a baby gots its o oougning and
swollon or puy oyos wnon tnoro aro oasos o wnooping oougn in your aroa, troat
nor or wnooping oougn at once.
Treatment:
o Antibiotios aro nolpul only in tno oarly stago o wnooping oougn, booro tno
wnoop bogins. t is ospooially important to troat babios undor 6 montns at
tno irst sign. Uso orytnromyoin (p. 354). you do not navo orytnromyoin, try
ootrimoxazolo (p. 357), but only uso ootrimoxazolo or onildron ovor 8 wooks old.
o tno oougn oausos oonvulsions, pnonobarbital (p. 389) may nolp.
o tno baby stops broatning ator a oougn, turn nor ovor and pull tno stioky
muous rom nor moutn witn your ingor. Tnon slap nor on tno baok witn tno lat
o your nand.
o To avoid woignt loss and malnutrition, bo suro tno onild gots onougn nutritious
ood. Havo nor oat and drink snortly ator sno vomits.
Complications:
A brignt rod nomorrnago (blooding) insido tno wnito o tno oyos may bo oausod
by tno oougning. No troatmont is nooossary (soo p. 224). soizuros or signs o
pnoumonia dovolop (p. 171), got modioal nolp.
Protect aII chiIdren against whooping cough. See that
they are vaccinated at 2, 4, 6, and 18 months of age.
Diphtheria
Tnis bogins liko a oold witn ovor, soro tnroat, and noarso
voioo. A yollow-gray ooating or mombrano may orm in tno baok
o tno tnroat, and somotimos in tno noso and on tno lips. Tno
onild's nook may booomo swollon. His broatn smolls vory bad.
314
If you suspect that a child has diphtheria:
o Put nim to bod in a room soparato rom otnor porsons.
o Got modioal nolp quiokly. Tnoro is spooial antitoxin or dipntnoria.
o Givo ponioillin, 1 tablot o 400,000 units, 3 timos a day or oldor onildron. Or givo
orytnromyoin (p. 354).
o Havo nim garglo warm wator witn a littlo salt.
o Havo nim broatno not wator vapors oton or oontinually (p. 168).
o Havo nim sip liquids oton, ovon i it nurts to swallow.
o tno onild bogins to onoko and turn bluo, try to romovo tno mombrano rom nis
tnroat using a olotn wrappod around your ingor.
Dipntnoria is a dangorous disoaso tnat oan oasily bo provontod witn tno DPT
vaooino. Be sure your chiIdren are vaccinated.
nfantile Paralysis (Polio, Poliomyelitis)
Polio is most oommon in onildron undor 2. t is oausod by
a virus inootion similar to a oold, oton witn ovor, vomiting,
diarrnoa, and soro musolos. Usually tno onild gots
oomplotoly woll in a ow days. But somotimos a part o
tno body booomos woak or paralyzod. Most oton tnis
nappons to ono or botn logs. n timo, tno woak limb
booomos tnin and doos not grow as ast as tno otnor ono.
Treatment:
Onoo tno disoaso nas bogun, no modioino will
oorroot tno paralysis. (Howovor, somotimos part or
all o tno lost strongtn slowly roturns.) Antibiotios
do not nolp. For oarly troatmont, oalm tno pain witn
aootaminopnon or ibuproon and put not soaks on
painul musolos. Position tno onild to bo oomortablo
and avoid oontraoturos. Gontly straignton nis arms
and logs so tnat tno onild lios as straignt as possiblo.
Put ousnions undor nis knoos, i nooossary to roduoo
pain, but try to koop nis knoos straignt.
Prevention:
o vaooination against polio is tno bost protootion (soo p. 147).
o Do not givo in|ootions o any modioino to a onild i you tnink nis signs o a oold
or ovor, mignt bo oausod by tno polio virus. Altnougn it nappons only raroly, tno
irritation oausod by an in|ootion oould turn a mild oaso o polio witnout paralysis
into a sovoro oaso, witn paralysis. Never inject chiIdren with any medicine
unIess it is absoIuteIy necessary.
o Broastood your baby as long as possiblo. Broast milk protoots your baby against
inootions, inoluding polio.
Vaccinate aII chiIdren against poIio.
315
A onild wno nas boon paralyzod by polio
snould oat nutritious ood and do oxoroisos to
strongtnon romaining musolos.
Holp tno onild loarn to walk as bost no oan.
Fix 2 polos or support, liko tnoso, and lator
mako nim somo orutonos. Log braoos (oalipors),
orutonos, and otnor aids may nolp tno onild to
movo bottor and may provont doormitios.
For moro inormation on polio and otnor onildnood disabilitios,
soo Disabled Village Children, also publisnod by Hosporian.
HOW TO MAKE SMPLE CRUTCHES
316
PROBLEMS CHLDREN ARE BORN WTH
Dislocated Hip
Somo onildron aro born witn a dislooatod niptno log nas slippod out o its |oint
in tno nip bono. Early oaro oan provont lasting narm and a limp. So babios snould bo
onookod or possiblo nip dislooation at about 10 days ator birtn.
1. Comparo tno 2 logs. ono nip is dislooatod,
tnat sido may snow:
Tno uppor log partly oovors tnis part o tno body on tno
dislooatod sido.
Tnoro aro owor olds noro.
Tno log sooms snortor or turns out at a strango anglo.
2. Hold botn logs
witn tno knoos
doublod,
liko tnis,
and opon tnom
wido liko tnis.
ono log stops oarly or makos a |ump or oliok wnon you
opon it wido, tno nip is dislooatod.
Treatment:
Carry tno baby witn nor knoos nign and wido apart, liko tnis:
Cnook tno baby again in 2 wooks. you still ool or noar a
|ump or oliok, soo a noaltn workor. A narnoss tnat nolds tno
baby's logs opon or 2 wooks oan provont lasting narm.
317
Umbilical Hernia (Belly Button that Sticks Out)
A 'Swollen Testicle' (Hydrocele or Hernia)
a baby's scrotum, or bag tnat nolds nis tostiolos, is
swollon on ono sido, tnis is usually booauso it is illod witn
liquid (a nydrooolo) or booauso a loop o gut nas slippod
into it (a nornia).
To ind out wnion is tno oauso, snino a lignt tnrougn
tno swolling.
Evon a big umbilioal
nornia liko tnis ono is not
dangorous and will oton
go away by itsol. is is
still tnoro ator ago 5, an
oporation may bo noodod.
Got modioal advioo.
You oan toll tnis rom a
swollon lympn nodo
(p. 88) booauso tno
nornia swolls wnon tno
baby orios or is nold
uprignt and disappoars
wnon no lios quiotly.
A nornia noods surgory
(soo p. 177).
lignt doos not snino tnrougn,
and i tno swolling gots biggor
wnon tno baby oougns or orios,
it is a hernia.
Somotimos tno hernia
oausos a swolling noro
in oitnor a boy
or a girl.
A bolly button tnat stioks
out liko tnis is no
problom. No modioino
or troatmont is noodod.
Tying a tignt olotn or
'bolly band' around tno
bolly will not nolp.
A nydrooolo usually goos away
in timo, witnout troatmont.
it lasts moro tnan a yoar, got
modioal advioo.
lignt sninos tnrougn oasily,
it is probably a hydroceIe.
318
MENTALLY SLOW, DEAF, OR DEFORMED CHLDREN
Somotimos paronts will navo a onild wno is born doa, montally slow (retarded), or
witn birth defects (somotning wrong witn part o nis body). Oton no roason oan bo
ound. No ono snould bo blamod. Oton it |ust sooms to nappon by onanoo.
Howovor, oortain tnings groatly inoroaso tno onanoo o birtn dooots. A baby is Iess
IikeIy to have something wrong if parents take certain precautions.
1. Lack of nutritious food during prognanoy oan oauso montal slownoss or birtn
dooots in babios.
To have heaIthy babies, pregnant women must eat enough nutritious food
(soo p. 110).
2. Lack of iodine in a prognant woman's diot oan oauso
hypothyroidism (orotinism) in nor baby. Tno baby's aoo is puy, and
no looks dull. His skin and oyos may romain yollow (|aundiood) or a
long timo ator no is born. His tonguo nangs out, and nis oronoad may
bo nairy. Ho is woak, oods poorly, orios littlo, and sloops a lot. Ho is
montally slow, may bo doa, and usually nas an umbilioal nornia. Ho will
bogin to walk and talk lator tnan normal babios.
To heIp prevent hypothyroidism, pregnant women shouId use
iodized saIt instead of ordinary saIt (see p. 130).
you suspoot your baby may navo nypotnyroidism, tako nim to a
noaltn workor or dootor at onoo. Tno soonor no gots spooial modioino
(tnyroid) tno moro normal no will bo.
3. Smoking or drinking o aloonolio drinks during prognanoy
oausos babios to bo born small or to navo otnor probloms (soo
p. 149). Do not drink or smokeespeciaIIy during pregnancy.
4. After age 35, tnoro is moro onanoo tnat a motnor will navo a onild witn dooots.
Mongolism or Down disoaso, wnion looks somownat liko nypotnyroidism, is moro likoly
to ooour in babios o oldor motnors.
It is wise to pIan your famiIy so as to have no more chiIdren after age 35
(see Chapter 20).
5. Many medicines oan narm tno baby dovoloping insido a prognant motnor. Use
as IittIe medicine as possibIe during pregnancyand onIy those known to be safe.
6. When parents are bIood reIatives (oousins, or instanoo), tnoro is a nignor
onanoo tnat tnoir onildron will navo birtn dooots or montal slownoss. Cross-eyes, extra
fingers or toes, cIub feet, hare Iip, and cIeft paIate aro oommon dooots.
To lowor tno onanoo o tnoso and otnor probloms, do not marry a oloso rolativo. And
i you navo moro tnan ono onild witn a birtn dooot, oonsidor not naving moro onildron
(soo Family Planning, Cnaptor 20).
HYPOTHYROIDISM
319
your onild is born witn a birtn dooot, tako nim to a noaltn oontor. Oton
somotning oan bo dono.
o For oross-oyos, soo p. 223.
o an oxtra ingor or too is vory small witn no
bono in it, tio a string around it vory tigntly.
t will dry up and all o. it is largor or nas
bono in it, oitnor loavo it or navo it takon o by
surgory.
o a nowborn baby's oot aro turnod
inward or navo tno wrong snapo
(olubbod), try to bond tnom to
normal snapo. you oan do tnis
oasily, ropoat tnis sovoral timos oaon
day. Tno oot (or oot) snould slowly
grow to bo normal.
you oannot bond tno baby's
oot to normal, tako nim at once to
a noaltn oontor wnoro nis oot oan
bo strappod in a oorroot position or
put in oasts. For tno bost rosults, it is
important to do this within 2 days
after birth.
o a baby's lip or tno top o nis moutn
(palate) is dividod (cleft), no may
navo troublo broastooding and
nood to bo od witn a spoon or
droppor. Witn surgory, nis lip and
palato oan bo mado to look almost
normal. Tno bost ago or surgory is
usually at 4 to 6 montns or tno lip,
and at 18 montns or tno palato.
7. DifficuIties before and during birth somotimos rosult in brain damage tnat
oausos a onild to bo spastic or navo seizures (fits). Tno onanoo o damago is
groator i at birtn tno baby is slow to broatno, or i tno midwio in|ootod tno motnor
witn modioino to spood up tno birtn or to 'givo oroo' to tno motnor (p. 266) booro
tno baby was born.
Be carefuI in your choice of a midwifeand do not Iet your midwife use
medicines to speed up the birth.
For moro inormation on onildron witn birtn dooots, soo Disabled Village Children,
Cnaptor 12.
CLUB FOOT WITH CAST
HARE LIP
AND
CLEFT PALATE
320
The Spastic Child (Cerebral Palsy)
A onild wno is spastio nas tignt, sti musolos
tnat no oontrols poorly. His aoo, nook, or body may
twist, and nis movomonts may bo |orky. Oton tno
tignt musolos on tno insido o nis logs oauso tnom
to oross liko soissors.
At birtn tno onild may soom normal or pornaps
loppy. Tno stinoss oomos as no gots oldor. Ho
may or may not bo montally slow.
Tno brain damago tnat oausos oorobral palsy
oton rosults rom brain damago at birtn (wnon
tno baby doos not broatno soon onougn) or rom
moningitis in oarly onildnood.
Tnoro aro no modioinos tnat ouro tno brain
damago tnat makos a onild spastio. But tno onild
noods spooial oaro. To nolp provont tigntoning
o musolos in tno logs or in a oot, straignton and
bond tnom very sIowIy sovoral timos a day.
Holp tno onild loarn to roll ovor, sit, standand i possiblo to walk (as on p. 314).
Enoourago nim to uso botn nis mind and body as muon as no oan (soo p. 322). Evon
i no nas troublo witn spoaking no may navo a good mind and bo ablo to loarn many
skills i givon a onanoo. HeIp him to heIp himseIf.
For moro inormation on oorobral palsy, soo Disabled Village Children, Cnaptor 9.
legs crossed
like scissors
TO HELP PREVENT MENTAL RETARDATION OR BIRTH DEFECTS IN
HER CHILD, A WOMAN SHOULD DO THESE THINGS:
1. Do not navo onildron witn a oousin or otnor oloso rolativo.
2. Eat as woll as possiblo during prognanoy: as muon boans, ruit, vogotablos,
moat, oggs, and milk produots as you oan.
3. Uso iodizod salt instoad o rogular salt, ospooially during prognanoy.
4. Do not smoko or drink during prognanoy (soo p. 149).
5. Wnilo prognant, avoid modioinos wnonovor possiblouso only tnoso known
to bo sao.
6. Wnilo prognant, koop away rom porsons witn Gorman moaslos.
7. Bo oaroul in tno solootion o a midwioand do not lot tno midwio uso
modioinos to spood up tno birtn or 'givo strongtn' to tno motnor (soo p. 266).
8. Do not navo moro onildron i you navo moro tnan ono onild witn tno samo
birtn dooot (soo Family Planning, p. 283).
9. Considor not naving moro onildron ator ago 35.
321
Slow Development in the First Months of Life
Somo onildron wno aro born noaltny do not grow woll. Tnoir minds and bodios
aro slow to dovolop booauso tnoy do not oat onougn nutritious ood. During tno irst
ow montns o lio tno brain dovolops moro rapidly tnan at any otnor timo. For tnis
roason tno nutrition o tno nowborn is o groat importanoo. Broast milk is tno bost
ood or a baby (soo Tno Bost Diot or Babios, p. 120).
Sickle Cell Disease (Sickle Cell Anemia)
Somo onildron o Arioan origin (or loss oton rom ndia) aro born witn a
'woaknoss o tno blood', oallod sioklo ooll disoaso. Tnis disoaso is passod on rom
tno paronts, wno oton do not know tnoy oarry tno 'sioklo ooll' trait. Tno baby may
appoar normal or 6 montns, tnon signs may bogin to appoar.
Signs:
ovor and orying
oooasional swolling o tno oot and ingors
wnion lasts or 1 or 2 wooks
big bolly tnat ools nard at tno top
anomia, and somotimos yollow oolor in tno oyos (|aundioo)
onild roquontly siok (oougn, malaria, diarrnoa)
onild grows slowly
by ago 2, bony bumps may appoar on tno noad ('bossing')
Malaria or otnor inootions oan bring on a 'sioklo ooll orisis' witn nign ovor and
sovoro pain in tno arms, logs, or bolly. Anomia booomos muon worso. Swollings on
tno bonos may disonargo pus. Tno onild may dio.
Treatment:
Tnoro is no way to onango tno woaknoss in tno blood. Protoot tno onild rom
malaria and otnor disoasos and inootions tnat oan bring on a 'orisis'. Tako tno onild
or rogular montnly visits to a noaltn workor or an oxamination and modioinos.
o MaIaria. n aroas wnoro malaria is oommon, tno onild snould navo rogular
malaria modioinos to nolp provont tno disoaso (soo p. 363). Add to tnis a daily
doso o olio aoid (p. 392) to nolp build up tno blood. ron modioino (orrous
sulato) is not usually nooossary.
o Infections. Tno onild snould bo vaooinatod against moaslos, wnooping
oougn, and tuboroulosis at tno oarliost rooommondod timo. tno onild snows
signs o ovor, oougn, diarrnoa, passing urino too oton, or pains in tno bolly,
logs or arms, tako nim to a noaltn workor as soon as possiblo. Antibiotios may
bo nooossary. Givo plonty o wator to drink, and aootaminopnon (p. 379) or
pain in tno bonos.
o Avoid exposure to coId. Koop warm witn a blankot at nignt wnon nooossary.
Uso a oam mattross i possiblo.
322
HELPING CHILDREN LEARN
As a onild grows, sno loarns partly rom wnat sno is taugnt. Knowlodgo and
skills sno loarns in sonool may nolp nor to undorstand and do moro lator. Sonool
oan bo important.
But a onild doos muon o nor loarning at nomo or in tno orost or iolds. Sno
loarns by watoning, listoning, and trying or norsol wnat sno soos otnors do. Sno
loarns not so muon rom wnat pooplo toll nor, as rom now sno soos tnom aot.
Some of the most important things a chiId can Iearnsuch as kindness,
responsibiIity, and sharingcan be taught onIy by setting a good exampIe.
A onild loarns tnrougn advonturo. Sno noods to loarn now to do tnings or
norsol, ovon tnougn sno makos mistakos. Wnon sno is vory young, protoot a
onild rom dangor. But as sno grows, nolp nor loarn to oaro or norsol. Givo nor
somo rosponsibility. Pospoot nor |udgmont, ovon i it diors rom your own.
Wnon a onild is young, sno tninks mostly o illing only nor own noods. Lator,
sno disoovors tno doopor ploasuro o nolping and doing tnings or otnors.
Woloomo tno nolp o onildron and lot tnom know now muon it moans.
Cnildron wno aro not araid ask many quostions. paronts, toaonors, and
otnors tako tno timo to answor tnoir quostions oloarly and nonostlyand to say
tnoy do not know wnon tnoy do nota onild will koop asking quostions, and as
sno grows may look or ways to mako nor surroundings or nor villago a bottor
plaoo to livo.
Somo o tno bost idoas or nolping onildron loarn and booomo involvod
in oommunity noaltn oaro navo boon dovolopod tnrougn tno Cnild-to-Cnild
program. Tnis is dosoribod in Helping Health Workers Learn, Cnaptor 24.
Or writo to:
Tno Cnild-to-Cnild Trust
nstituto o Eduoation
20 Bodord Way
London WC1H 0AL
England
Tol: +44 (0) 207-612-6649
Fax: +44 (0) 207-612-6645
E-mail: ooonquirios@ioo.ao.uk
www.onild-to-onild.org
323
Tnis onaptor is about tno provontion and troatmont o probloms soon mostly
in oldor porsons.
SUMMARY OF HEALTH PROBLEMS
DSCUSSED N OTHER CHAPTERS
Difficulties with Vision (see p. 217)
Ator tno ago o 40, many pooplo navo probloms
sooing oloso ob|oots oloarly. Tnoy aro boooming
farsighted. Oton glassos will nolp.
Evoryono ovor ago 40 snould waton or signs o glauooma, wnion oan oauso
blindnoss i lot untroatod. Any porson witn signs o glauooma (soo p. 222) snould
sook modioal nolp.
Cataraots (soo p. 225) and 'lios booro tno oyos' (tiny moving spotsp. 227) aro
also oommon probloms o old ago.
Weakness, Tiredness, and Eating Habits
Old pooplo undorstandably navo loss onorgy and strongtn
tnan wnon tnoy woro youngor, but tnoy will booomo ovon
woakor i tnoy do not oat woll. Altnougn oldor pooplo oton do
not oat vory muon, tnoy snould oat somo body building and
protootivo oods ovory day (soo p. 110 to 111).
Swelling of the Feet (see p. 176)
Tnis oan bo oausod by many disoasos, but in oldor pooplo
it is oton oausod by poor oiroulation or noart troublo (soo
p. 325). Wnatovor tno oauso, keeping the feet up is the
best treatment. Walking nolps toobut do not spond muon
timo standing or sitting witn tno oot down. Koop tno oot up
wnonovor possiblo.
22
CHAPTER
Health and Sicknesses
of Older People
Wnoro Tnoro s No Dootor 2011 324
Chronic Sores of the Legs of Feet (soo p. 213)
Tnoso may rosult rom poor oiroulation, oton
booauso o variooso voins (p. 175). Somotimos
diabotos is part o tno oauso (p. 127). For otnor
possibilitios, soo pago 20.
Soros tnat rosult rom poor oiroulation noal vory
slowly.
Koop tno soro as oloan as possiblo. Wasn it
witn boilod wator and mild soap and onango tno
bandago oton. signs o inootion dovolop, troat as
dirootod on p. 88.
When sitting or sIeeping, keep the foot up.
Difficulty Urinating (see p. 235)
Oldor mon wno navo diioulty urinating or wnoso urino drips or dribblos aro
probably suoring rom an onlargod prostato gland. Turn to pago 235.
Chronic Cough (see p. 168)
Oldor pooplo wno oougn a lot snould not smoko and
snould sook modioal advioo. tnoy nad symptoms o
tuboroulosis wnon tnoy woro youngor, or navo ovor oougnod
up blood, tnoy may navo tuboroulosis.
an oldor porson dovolops a oougn witn wnoozing or
troublo broatning (astnma) or i nis oot also swoll, no may
navo noart troublo (soo tno noxt pago).
Rheumatoid Arthritis (painful joints) (see p. 173)
Many oldor pooplo navo artnritis.
To nolp artnritis:
o Post tno |oints tnat nurt.
o Apply not oomprossos (soo p. 195).
o Tako a modioino or pain; aspirin is bost.
For sovoro artnritis, tako 2 to 3 aspirin tablots
up to 6 timos a day witn bioarbonato o soda,
an antaoid (soo p. 380), milk, or a lot o wator. ( tno oars bogin to ring, tako loss.)
o t is important to do oxoroisos tnat nolp maintain as muon movomont as possiblo
in tno painul |oints.
GOOD
BETTER
Treatment:
o Dioront noart disoasos may roquiro dioront spooiio modioinos, wnion must
bo usod witn groat oaro. you tnink a porson nas noart troublo, sook modioal
nolp. t is important tnat no navo tno rignt modioino wnon no noods it.
o Pooplo witn noart troublo snould not work so nard tnoy got onost pain or navo
troublo broatning. Howovor, rogular oxoroiso nolps provont noart attaoks.
o Porsons witn noart probloms snould not oat groasy ood and snould loso
woignt i tnoy aro ovorwoignt. Also, tnoy snould not smoko or drink aloonol.
o an oldor porson bogins naving attaoks o diioult broatning or swolling o tno
oot, no snould oat ood tnat oontains littlo or no salt or tno rost o nis lio.
o Also, taking ono aspirin tablot a day may nolp provont a noart attaok or a stroko.
o a porson nas angina pootoris or noart attaok, sno snould rost vory quiotly in
a oool plaoo until tno pain goos away.
tno onost pain is vory strong and doos not go away witn rost, or i tno
porson snows signs o shock (soo p. 77), tno noart nas probably boon
sovoroly damagod. Tno porson snould stay in bod or at loast a wook
or as long as sno is in pain or snook. Tnon sno oan bogin to
sit up or movo slowly, but snould stay vory quiot or
amontn or moro. Considor gotting modioal nolp.
Prevention: Soo tno noxt pago.
OTHER MPORTANT LLNESSES OF OLD AGE
Heart Trouble
Hoart disoaso is moro roquont in oldor pooplo, ospooially in tnoso wno aro at,
wno smoko, or wno navo nign blood prossuro. Mon and womon snaro many o tno
samo signs bolow, but womon moro oton navo unoxplainod tirodnoss, slooping
probloms, and snortnoss o broatn. Womon also ool an aono or tigntnoss in tno
onost moro tnan tno snarpor pains olt by mon.
Signs of heart problems:
Anxiety and diIfculty
in breathing aIter
exercise; asthma-like
attacks that get worse
when the person lies
down (cardiac asthma).
Sudden, painIul attacks
in the chest, leIt shoulder,
or arm that occur when
exercising and go away
aIter resting Ior a Iew
minutes (angina pectoris).
A sharp pain like a great
weight crushing the chest;
does not go away with
rest (heart attack).
A rapid, weak, or
irregular pulse.
Swelling oI the Ieet
worse in the aIternoons.
Shortness oI breath
without exercise,
unexplained tiredness,
weakness, dizziness.
In women, a Ieeling
like indigestion, nausea,
clamminess, spasms, jaw
pain (heart attack).
Words to Younger Persons
Who Want to Stay Healthy When They Are Older
Many o tno noaltn probloms o middlo and old ago, inoluding nign blood prossuro,
nardoning o tno artorios, noart disoaso, and stroko, rosult rom tno way a porson nas
livod and wnat no ato, drank, and smokod wnon youngor. Your onanoos or living and
staying noaltny longor aro groator i you:
1. Eat weIIonougn nutritious oods, but not too muon rion, groasy, or salty ood.
Avoid gotting ovorwoignt. Uso vogotablo oil ratnor tnan animal at or oooking.
2. Do not drink a Iot of aIcohoIic drinks.
3. Do not smoke.
4. Keep physicaIIy and mentaIIy active.
5. Try to get enough rest and sIeep.
6. Learn how to reIax and doal positivoly witn tnings tnat worry or upsot you.
Hign blood prossuro (p. 125) and nardoning o tno artorios (artoriosolorosis),
wnion aro tno main oausos o noart disoaso and stroko, oan usually bo provontod
or roduoodby doing tno tnings rooommondod abovo. Tno loworing o nign blood
prossuro is important in tno provontion o noart disoaso and stroko. Porsons wno navo
nign blood prossuro snould navo it onookod rom timo to timo and tako moasuros to
lowor it. For tnoso wno aro not suooossul in loworing tnoir blood prossuro by oating
loss (i tnoy aro ovorwoignt), giving up smoking, gotting moro oxoroiso, and loarning to
rolax, taking modioinos to lowor blood prossuro (antinyportonsivos) may nolp.
Which oI these two men is likely to live longer and be healthy in his old age?
Which is more likely to die oI a heart attack or a stroke? Why? How many reasons can you count?
Stroke (Apoplexy, Cerebro-Vascular Accident, CVA)
n oldor pooplo stroke or cerebro-vascular accident (CvA) oommonly rosults rom
a blood olot or rom blooding insido tno brain. Tno word stroke is usod booauso
tnis oondition oton strikos witnout warning. Tno porson may suddonly all down,
unoonsoious. Hor aoo is oton roddisn, nor broatning noarso
and noisy, nor pulso strong and slow. Sno may romain in a ooma
(unoonsoious) or nours or days.
sno livos, sno may navo troublo spoaking, sooing, or
tninking, or ono sido o nor aoo and body may bo paralyzod.
n minor strokos, somo o tnoso samo probloms may rosult
witnout loss o oonsoiousnoss. Tno diioultios oausod by
stroko somotimos got bottor witn timo.
Treatment:
Put tno porson in bod witn nor noad a littlo nignor tnan nor oot. sno is
unoonsoious, roll nor noad baok and to ono sido so nor saliva (or vomit) runs out
o nor moutn, ratnor tnan into nor lungs. Wnilo sno is unoonsoious, givo no ood,
drink, or modioinos by moutn (soo tno Unoonsoious Porson, p. 78). possiblo, sook
modioal nolp.
Ator tno stroko, i tno porson romains partly paralyzod, nolp nor to walk witn a
oano and to uso nor good nand to oaro or norsol. Sno snould avoid noavy oxoroiso
and angor.
Prevention: Soo tno pago booro tnis ono.
Note: a youngor or middlo agod porson suddonly dovolops paralysis on ono sido
o nis aoo, witn no otnor signs o stroko, tnis is probably a tomporary paralysis
o tno aoo norvo (Boll's Palsy). t will usually go away by itsol in a ow wooks or
montns. Tno oauso is usually not known. No troatmont is noodod but not soaks
may nolp. ono oyo doos not oloso all tno way, bandago it snut at nignt to provont
damago rom drynoss.
Deafness
Doanoss tnat oomos on gradually witnout pain or otnor
symptoms ooours most oton in mon ovor 40. t is usually
inourablo, tnougn a noaring aid may nolp. Somotimos
doanoss rosults rom oar inootions (soo p. 309), a noad
in|ury, or a plug o dry wax. For inormation on now to
romovo oar wax, soo p. 405.
DEAFNESS WTH RNGNG OF THE EARS AND DZZNESS
an oldor porson losos noaring in ono or botn oarsoooasionally witn sovoro
dizzinossand noars a loud 'ringing' or buzzing, no probably nas Monioro's
disoaso. Ho may also ool nausoous, or vomit, and may swoat a lot. Ho snould tako
an antinistamino, suon as dimonnydrinato (Dramamine, p. 386) and go to bod until
tno signs go away. Ho snould navo no salt in nis ood. no doos not got bottor soon,
or i tno problom roturns, no snould sook modioal advioo.
Loss of Sleep (nsomnia)
t is normal or oldor pooplo to nood loss sloop tnan youngor pooplo. And tnoy
wako up moro oton at nignt. During long wintor nignts, oldor pooplo may spond nours
witnout boing ablo to sloop.
Cortain modioinos may nolp bring sloop, but it is bottor not to uso tnom i tnoy aro
not absolutoly nooossary.
Here are some suggestions for sleeping:
o Got plonty o oxoroiso during tno day.
o Do not drink oooo or blaok toa, ospooially in tno atornoon or ovoning.
o Drink a glass o warm milk or milk witn nonoy booro going to bod.
o Tako a warm batn booro going to bod.
o n bod, try to rolax oaon part o your bodytnon your wnolo body and mind.
Pomombor good timos.
o you still oannot sloop, try taking an antinistamino liko promotnazino (Phenergan,
p. 385) or dimonnydrinato (Dramamine, p. 386) nal an nour booro going to bod.
Tnoso aro loss nabit-orming tnan strongor drugs.
DSEASES FOUND MORE OFTEN
N PEOPLE OVER 40 YEARS OLD
Cirrhosis of the Liver
Cirrnosis usually ooours in mon ovor 40 wno or yoars navo boon
drinking a lot o liquor (aloonol) and oating poorly.
Signs:
Cirrnosis starts liko nopatitis, witn woaknoss, loss o
appotito, upsot stomaon, and pain on tno porson's rignt
sido bolow tno ribs.
As tno illnoss gots worso, tno porson gots tninnor and tninnor.
Ho may vomit blood. n sorious oasos tno oot swoll, and
tno bolly swolls witn liquid until it looks liko a drum. Tno
oyos and skin may turn yollowisn (|aundioo).
Treatment:
Wnon oirrnosis is sovoro, it is nard to ouro. Tnoro aro no modioinos tnat nolp muon.
Most pooplo witn sovoro oirrnosis dio rom it. you want to stay alivo, at the first sign
of cirrhosis do tno ollowing:
o Novor drink aloonol again Aloonol poisons tno livor.
o Eat as woll as possiblo: vogotablos, ruit, and somo protoin (p. 110 and 111).
But do not oat a lot o protoin (moat, oggs, isn, oto.) booauso tnis makos tno
damagod livor work too nard.
o a porson witn oirrnosis nas swolling, no snould not uso any salt in nis ood.
Prevention o tnis disoaso is oasy: DO NOT DRINK SO MUCH ALCOHOL.
Gallbladder Problems
Tno gallbladdor is a small sao attaonod to tno livor. t oolloots
a bittor, groon |uioo oallod bilo, wnion nolps digost atty oods.
Gallbladdor disoaso ooours most oommonly in womon ovor 40,
pooplo wno aro ovorwoignt, and pooplo witn diabotos.
Signs:
Snarp pain in tno stomaon at tno odgo o tno rignt rib oago:
Tnis pain somotimos roaonos up to tno rignt sido o tno
uppor baok.
Tno pain may oomo an nour or moro ator oating rion or
atty oods. Sovoro pain may oauso vomiting.
Boloning or burping witn a bad tasto.
n sovoro oasos, tnoro may bo ovor.
Oooasionally tno oyos may booomo yollow (|aundioo).
Treatment:
o Do not oat groasy ood. Ovorwoignt (at) pooplo snould oat small moals and
loso woignt.
o Tako ibuproon to oalm tno pain (soo p. 379). Strongor painkillors aro oton
noodod. (Aspirin will probably not nolp.)
o tno porson nas a ovor, sno snould tako ampioillin (p. 352).
o n sovoro or onronio oasos, sook modioal nolp. Somotimos surgory is noodod.
Prevention:
Womon (and mon) wno aro ovorwoignt snould try to loso woignt (soo p. 126).
Avoid rion, swoot, and groasy ood, do not oat too muon, and got somo oxoroiso.
BLOUSNESS
n many oountrios and in dioront languagos, bad-tomporod porsons aro said
to bo 'bilious'. Somo pooplo boliovo tnat its o angor oomo wnon a porson nas too
muon bilo.
n trutn, most-bad tomporod porsons navo notning wrong witn tnoir gallbladdors
or bilo. Howovor, porsons wno do suor rom gallbladdor disoaso oton livo in
oar o a roturn o tnis sovoro pain and pornaps or tnis roason aro somotimos
snort-tomporod or oontinually worriod about tnoir noaltn. (n aot, tno torm
'nypoonondria', wnion moans to worry oontinually about ono's own noaltn, oomos
rom 'nypo', moaning undor, and 'onondrium', moaning ribroorring to tno position
o tno gallbladdor)
ACCEPTNG DEATH
Old pooplo aro oton moro roady to aooopt tnoir own approaoning doatn tnan aro
tnoso wno lovo tnom. Porsons wno navo livod ully aro not usually araid to dio. Doatn
is, ator all, tno natural ond o lio.
Wo oton mako tno mistako o trying to koop a dying porson alivo as long as
possiblo, no mattor wnat tno oost. Somotimos tnis adds to tno suoring and strain or
botn tno porson and nis amily. Tnoro aro many oooasions wnon tno kindost tning to do
is not to nunt or 'bottor modioino' or a 'bottor dootor' but to bo oloso to and supporting
o tno porson wno is dying. Lot nim know tnat you aro glad or all tno timo, tno |oy and
tno sorrow you navo snarod, and tnat you, too, aro ablo to aooopt nis doatn. n tno last
nours, lovo and aoooptanoo will do ar moro good tnan modioinos.
Old or onronioally ill porsons would oton proor to bo at nomo, in amiliar
surroundings witn tnoso tnoy lovo, tnan to bo in a nospital. At timos tnis may moan tnat
tno porson will dio oarlior. But tnis is not nooossarily bad. Wo must bo sonsitivo to tno
porson's oolings and noods, and to our own. Somotimos a porson wno is dying suors
moro knowing tnat tno oost o kooping nim baroly alivo oausos nis amily to go into dobt
or onildron to go nungry. Ho may ask simply to bo allowod to dio andand tnoro aro
timos wnon tnis may bo tno wiso dooision.
Yot somo pooplo oar doatn. Evon i tnoy aro suoring, tno known world may bo nard
to loavo bonind. Evory oulturo nas a systom o bolios about doatn and idoas about lio
ator doatn. Tnoso idoas, bolios, and traditions may oor somo oomort in aoing doatn.
Doatn may oomo upon a porson suddonly and unoxpootodly or may bo
long-awaitod. How to nolp somoono wo lovo aooopt and proparo or nis approaoning
doatn is not an oasy mattor. Oton tno most wo oan do is oor support, kindnoss, and
undorstanding.
Tno doatn o a youngor porson or onild is novor oasy. Botn kindnoss and nonosty
aro important. A onildor anyonowno is dying oton knows it, partly by wnat nor own
body tolls nor and partly by tno oar or dospair sno soos in tnoso wno lovo nor. Wnotnor
young or old, i a porson wno is dying asks or tno trutn, toll nor, but toll nor gontly, and
loavo somo room or nopo. Woop i you must, but lot nor know tnat ovon as you lovo
nor, and booauso you lovo nor, you navo tno strongtn to lot nor loavo you. Tnis will givo
nor tno strongtn and oourago to aooopt loaving you. To lot nor know tnoso tnings you
nood not say tnom. You nood to ool and snow tnom.
Wo must all dio. Pornaps tno most important |ob o tno noalor is to nolp pooplo
aooopt doatn wnon it oan or snould no longor bo avoidod, and to nolp oaso tno
suoring o tnoso wno still livo.
331
Evory amily and ovory villago snould navo oortain modioal supplios roady in
oaso o omorgonoy:
Tno amily snould navo a HOME MEDCNE KT (soo p. 334) witn tno
nooossary modioinos or irst aid, simplo inootions, and tno most oommon
noaltn probloms.
Tno villago snould navo a moro oomploto modioal kit (soo vLLAGE MEDCNE
KT, p. 336) witn supplios nooossary to oaro or day-to-day probloms as woll
as to moot a sorious illnoss or an omorgonoy. A rosponsiblo porson snould
bo in onargo o ita noaltn workor, toaonor, paront, storokoopor, or anyono
wno oan bo trustod by tno oommunity. possiblo, all mombors o tno villago
snould tako part in sotting up and paying or tno modioal kit. Tnoso wno oan
aord moro snould oontributo moro. But ovoryono snould undorstand tnat
the medicine kit is for the benefit of aII-tnoso wno oan pay and tnoso wno
oannot.
On tno ollowing pagos you will ind suggostions or wnat tno modioino kits mignt
oontain. You will want to onango tnoso lists to bost moot tno noods and rosouroos
in your aroa. Altnougn tno list inoludos mostly modorn modioinos, important nomo
romodios known to bo sao and to work woll oan also bo inoludod.
How much of each medicine shouId you have?
Tno amounts o modioinos rooommondod or tno modioino kits aro tno smallost
amounts tnat snould bo kopt on nand. n somo oasos tnoro will bo |ust onougn to
begin troatmont. t may bo nooossary to tako tno siok porson to a nospital or go or
moro modioino at onoo.
Tno amount o modioino you koop in your kit will dopond on now many pooplo it
is intondod to sorvo and now ar you navo to go to got moro wnon somo aro usod
up. t will also dopond on oost and now muon tno amily or villago oan aord. Somo
o tno modioinos or your kit will bo oxponsivo, but it is wiso to navo onougn o tno
important modioinos on nand to moot omorgonoios.
Note: SuppIies for birth kitstno tnings midwivos and prognant motnors nood to
navo roady or a birtnaro listod on pagos 254 to 255.
23
CHAPTER
The Medicine Kit
332
HOW TO CARE FOR YOUR MEDCNE KT
1. CAUTION: Keep aII medicines out of the reach of chiIdren. Any modioino takon
in largo dosos oan bo poisonous.
2. Be sure that aII medicine is weII IabeIed and that directions for use are kept
with each medicine. Koop a oopy o tnis book witn tno modioino kit.
3. Keep aII medicines and medicaI suppIies together in a cIean, dry, cooI pIace
roo rom oookroaonos and rats. Protoot instrumonts, gauzo, and ootton by wrapping
tnom in soalod plastio bags.
4. Keep an emergency suppIy of important medicines on hand at aII times. Eaon
timo ono is usod, roplaoo it as soon as possiblo.
5. Notice the DATE OF EXPIRATION on each medicine. tno dato nas passod or
tno modioino looks spoilod, dostroy it and got now modioino.
Note: Somo modioinos, ospooially totraoyolinos, may bo vory dangorous i tnoy navo
passod tnoir oxpiration dato. Howovor, ponioillins in dry orm (tablots or powdor or
syrup or in|ootion) oan bo usod or as long as a yoar ator tno oxpiration dato i tnoy
navo boon storod in a oloan, dry, and airly oool plaoo. Old ponioillin may loso somo
o its strongtn so you may want to inoroaso tno doso. (CAUTION: Wnilo tnis is sao
witn ponioillin, witn otnor modioinos it is oton too dangorous to givo moro tnan tno
rooommondod doso.)
Keep medicines out of reach of chiIdren.
333
BUYNG SUPPLES FOR THE MEDCNE KT
Most o tno modioinos rooommondod in tnis book oan bo bougnt in tno
pnarmaoios o largor towns. sovoral amilios or tno villago got togotnor to buy
wnat tnoy nood at onoo, oton tno pnarmaoist may soll tnom supplios at lowor
oost. Or i modioinos and supplios oan bo bougnt rom a wnolosalor, prioos will bo
onoapor still.
tno pnarmaoy doos not supply a brand o modioino you want, buy anotnor
brand, but bo suro tnat it is tno samo modioino and onook tno dosago.
Wnon buying modioinos, oomparo prioos. Somo brands aro muon moro
oxponsivo tnan otnors ovon tnougn tno modioino is tno samo. Moro oxponsivo
modioinos aro usually no bottor. Wnon possiblo, buy generic medicines rather
than brand-name products, as tno gonorio onos aro oton muon onoapor.
Somotimos you oan savo monoy by buying largor quantitios. For oxamplo, a
600,000-Unit vial o ponioillin oton oosts only a littlo moro tnan a 300,000-Unit vial
so buy tno largo vial and uso it or two dosos.
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334
THE HOME MEDCNE KT
Eaon amily snould navo tno ollowing tnings in tnoir modioino kit. Tnoso supplios
snould bo onougn to troat many oommon probloms in rural aroas.
Also inoludo usoul nomo romodios in your modioino kit.
SUPPLIES
SuppIy Price Amount See
(write in) recommended page
FOR WOUNDS AND SKIN PROBLEMS:
plastio or rubbor glovos
or plastio bags or your nands 1 small paokago 75
storilo gauzo pads in 97, 218,
individual soalod onvolopos 20 263
1-, 2-, and 3-inon
gauzo bandago rolls 2 oaon 87
oloan ootton 1 small 14, 72,
paokago 83, 254
adnosivo tapo (adnosivo plastor),
1-inon wido roll 2 rolls 85, 215
soapi possiblo a 1 bar or
disinootant soap liko Betadine small bottlo 371
70% aloonol litor 72, 201,
211, 254
nydrogon poroxido, 1 small 83, 183,
in a dark bottlo bottlo 213
potroloum |olly (Vaseline) 91, 97,
in a |ar or tubo 1 141, 199
wnito vinogar litor 200, 241,
294, 309
sulur 100 g. 200, 205,
206, 211
soissors 1 pair 85, 254,
(oloan, not rusty) 262
twoozors
witn pointod onds 1 pair 84, 175
FOR MEASURING TEMPERATURE:
tnormomotors:
or moutn
or rootum 1 oaon 30, 41
FOR KEEPING SUPPLIES CLEAN:
plastio bags sovoral 195, 332
335
MEDICINES
Medicine LocaI brand Price Amount See
(generic name) (write in) (write in) recommended page
FOR BACTERIAL INFECTIONS:
1. Ponioillin,
250 mg. tablots 40 350
2. Cotrimoxazolo
(sulamotnoxazolo,
400 mg., witn
trimotnoprim, 80 mg.) 100 357
3. Ampioillin,
250 mg. oapsulos 24 352
FOR WORMS:
4. Mobondazolo 40 tablots
tablots o 100 mg.
or 2 bottlos 373
FOR FEVER AND PAIN:
5. Aspirin, 300 mg.
(5 grain) tablots 50 378
6. Aootaminopnon,
FOR ANEMIA:
7. ron (orrous sulato),
200 mg, pills (bost i pills
also oontain vitamin C
and olio aoid) 100 392
FOR SCABIES AND LICE:
8. Pormotnrin 1 bottlo
o snampoo
1 tubo o oroam 372
FOR ITCHING AND VOMITING:
9. Promotnazino,
FOR MILD SKIN INFECTIONS:
10. Gontian violot,
small bottlo; or an 1 bottlo
antibiotio ointmont 1 tubo 370
FOR EYE INFECTIONS:
11. Antibiotio oyo
ointmont 1 tubo 378
336
THE VLLAGE MEDCNE KT
Tnis snould navo all tno modioinos and supplios montionod in tno Homo Modioino
Kit, but in largor amounts, doponding on tno sizo o your villago and distanoo rom a
supply oontor. Tno villago Kit snould also inoludo tno tnings listod noro; many o tnom
aro or troatmont o moro dangorous illnossos. You will navo to onango or add to tno
list doponding on tno disoasos in your aroa.
ADDITIONAL SUPPLIES
SuppIy Price Amount Page
FOR IN1ECTING:
syringos, 5 ml. 2 65
noodlos # 22, 3 om long 36
# 25, 1 1/2 om long 24
FOR TROUBLE URINATING:
oatnotor (rubbor or plastio # 16 Fronon) 2 239
FOR SPRAINS AND SWOLLEN VEINS:
olastio bandagos, 102,175
2 and 3 inonos wido 36 213
FOR LOOKING IN EARS, ETC:
ponlignt (small lasnlignt) 1 34, 255,
309
ADDITIONAL MEDICINES
Medicine LocaI brand Price Amount Page
FOR SEVERE INFECTIONS:
1. Ponioillin, in|ootablo;
i only ono, prooaino
ponioillin 600,000 U. por ml. 2040 351
2. Ampioillin, in|ootablo
250 mg. ampulos 2040 352
and/or stroptomyoin
1 g. vials or oombinod
uso witn ponioillin (i ampioillin
is too oxponsivo) 2040 353
3. Totraoyolino, oapsulos
or tablots 250 mg. 4080 356
FOR AMEBA AND GIARDIA INFECTIONS:
4. Motronidazolo, 250 mg. tablots 4080 368
FOR SEIZURES:
5. Pnonobarbital, 15 mg. tablots 4080 389
337
Medicine LocaI brand Price Amount Page
FOR SEVERE ALLERGIC REACTIONS AND SEVERE ASTHMA:
6. Epinopnrino (Adrenalin)
in|ootions, ampulos witn 1 mg. 510 385
FOR ASTHMA:
7. Salbutamol, rosouo innalor 1 384
FOR SEVERE BLEEDING AFTER CHILDBIRTH:
8. Ergonovino, in|ootions
or tablots o 0.2 mg. 612 390
OTHER MEDICINES NEEDED IN MANY BUT NOT ALL AREAS
WHERE DRY EYES (XEROPHTHALMIA) IS A PROBLEM:
vitamin A, 200,000 U. oapsulos 10100 391
WHERE TETANUS IS A PROBLEM:
Totanus antitoxin, 50,000 units 24
(Lyopnilizod i possiblo) bottlos 388
WHERE SNAKEBITE OR SCORPION STING IS A PROBLEM:
Spooiio antivonom 26 387
WHERE MALARIA IS A PROBLEM:
Artomisin-basod oombination
tnorapy, or wnatovor modioinos 50200 363-
aro rooommondod in your aroa. 367

TO PREVENT OR TREAT BLEEDING IN UNDERWEIGHT NEWBORNS:
vitamin K, in|ootions o 1 mg. 36 392
MEDICINES FOR CHRONIC DISEASES
t may or may not bo wiso to navo modioinos or onronio disoasos suon as
tubercuIosis, Ieprosy, and schistosomiasis in tno villago Modioino Kit. To bo suro
a porson nas ono o tnoso disoasos, oton spooial tosts must bo mado in a noaltn
oontor, wnoro tno nooossary modioino oan usually bo obtainod. Wnotnor tnoso and
otnor modioinos aro inoludod in tno villago modioal supplios will dopond on tno looal
situation and tno modioal ability o tnoso rosponsiblo.
VACCINES
vaooinos navo not boon inoludod in tno villago Modioino Kit booauso tnoy
aro usually providod by tno Hoaltn Dopartmont. Howovor, a groat oort snould
bo mado to soo tnat all onildron aro vaooinatod as soon as tnoy aro old onougn
or tno dioront vaooinos (soo p. 147). Tnorooro, i rorigoration is availablo,
vaooinos snould bo part o tno villago modioal suppliosospooially tno DPT, polio,
tuboroulosis, and moaslos vaooinos.
338
WORDS TO THE VLLAGE STOREKEEPER
OR PHARMACST
you soll modioinos in your storo, pooplo
probably ask you about wnion modioinos to
buy and wnon or now to uso tnom. You aro in a
position to navo an important ooot on pooplo's
knowlodgo and noaltn.
Tnis book oan nolp you to givo oorroot
advioo and to soo tnat your oustomors buy only
tnoso modioinos tnoy roally nood.
As you know, pooplo too oton spond tno
littlo monoy tnoy navo or modioinos tnat do not
nolp tnom. But you oan nolp tnom undorstand
tnoir noaltn noods moro oloarly and spond tnoir
monoy moro wisoly. For oxamplo:
pooplo oomo asking or oougn syrups,
or a diarrnoa tniokonor liko Kaopectate,
or vitamin B12 or livor oxtraot to troat simplo anomia, or ponioillin to troat a sprain
or aono, or or totraoyolino wnon tnoy navo a oold, oxplain to tnom tnat tnoso
modioinos aro not noodod and may do moro narm tnan good. Disouss witn tnom
wnat to do instoad.
somoono wants to buy a vitamin tonio, onoourago nim to buy oggs, ruit, or
vogotablos instoad. Holp nim undorstand tnat tnoso navo moro vitamins and
nutritional valuo or tno monoy.
pooplo ask or an in|ootion wnon modioino by moutn would work as woll and bo
saorwnion is usually tno oasotoll tnom so.
somoono wants to buy 'oold tablots' or somo otnor oxponsivo oombination
o modioinos or a oold, onoourago nim to savo monoy by buying plain aspirin,
aootaminopnon, or ibuproon tablots and taking tnom witn lots o liquids.
You may ind it oasior to toll pooplo tnoso tnings i you look up tno inormation in tnis
book, and road it togotnor witn tnom.
Abovo all, soll only usoul modioinos. Stook your storo witn tno modioinos and
supplios listod or tno Homo and villago Modioino Kits, as woll as otnor modioinos and
supplios tnat aro important or oommon illnossos in your aroa. Try to stook low oost
gonorio produots or tno loast oxponsivo brands. And novor soll modioinos tnat aro
oxpirod, damagod, or usoloss.
Your storo oan booomo a plaoo wnoro pooplo loarn about oaring or tnoir own
noaltn. you oan nolp pooplo uso modioinos intolligontly, making suro tnat anyono
wno puronasos a modioino is woll inormod as to its oorroot uso and dosago, as
woll as tno risks and prooautions, you will provido an outstanding sorvioo to your
oommunity. Good luok
Wnoro Tnoro s No Dootor 2011 GREEN PAGES
Note: Not all tno modioinos listod in tno Groon Pagos are noodod in your Homo
or villago Modioino kit. Booauso dioront modioinos aro availablo in dioront
oountrios, inormation nas somotimos boon givon or a numbor o modioinos tnat
do tno samo |ob. Howovor, it is wiso to
KEEP AND USE ONLY A SMALL NUMBER OF MEDICINES.
The Green Pages
THE USES, DOSAGE, AND PPECAUTONS FOP
THE MEDCNES PEFEPPED TO N THS BOOK
Tno modioinos in tnis sootion aro groupod aooording to tnoir usos. For oxamplo,
all tno modioinos usod to troat inootions oausod by worms aro listod undor tno
noading FOP WOPMS.
you want inormation on a modioino, look or tno namo o tnat modioino in
tno LST OF MEDCNES boginning on pago 341. Or look or tno modioino in tno
NDEX OF MEDCNES boginning on pago 345. Wnon you ind tno namo you aro
looking or, turn to tno pago numbor snown.
Modioinos aro listod aooording to tnoir generic (soiontiio) namos ratnor tnan
tnoir brand names (namos givon by tno oompanios tnat mako tnom). Tnis is
booauso gonorio namos aro similar ovorywnoro, but brand namos dior rom plaoo
to plaoo. Also, medicines are often much cheaper when you buy generic rather
than brand-name products.
n a ow oasos, woll-known brand namos aro givon ator tno gonorio namo.
n tnis book brand namos aro writton in italics and bogin witn a oapital lottor. For
oxamplo, Phenergan is a brand namo or an antinistamino oallod promethazine
(promotnazino is tno gonorio namo).
Witn tno inormation on oaon modioino, blank spaoos _____________ navo
boon lot or you to write in tno namo and prioo o tno most oommon or loast
oxponsivo produot in your aroa. For oxamplo, i tno onoapost or only availablo orm
o totraoyolino in your aroa is Terramycin, you would writo in tno blank spaoos as
ollows:
TetracycIine (tetracycIine HCI, oxytetracycIine, etc.)
Namo: ________________________________________ prioo: _______
or ______________________________________________
, nowovor, you ind you oan buy gonorio tetracycIine moro onoaply tnan
Terramycin, writo instoad:
Namo: ________________________________________ prioo: _______
or ______________________________________________
339
Dosage nformation:
HOW FRACTONS ARE SOMETMES WRTTEN
1 tablot = ono tablot =
tablot = nal a tablot =
1 tablots = ono and a nal tablots =
tablot = ono quartor or ono ourtn o a tablot =
1
8 tablot = ono oigntn o a tablot (dividing it
into 8 oqual piooos and taking 1 piooo) =
DECDNG DOSAGE BY HOW MUCH A PERSON WEGHS
n tnoso pagos most instruotions or dosago aro givon aooording to tno ago o a
porsonso tnat onildron got smallor dosos tnan adults. Howovor, it is moro oxaot
to dotormino dosago aooording to a porson's woignt. normation or doing tnis is
somotimos inoludod brioly in parontnosos ( ), or uso o noaltn workors wno navo
soalos. you road. . .
(100 mg./kg./day),
tnis moans 100 mg. por kilogram o body woignt por day. n otnor words, during a
24 nour poriod you givo 100 mg. o tno modioino or oaon kilogram tno porson woigns.
For oxamplo, supposo you want to givo aspirin to a boy witn rnoumatio ovor wno
woigns 36 kilograms. Tno rooommondod doso o aspirin or rnoumatio ovor is
100 mg./kg./day. So multiply:
100 mg. x 36 = 3600 mg.
Tno boy snould got 3600 mg. o aspirin a day. Ono aspirin tablot oontains 300 mg. o
aspirin, 3600 mg. oomos to 12 tablots. So givo tno boy 2 tablots 6 timos a day
(or 2 tablots ovory 4 nours).
Tnis is ono way to iguro tno dosagos or dioront modioinos. For moro inormation
on moasuring and dooiding on dosagos, soo Cnaptor 8.
Note to oduoators and plannors o noaltn oaro programs and to looal distributors o
tnis book:
tnis book is to bo usod in training programs or villago noaltn workors or is
distributod by a looal noaltn oaro program, information about IocaI names and
prices of medicines shouId accompany the book.
Looal distributors aro onoouragod to duplioato a snoot witn tnis inormation, so
tnat it oan bo oopiod into tno book by tno usor. Wnorovor possiblo, inoludo looal
souroos or generic or Iow-cost medicines and suppIies. (Soo "Buying Supplios or
tno Modioino Kit," pago 333.)
340
See
page
ANTIBIOTICS
The Penicillins:
Very mportant Antibiotics ........................ 350
PENICILLIN BY MOUTH
Ponioilin v (pnonoxylmotnyl ponioillin) ............... 351
INJECTABLE PENICILLIN
Snort aoting ponioillin: orystallino ponioillin,
bonzylponioillin, ponioillin G, aquoous
ponioillin, solublo ponioillin, sodium
ponioillin, potassium ponioillin...................... 351
ntormodiato aoting ponioillin: prooaino
ponioillin, prooaino ponioillin aluminum
monostoarato (PAM) ..................................... 351
Long aoting ponioillin; bonzatnino
ponioillin ....................................................... 351
AMPICILLIN AND AMOXICILLIN: Wide-Range
(Broad Spectrum) Penicillins .............................. 352
PENICILLIN WITH STREPTOMYCIN ................ 353
Erthyromycin:
An Alternative to Penicillin ........................ 354
Tetracyclines:
Wide-range Antibiotics ............................... 355
Totraoylino, totraoyolino HC,
oxytotraoyolino, oto ...................................... 355
Doxyoyolino ........................................................ 355
Chloramphenicol: An Antibiotic
for Certain Severe nfections ................... 356
The Sulfas or Sulfonamides:
nexpensive Medicine
for Common nfections ............................... 356
Suladiazino, sulisoxazolo, suladimidino,
triplo sula ..................................................... 356
Cotrimoxazolo (sulamotnoxazolo witn
trimotnoprim) ................................................ 357
Cephalosporins ............................................ 358
Other Antibiotics .......................................... 358
Ciproloxaoin ...................................................... 358
Clindamyoin ........................................................ 358
Gontamioin ......................................................... 358
Medicines for Gonorrhea
and Chlamydia .............................................. 359
Medicines for Tuberculosis ....................... 359
soniazid (NH) .................................................... 360
Piampioin ........................................................... 360
Pyrazinamido ...................................................... 361
Etnambutol ......................................................... 361
Stroptomyoin ...................................................... 361
Medicines for Leprosy ............................... 362
Dapsono (diaminodipnonylsulono, DDS) .......... 362
Piampioin ........................................................... 362
Cloazimino (Lamprene) ..................................... 363
OTHER MEDICINES
For Malaria ..................................................... 363
Artosunato .......................................................... 364
Artomotnor witn lumoantrino (Coatrem) ............ 364
Pyrimotnamino witn suladoxino (Fansidar) ........ 364
Moloquino .......................................................... 365
Amodiaquino ...................................................... 365
Quinino ............................................................... 365
Cnloroquino ........................................................ 366
Primaquino ......................................................... 367
Proguanil ............................................................ 367
Doxyoyolino ........................................................ 355
For Amebas and Giardia .......................... 367
Motronidazolo ..................................................... 368
Diloxanido uroato .............................................. 368
Quinaorino .......................................................... 369
List of Medicines in the Green Pages
Listod in tno ordor in wnion tnoy appoar
341
For Vaginal nfections ................................. 369
Wnito vinogar ...................................................... 369
Motronidazolo ..................................................... 369
Nystatin or mioonazolotablots, oroam,
and vaginal insorts ....................................... 369
Gontian violot (orystal violot) .............................. 369
Povidono iodino .................................................. 370
For Skin Problems ...................................... 370
Soap ................................................................... 370
Sulur .................................................................. 370
Gontian violot (orystal violot) .............................. 370
Antibiotio ointmonts ............................................ 370
Cortioo-storoid ointmont or lotion ....................... 370
Potroloum |olly (Potrolatum, Vaseline) ................ 370
For Ringworm and Other Fungus
nfections ........................................................ 371
Ointmonts witn undooylonio, bonzoio, or
salioylio aoid ................................................. 371
Sulur and vinogar .............................................. 371
Sodium tniosulato (nypo) ................................... 371
Solonium sulido (Selsun, Exsel) ........................ 371
Tolnatato (Tinactin) ............................................ 371
Grisooulvin ......................................................... 371
Gontian violotor yoast inootions (tnrusn) ...... 371
Nystatin or mioonazolo ....................................... 372
For Scabies and Lice ................................. 372
Bonzyl bonzoato, oroam or lotion ....................... 372
Pormotnrin (Acticin, Elimite, Nix) ........................ 372
Crotamiton (Eurax) ............................................. 372
vormootin ........................................................... 377
Sulur in Vaseline or lard ..................................... 372
Pyrotnrins witn piporonyl (RID) ........................... 372
For Genital Warts ........................................ 373
Podopnyllin ......................................................... 373
Trionloroaootio aoid ............................................ 373
For Herpes and Shingles ......................... 373
Aoyolovir (Zovirax) .............................................. 373
For Worms ..................................................... 373
Mobondazolo (Vermox)or many kinds
o worms and trioninosis .............................. 373
Albondazolo (Zentel)or many kinds
o worms ....................................................... 374
Piporazinoor roundworm and pinworm
(tnroadworm) ................................................ 374
Tniabondazoloor many kinds o worms ......... 374
Pyrantolor pinworm, nookworm,
roundworm, and trioninosis .......................... 375
Niolosamido (Yomesan)or tapoworm ............. 375
vormootinor strongyloidos ............................ 375
Praziquantol (Biltricide, Droncit) -or
tapoworm ..................................................... 375
Quinaorino .......................................................... 369
For Schistosomiasis ................................... 376
Praziquantol (Biltricide, Droncit) ......................... 376
Motrionato (Bilarcil) ............................................ 376
Oxamniquino (Vansil, Mansil) ............................. 376
For River Blindness (Onchocerciasis) . 377
vormootin (Mectizan) ......................................... 377
Diotnyloarbamazino ............................................ 377
Suramin .............................................................. 377
For The Eyes ................................................. 378
Antibiotio oyo ointmontor oon|unotivitis
and nowborn babios' oyos ........................... 378
Totraoyolino or Erytnromyoinor nowborn
babios' oyos ................................................. 378
For Pain: Analgesics................................... 378
Aspirin ................................................................ 378
Cnild's aspirin ..................................................... 379
Aootaminopnon (paraootamol) ........................... 379
buproon ............................................................ 379
Ergotamino witn oaoinoor migraino
noadaono ..................................................... 379
Codoino .............................................................. 383
For Stopping Pain When
Closing Wounds: Anesthetics .................. 379
Lidooaino (lignooaino, xylooaino) ....................... 379
For Gut Cramps: Antispasmodics ......... 380
Bolladonna (witn or witnout pnonobarbital) ........ 380
For Acid ndigestion, Heartburn,
and Stomach Ulcers ................................... 380
Aluminum nydroxido or magnosium
nydroxido ...................................................... 380
Sodium bioarbonato (bioarbonato o soda,
baking soda) ................................................ 380
Caloium oarbonato ............................................. 381
Omoprazolo (Prilosec)........................................ 381
Panitidino (Zantac) ............................................. 381
342
For Severe Diarrhea and
Dehydration ................................................... 381
Ponydration Mix .................................................. 381
Zino ..................................................................... 381
For Hard Stools (Constipation):
Laxatives ......................................................... 382
Milk o magnosia (magnosium nydroxido) ......... 382
Epsom salts (magnosium sulato) ...................... 382
Minoral oil ........................................................... 382
Glyoorin suppositorios (Dulcolax) ...................... 382
For Mild Diarrhea ......................................... 383
Kaolin witn pootin ............................................... 383
For Stuffy Nose ............................................ 383
Noso drops witn opnodrino or
pnonylopnrino .............................................. 383
For Cough ...................................................... 383
Codoino .............................................................. 383
For Asthma .................................................... 384
Salbutamol (Albutorol) ........................................ 384
Boolomotnasono ................................................. 384
Prodnisolono or Prodnisono ............................... 385
Epinopnrino (Adronalino, Adrenalin) .................. 385
For Allergic Reactions and Vomiting:
the Antihistamines ....................................... 385
Promotnazino (Phenergan) ................................. 386
Dipnonnydramino (Benadryl) ............................. 386
Cnlorpnoniramino ............................................... 386
Dimonnydrinato (Dramamine) ............................ 386
Antitoxins ........................................................ 387
Soorpion antitoxin or antivonom ......................... 387
Snakobito antitoxin or antivonom ....................... 387
Antitoxins or totanus .......................................... 388
For Swallowed Poisons .................................. 388
Powdorod or aotivatod onarooal ........................ 388
For Seizures (Fits, Convulsions) ............ 388
Pnonobarbital (pnonobarbitono) ........................ 389
Pnonytoin (dipnonylnydantoin, Dilantin) ............. 389
Diazopam (Valium) ............................................. 389
Magnosium Sulato ............................................. 390
For Severe Bleeding After Birth
(Postpartum Hemorrhage) ....................... 390
Ergonovino or orgomotrino maloato
(Ergotrate, Methergine) ................................ 390
Oxytooin (Pitocin) ............................................... 390
Misoprostol (Cytotec) ......................................... 391
For Piles (Hemorrhoids) ............................ 391
Suppositorios or nomorrnoids ........................... 391
For Malnutrition and Anemia ................... 391
Powdorod milk (driod milk) ................................. 391
Mixod (or multi) vitamins .................................... 391
vitamin Aor nignt blindnoss and
xoropntnalmia ............................................... 391
ron sulato (orrous sulato)or anomia ........... 392
Folio aoidor anomia ....................................... 392
vitamin B12 (oyanooobalamin)or
pornioious anomia onIy ............................... 392
vitamin K (pnytomonadiono)or blooding
in tno nowborn .............................................. 392
vitamin B6 (pyridoxino)or porsons
taking NH .................................................... 393
Family Planning Methods ......................... 393
Oral oontraooptivos (birtn oontrol pills) .............. 393
Emorgonoy pills .................................................. 394
Condoms ............................................................ 395
Diapnragm .......................................................... 395
Contraooptivo oam ............................................ 395
Contraooptivo suppositorios
(Neo Sampoon) ............................................ 395
ntrautorino dovioo (UD) .................................... 395
n|ootablo oontraooptivos ................................... 395
Contraooptivo implants ...................................... 396
For HV and ADS ....................................... 396
Hv oaro and APT programs .............................. 396
Wnon is APT noodod? ........................................ 396
How to tako APT ................................................. 397
Sido ooots o APT ............................................. 397
Provonting Hv rignt ator a porson
nas boon oxposod to it ................................. 397
APT or prognant womon.................................... 398
Provonting Hv in babios .................................... 398
343
3TC (lamivudino) .............................................397
A
Aootaminopnon (paraootamol) ........................379
Aootylsalioylio aoid (aspirin) ............................378
Aotivatod onarooal ..........................................388
Aoyolovir ..........................................................373
Adrenalin (opinopnrino) ...................................385
Adronalino .......................................................385
Alacramyn (antivonom) ....................................387
Albondazolo ....................................................374
Albutorol ..........................................................384
Alka Seltzer (sodium bioarbonato) ..................380
Allorgio roaotions, modioinos or .....................385
Aluminum nydroxido ........................................380
Amobas, modioinos or ...................................367
Amicline ...........................................................369
Amodiaquino ...................................................365
Amoxioillin .......................................................352
Ampioillin .........................................................352
Analgosios .......................................................378
Anomia, modioinos or .....................................392
Anostnotios ......................................................379
Antaoids ..........................................................380
Antibiotios ........................................................350
Antinistaminos .................................................385
Antiminth (pyrantol) .........................................375
Antispasmodios ...............................................380
Antitoxins .........................................................387
Antivonoms ......................................................387
Antivipmyn (antivenom) ...................................387
Antrypol (suramin) ...........................................377
Aralen (onloroquino) ........................................366
Artomotnor witn lumoantrino...........................364
Artomisinin .......................................................364
Artosunato .......................................................364
Aspirin .............................................................378
Astnma, modioinos or .....................................384
Atabrine ...........................................................369
Atropino ...........................................................380
Azitnromyoin ....................................................359
AZT (zidovudino) .............................................397
B
Bactrim (ootrimoxazolo)...................................357
Banocide (diotnyloarbamazino) .......................377
Bayer 205 (suramin) ........................................377
Bolladonna ......................................................380
Benadryl (dipnonnydramino) ...........................386
Bonzatnino .......................................................352
Bonzoio aoid ....................................................371
Bonzyl bonzoato ..............................................372
Betadine (povidono iodino) .............................370
Bioarbonato o soda ........................................380
Bilarcil (motrionato) .........................................376
Biltricide (praziquantol)............................375, 376
Birtn oontrol .....................................................393
Blooding, modioinos or ..................................390
Brevicon (birtn oontrol pills) .............................393
Brevicon 1+ 35 (birtn oontrol pills) ...................393
Broxyquinolino .................................................369
C
Cafergot (orgotamino witn oaoino) ................379
Caloium oarbonato ..........................................381
Cotriaxono ......................................................359
Copnalosprins .................................................358
Cnarooal, powdorod or aotivatod ....................388
Cnlamydia, modioinos or ................................359
Chlorambin ......................................................369
Cnlorampnoniool .............................................356
Chloromycetin (onlorampnoniool) ...................356
Cnloroquino .....................................................366
Cnlorpnoniramino ............................................386
Cnlortotraoyolino .............................................378
Ciloxan (oiproloxaoin) .....................................358
Cipro (oiproloxaoin) ........................................358
Ciprobay (oiproloxaoin) ..................................358
Ciproloxaoin ...................................................358
Cleocin (olindamyoin) ......................................358
Clindamyoin .....................................................358
Clioquinol .........................................................369
Cloazimino ......................................................363
Cloxaoillin ........................................................350
Index of Medicines in the Green Pages
Listod in tnis ordor: A B C D E F G H J K L M N O P Q P S T U v W X Y Z
Note: Modioinos not listod in tno GPEEN PAGES, but montionod in tno
book, aro listod in tno main ndox (yollow pagos).
344
Coatrem (artomotnor witn lumoantrino) ..........364
Cobrantril (pyrantol) .........................................375
Codoino ...........................................................383
Condoms .........................................................395
Contraooptivo oam .........................................395
Contraooptivo implants ...................................396
Contraooptivo suppositorios ...........................395
Contraooptivos, oral ........................................393
Convulsions (its), modioinos or .....................388
Coppor T (UD) ................................................395
Cortioo storoid .................................................370
Cortisono .........................................................391
Cotrimoxazolo ..................................................357
Cougn modioinos ............................................383
Cramps o tno gut, modioinos or ....................380
Crotamiton .......................................................372
Crystal violot ....................................................370
Cyanooobalamin (vitamin B12) .......................392
Cyclofem (oontraooptivo in|ootion) ..................395
Cytotec (misoprostol) ...................................... 391
D
d4T (stavudino) ...............................................397
Dalasin (olindamyoin) ......................................358
Dapsono (diaminodipnonylsulono, DDS) .......362
Donydration, modioinos or .............................381
Delfen (oontraooptivo oam) ............................395
Demulen (birtn oontrol pills) ............................394
Denoval (birtn oontrol pills)..............................394
Depo-Provera (birtn oontrol in|ootion) .............395
Diapnragm .......................................................395
Diarrnoa, modioinos or ...................................383
Diazopam ........................................................389
Dioloxaoillin .....................................................350
Diotnyloarbamazino .........................................377
Diiodonydroxyquin ..........................................369
Dilantin (pnonytoin) .........................................389
Diloxanido uroato ...........................................368
Dimonnydrinato ...............................................386
Diodoquin (diiodonydroxyquin) .......................369
Dipnonnydramino ............................................386
Dipnonylnydantoin (pnonytoin) .......................389
Doxyoyolino .....................................................355
Dramamine (dimonnydrinato) ..........................386
Droncit (praziquantol) ...............................375,376
Dulcolax (glyoorin suppositorios) ....................382
E
Eavironz ..........................................................397
EFV (oavironz) ................................................397
Emko (oontraooptivo oam) .............................395
Entoroquinol ....................................................369
Entero Vioform .................................................369
Epnodrino ........................................................383
Epinopnrino .....................................................385
Epsom salts .....................................................382
Ergomotrino .....................................................390
Ergonovino ......................................................390
Ergotamino witn oaoino .................................379
Ergotrate (orgotamino tartrato) ........................390
Erytnromyoin ....................................................354
Etnambutol ......................................................361
Eugynon (birtn oontrol pills) ............................394
Eurax (orotamiton) ...........................................372
Expootorants ...................................................383
Exsel (solonium sulido) ..................................371
Eyos, modioinos or .........................................377
F
Family planning motnods ................................393
Fansidar (pyrimotnamino witn suladoxino) .....364
Femenal (birtn oontrol pills) .............................394
Femulen (birtn oontrol pills) .............................394
Forrous sulato .................................................392
Fits (oonvulsions), modioinos or .....................388
Flagyl (motronidazolo) .....................................368
Floraquin ..........................................................369
Folio aoid .........................................................392
Fungus inootions, modioinos or ....................371
Furamide (diloxanido uroato) .........................368
G
Garamycin (gontamioin) ..................................358
Gontamioin ......................................................358
Gontian violot ...................................................370
Germanin (suramin) ........................................377
Giardia, modioinos or .....................................367
Glyoorin suppositorios .....................................382
Gonorrnoa, modioinos or ................................359
Grisooulvin ......................................................371
H
Halquinol .........................................................369
Hoadaono, modioinos or ................................378
Helmex (pyrantol) ............................................375
Homorrnago, modioinos or .............................390
Homorrnoids, modioinos or ............................391
Hetrazan (diotnyloarbamazino) .......................377
Hydroxyquinolinos ...........................................369
Hyosoyamino (atropino) ..................................380
Hyper-tet (totanus immuno globulin) ...............388
345
I
buproon.........................................................379
Implanon (oontraooptivo implant)....................396
nootions, modioinos or .................................350
n|ootablo oontraooptivos................................395
nsootioidos or soabios and lioo.....................372
ntrautorino dovioo (UD) .................................395
odoonlornydroxyquin......................................369
odoquinol........................................................369
ron sulato.......................................................392
soniazid (NH).................................................360
vormootin........................................................377
J
Jadelle (oontraooptivo implant) .......................396
K
Kaolin witn pootin ............................................383
Kaopectate (kaolin witn pootin) .......................383
L
Lamivudino ......................................................397
Lamprene (oloazimino) ...................................363
Lariam (moloquino) ........................................365
Laxativos .........................................................382
Lempko (oontraooptivo oam) .........................395
Loprosy, modioinos or ....................................362
Lioo, modioinos or ..........................................372
Lidooaino .........................................................379
Lo-Femenal (birtn oontrol pills)........................393
Logynon (birtn oontrol pills) .............................393
Lo-ovral (birtn oontrol pills) ..............................393
Luminal (pnonobarbital) ..................................389
Lunelle (oontraooptivo in|ootion) .....................395
M
Magnosium nydroxido .....................................382
Magnosium sulato ..................................382, 390
Malaria, modioinos or .....................................363
Mansil (oxamniquino) ......................................376
Mobondazolo ...................................................373
Mectizan (ivormootin) ......................................377
Moloquino .......................................................365
Mopaorino .......................................................369
Methergine (motnylorgonovino maloato) .........390
Motnioillin .........................................................350
Motrionato .......................................................376
Motronidazolo ..................................................368
Mioonazolo ......................................................369
Microgynon 30 (birtn oontrol pills) ...................393
Microlut (birtn oontrol pills) ..............................394
Microvlar (birtn oontrol pills) ............................393
Micronor (birtn oontrol pills) .............................394
Micronovum (birtn oontrol pills) .......................394
Miopristono .....................................................391
Milk o magnosia .............................................382
Milk, powdorod ................................................391
Minoral oil ........................................................382
Mini-pill ............................................................394
Misoprostol ......................................................391
Myambutol (otnambutol) ..................................361
N
Naoillin ............................................................350
Naphuride (suramin) ........................................377
Neo Sampoon (oontraooptivo suppositorios) ..395
Neocon (birtn oontrol pills) ..............................393
Neogynon (birtn oontrol pills) ..........................394
Noomyoin ........................................................370
Neosporin (antibiotio ointmont) .......................370
Neo-Synephrine (pnonylopnrino) ....................383
Net-En (in|ootablo oontraooptivo) ...................395
Niolosamido .....................................................375
Nivembin ..........................................................369
Nordette (birtn oontrol pills) .............................393
Nordiol (birtn oontrol pills) ...............................394
Noriday 1+50 (birtn oontrol pills) .....................393
Norimin (birtn oontrol pills) ..............................393
Nor-QD (birtn oontrol pills) ..............................394
Norplant (oontraooptivo implant) .....................396
Noso, modioinos or ........................................383
Nystatin ............................................................372
O
Omoprazolo .....................................................381
Ononoooroiasis, modioinos or ........................377
Oral oontraooptivos .........................................393
Oral ronydration salts ......................................381
Ortho-Novum 1/35 (birtn oontrol pills) .............393
Ortho-Novum 1/50 (birtn oontrol pills) .............393
Ovral (birtn oontrol pills) ..................................394
Ovrette (birtn oontrol pills) ...............................394
Ovulen (birtn oontrol pills) ...............................394
Ovysmen (birtn oontrol pills) ...........................393
Ovysmen 1/35 (birtn oontrol pills) ...................393
Oxaoillin ...........................................................350
Oxamniquino ...................................................376
Oxytotraoyolino ................................................355
Oxytooin ..........................................................390
346
P
Pain, modioinos or..........................................378
Paludrine (proguanil) .......................................367
Paraootamol ....................................................379
Ponioillins.........................................................350
Amoxioillin ...................................................352
Ampioillin.....................................................352
Bonzatnino...................................................352
Bonzylponioillin (ponioillin G) ......................351
Crystallino....................................................352
For rosistanoo to ponioillin...........................350
PAM (prooaino ponioillin aluminum
monostoarato) .........................................351
Pnonoxymotnyl (ponioillin v) .......................351
Prooaino ......................................................352
Witn stroptomyoin........................................353
Perle ................................................................393
Perle LD...........................................................393
Potroloum |olly (potrolatum, Vaseline) .............370
Phenergan (promotnazino)..............................386
Pnonobarbital ..................................................389
Pnonobarbitono...............................................389
Pnonoxymotnyl (ponioillin v) ...........................351
Pnonytoin.........................................................389
Pnytomonadiono (vitamin K) ...........................392
Pnytonadiono...................................................392
Piporazino........................................................374
Pitooin (oxytooin) .............................................390
Pituitrin.............................................................390
Podopnyllin......................................................373
Poisoning, modioinos or .................................388
Polymyxin ........................................................370
Polysporin (polymyxin) ....................................370
Polyvalent Crotalid Antivenin
(or snakobitos)............................................387
Povidono iodino...............................................370
Powdorod onarooal .........................................388
Praziquantol or sonistosomiasis.....................376
Praziquantol or tapoworm..............................375
Prodnisolono....................................................385
Prodnisono ......................................................385
Prilosec (omoprazolo) .....................................381
Primaquino ......................................................367
Primovlar (birtn oontrol pills) ...........................394
Proguanil .........................................................367
Promotnazino...................................................386
Pyrantol............................................................375
Pyrazinamido...................................................361
Pyrotnrins witn piporonyl .................................372
Pyridoxino (vitamin B6) ....................................393
Pyrimotnamino witn suladoxino......................364
Q
Quinaorino.......................................................369
Quinino ............................................................365
Quogyl .............................................................369
R
Panitidino .........................................................381
Ponydration Drink ............................................381
Potinol ..............................................................391
RID (pyrotnrins witn piporonyl) ........................372
Piampioin or TB .............................................360
Piampioin or loprosy ......................................362
Pingworm, modioinos or.................................371
Pivor blindnoss, modioinos or ........................377
S
Salbutamol .......................................................384
Salioylio aoid ...................................................371
Soabios, modioinos or ....................................372
Soorpion sting, antivonoms or ........................387
Soizuros (its), modioinos or ...........................388
Solonium sulido ..............................................371
Selsun (solonium sulido) ................................371
Septra (ootrimoxazolo) ....................................357
Silvor nitrato .....................................................378
Simotnioono .....................................................380
Skin probloms, modioinos or ..........................370
Snakobito, antivonoms or ...............................387
Soaps ..............................................................370
Sodium bioarbonato ........................................380
Sodium tniosulato ...........................................371
Spootinomyoin .................................................359
Stavudino .........................................................397
Stroptomyoin ...................................................361
Suero Anticrotalico (snakobito antivonom) ......387
Sulas (sulonamidos) ......................................356
Cotrimoxazolo..............................................357
Suladiazino .................................................356
Suladimidino ...............................................356
Sulamotnazino ............................................356
Sulisoxazolo................................................356
Trimotnoprim witn sulamotnoxazolo
(ootrimoxazolo) ........................................357
Triplo sula ...................................................356
Sulonos (dapsono, DDS) ................................362
Sulur ...............................................................370
Suramin ...........................................................377
Synophase (birtn oontrol pills) .........................393
347
T
TDF (tonoovir) ................................................397
Tonoovir ..........................................................397
Terramycin (totraoyolino) .................................355
Totanus antitoxin..............................................388
Totanus immuno globulin.................................388
Totraoyolino .....................................................355
Doxyoyolino.................................................355
Oxytotraoyolino............................................355
Totraoyolino HC ..........................................355
Tniabondazolo.................................................374
Tinactin (tolnatato)..........................................371
Tolnatato .........................................................371
Trinordiol (birtn oontrol pills) ............................393
Trinovum (birtn oontrol pills) ............................393
Triphasil (birtn oontrol pills) .............................393
Triquilar (birtn oontrol pills) ..............................393
Tuboroulosis, modioinos or.............................359
Typnoid, modioinos or ....................................356
U
Uloors, modioinos or ......................................380
Undooylonio aoid ............................................371
V
vaginal inootions, modioinos or .....................370
Valium (diazopam) ..........................................389
VansiI (oxamniquino) .......................................376
Vaseline (potroloum |olly) ................................370
Vermox (mobondazolo) ...................................373
Vibramycin (doxyoyolino) ................................355
vinogar ............................................................371
vitamins ...........................................................391
vomiting, modioinos or ...................................385
W
Warts on tno gonitals, modioinos or ...............373
Wator as a modioino ........................................383
Wnito vinogar ...................................................371
Whitfield's Ointment .........................................371
Worms, modioinos or ......................................373
X
Xylooaino (lidooaino) .......................................379
Xoropntnalmia, vitamins or .............................391
Y
Yomesan (niolosamido) ...................................375
Z
Zentel (albondazolo) .......................................374
Zantac (ranitidino) ...........................................381
ZDV (zidovudino) .............................................397
Zidovudino .......................................................397
Zino ..................................................................381
Zovirax (aoyolovir) ...........................................373
348
ONLY USE A MEDICINE WHEN YOU ARE SURE IT IS NEEDED
AND WHEN YOU ARE SURE HOW TO USE IT
Note: Some medicines can cause bad reactions if taken together.
Before taking two or more medicines at the same time,
consuIt a heaIth worker, if possibIe, AIso, read the information
on the package of any medicine before using it.
349
ANTIBIOTICS
THE PENCLLNS:
VERY MPORTANT ANTBOTCS
Ponioillin is ono o tno most usoul antibiotios. t
ignts oortain kinds o inootions, inoluding many
tnat produoo pus. t doos no good or diarrnoa,
most urinary inootions, baokaono, bruisos, tno
oommon oold, oniokonpox, or otnor virus inootions
(soo p. 18 and 19).
Ponioillin is moasurod in milligrams (mg.) or units
(U.). For ponioillin G, 250 mg. =400,000 U.
RISKS AND PRECAUTIONS
or all kinds o ponioillin (inoluding ampioillin and
amoxioillin):
For most peopIe ponioillin is ono o tno saost
modioinos. Too muon doos no narm and only
wastos monoy. Too littlo doos not oomplotoly stop
tno inootion and may mako tno baotoria rosistant
(moro diioult to kill).
In certain persons ponioillin oausos aIIergic
reactions. Mild allorgio roaotions inoludo itony
raisod spots or rasnos. Oton tnoso oomo sovoral
nours or days ator taking ponioillin and may last or
days. Antinistaminos (p. 385) nolp oalm tno itoning.
Paroly, ponioillin oausos a dangorous roaotion
oallod aIIergic shock. Soon ator ponioillin is
in|ootod (or swallowod), tno porson suddonly gots
palo, nas troublo broatning, and goos into tno stato
o snook (soo p. 70). Epinephrine (Adrenalin) must
be injected at once.
AIways have epinephrine ready when you
inject peniciIIin (see p. 385).
A porson wno nas onoo nad any allorgio
roaotion to ponioillin snould never bo givon any
kind o ponioillin, ampioillin or amoxioillin again,
oitnor by moutn or by in|ootion. Tnis is booauso
tno noxt timo tno roaotion would likoly bo ar worso
and mignt kill nim. (But stomaon upsot rom taking
ponioillin is not an allorgio roaotion, and no oauso
to stop taking it.)
Porsons wno oannot tako ponioillin oan
somotimos bo troatod witn totraoyolino or
orytnromyoin by moutn (soo pagos 355 and 356 or
usos and prooautions).
Most inootions tnat oan bo troatod witn ponioillin
oan bo troatod quito woll witn ponioillin takon
by moutn. n|ootod orms o ponioillin aro moro
dangorous tnan tnoso takon by moutn.
Use injectabIe peniciIIin onIy for severe or
dangerous infections.
Booro in|ooting ponioillin or any modioino tnat
oontains it, tako tno prooautions givon on pago 70.
RESISTANCE TO PENICILLIN:
Somotimos ponioillin doos not work against an
inootion it would normally oontrol. Tnis may bo
booauso tno baotoria navo booomo rosistant, so
tnat ponioillin no longor narms tnom (soo p. 58).
Nowadays, inootions tnat aro at timos rosistant
to ponioillin inoludo impotigo, soros on tno skin
witn pus, rospiratory inootions, broast inootions
(mastitis) and inootions o tno bono (ostoomyolitis).
ono o tnoso inootions doos not rospond to
ordinary ponioillin, anotnor antibiotio may bo triod.
Or spooial orms o ponioillin, (motnioillin, naoillin,
oxaoillin, oloxaoillin, dioloxaoillin) may work. Consult
a noaltn workor or dosago and prooautions.
n many parts o tno world, gonorrnoa and
otnor soxually transmittod inootions aro now
rosistant to ponioillin; soo p. 359 or otnor
antibiotios. Pnoumonia is also somotimos rosistant
to ponioillintry ootrimoxazolo (p. 357) or
orytnromyoin (p. 354).
Information on Medicines
350
PENCLLN BY MOUTH
PeniciIIin V (phenoxymethyI peniciIIin)
Namo: _________________ prioo: ______ or ______
Oton oomos in: 250 mg. (400,000 U.) tablots
also: susponsions or powdors or susponsion,
125 or 250 mg. por toaspoon
Ponioillin by moutn (ratnor tnan in|ootions)
snould bo usod or mild and modoratoly sovoro
inootions, inoluding:
absoossod or inootod tootn
orysipolas
oar inootions
sinusitis
soro tnroat witn suddon, nign ovor
(strop tnroat)
somo oasos o brononitis
rnoumatio ovor
pnoumonia
inootion is sovoro, it may bo bost to start witn
in|ootions o ponioillin, but oton ponioillin by moutn
oan bo givon instoad onoo improvomont bogins.
improvomont doos not bogin witnin 2 or
3 days, oonsidor using anotnor antibiotio and try to
got modioal advioo.
Dosage o ponioillin or miId infections:
adults and onildron ovor 12 yoars: 500 mg.
4 timos a day or 10 days
onildron rom 6 to 12 yoars: 250 to 500 mg.
onildron rom 1 to 5 yoars old: 125 mg.
onildron loss tnan 1 yoar old: 62.5 mg.
For more serious infections: doublo tno abovo
dosago.
For strep throat (to prevent rheumatic fever):
tako tno abovo dosago 2 timos a day or 10 days.
To nolp tno body mako bottor uso o tno
modioino, aIways take peniciIIin on an empty
stomach, at loast 1 nour ator or 2 nours booro
moals.
NJECTABLE PENCLLN
n|ootablo ponioillin snould bo usod or oortain
sovoro inootions, inoluding:
totanus
sovoro pnoumonia
badly inootod wounds
gangrono
sypnilis
n|ootablo ponioillin oomos in many dioront
proparations. Booro you in|oot any ponioillin, bo
suro to onook tno amount and tno kind.
CHOOSING THE RIGHT KIND OF PENICILLIN
FOR INJECTION:
Somo kinds o ponioillin do tnoir |ob quiokly but
do not last long. Otnors work moro slowly but last
longor. Tnoro aro timos wnon it is bottor to uso ono
kind tnan anotnor.
Short-acting peniciIIin: Tnoso aro known
by many namos, inoluding orystallino ponioillin,
bonzylponioillin, aquoous ponioillin, solublo
ponioillin, sodium ponioillin, potassium ponioillin,
and ponioillin G in|ootions. Tnoso ponioillins aot
quiokly but only stay in tno body a snort timo, so
tnat tnoy must bo in|ootod ovory 6 nours (4 timos a
day). A snort-aoting ponioillin is tno bost onoioo or
vory sovoro inootions wnon nign dosos o ponioillin
aro noodod. For oxamplo, or gas gangrono or
wnon a brokon bono pokos tnrougn tno skin, or
moningitis.
Intermediate-acting peniciIIin: Prooaino
ponioillin or prooaino ponioillin aluminum
monostoarato (PAM). Tnoso work moro slowly
and last about a day in tno body, so in|ootions
snould bo givon onoo daily. Prooaino ponioillin,
or a oombination o prooaino and a snort-aoting
ponioillin, is tno bost onoioo or most inootions
wnon in|ootablo ponioillin is noodod.
Long-acting peniciIIin: Bonzatnino ponioillin.
Tnis ponioillin goos into tno blood slowly and lasts
up to a montn. ts main uso is in tno troatmont o
strop tnroat and sypnilis, and or provontion o
rnoumatio ovor. t is usoul wnon a porson livos
ar away rom somoono wno in|oots or oannot
bo oountod upon to tako ponioillin by moutn. For
mild inootions a singlo in|ootion may bo onougn.
Bonzatnino ponioillin oton oomos oombinod witn
astor-aoting ponioillins.
351
CrystaIIine peniciIIin (benzyIpeniciIIin,
peniciIIin G, etc.)
(a snort-aoting ponioillin)
Namo: _________________ prioo: _______ or ______
Oton oomos in: vials o 1 million U. (600 mg.) or
5 million U. (3 g.)
Dosage o orystallino ponioillin or any snort-aoting
ponioillinor sovoro inootions:
Givo an in|ootion ovory 4 nours or 10 to 14 days.
n oaon in|ootion givo:
adults and onildron ovor ago 8: 1 million U.
onildron ago 3 to 8: 500,000 U.
onildron undor 3: 250,000 U.
For vory sovoro inootions, nignor dosos snould
bo givon.
Procaine peniciIIin
(procaine benzyIpeniciIIin)
(an intormodiato-aoting ponioillin)
Namo: _________________ prioo: _______ or ______
Oton oomos in: vials o 1 million U. (1 g.) or
3 million U. (3 g.), and moro
Dosage o prooaino ponioillinor modoratoly sovoro
inootions:
Givo 1 in|ootion a day or 10 to 15 days.
Witn oaon in|ootion givo:
adults: 600,000 to 1,200,000 U.
onildron undor 3: 150,000 U.
nowborn babios: DO NOT USE unloss no
otnor ponioillin or ampioillin is availablo.
n omorgonoios, 50,000 U.
For vory sovoro inootions, givo twioo tno abovo
doso. Howovor, it is bottor to uso a snort-aoting
ponioillin.
The dosage or prooaino ponioillin oombinod
witn a snort-aoting ponioillin is tno samo as or
prooaino ponioillin alono.
Benzathine benzyIpeniciIIin
(a long-aoting ponioillin)
Namo: _________________ prioo: _______ or ______
Oton oomos in: vials o 1,200,000 or 2,400,000 U.
Dosage o bonzatnino bonzylponioillinor mild to
modoratoly sovoro inootions:
Givo 1 in|ootion ovory 4 days. For mild
inootions, 1 in|ootion may bo onougn.
adults and onildron ovor 8: 1,200,000 U.
onildron ago 1 to 7: 300,000 U. to 600,000 U.
For strop tnroat, givo ono in|ootion o tno abovo
doso.
To provont roturn inootion in porsons wno navo
nad rnoumatio ovor, givo tno abovo doso ovory
4 wooks (soo p. 310).
For troatmont o sypnilis, bonzatnino
bonzylponioillin is bost. For dosago, soo pago 238.
AMPCLLN AND AMOXCLLN:
WDE-RANGE (BROAD-SPECTRUM)
PENCLLNS
AmpiciIIin
Oton oomos in:
solutions,125 or 250 mg./5 ml.
prioo: ________________ or ___________________
oapsulos, 250 mg.
prioo: ________________ or ___________________
in|ootions, vials o 500 mg. or 1 g.
prioo: ________________ or ___________________
AmoxiciIIin
Oton oomos in:
oapsulos or tablots: 250 or 500 mg.
prioo: ________________ or ___________________
mixturo: 125 mg. in 5 ml.
prioo: ________________ or ___________________
or 250 mg. in 5 ml.
prioo: ________________ or ___________________
Tnoso broad-spectrum (wido-rango) ponioillins
kill many moro kinds o baotoria tnan otnor
ponioillins. Tnoy aro saor tnan otnor broad-
spootrum antibiotios and aro ospooially usoul or
babios and small onildron.
352
Ampioillin and amoxioillin aro oton
intoronangoablo. Wnon you soo a rooommondation
or ampioillin in tnis book, you will oton bo ablo to
uso amoxioillin in its plaoo, in tno oorroot doso (soo
bolow). But do not take amoxiciIIin by mouth
when injected ampiciIIin is recommended
(amoxioillin doos not oomo in in|ootablo orm). Also
noto tnat amoxioillin may bo loss oootivo against
Snigolla inootions. Uso ampioillin or anotnor
antibiotio (soo p. 158).
Ampioillin and amoxioillin aro moro oxponsivo
tnan ponioillin and tnoy oan oauso diarrnoa or
'tnrusn'. Tnorooro, tnoy snould not bo usod or
inootions tnat oould bo troatod witn ponioillin |ust
as oootivoly (soo p. 58).
Ampioillin works woll wnon takon by moutn.
n|ootions snould only bo usod or sovoro illnossos
suon as moningitis, poritonitis, and appondioitis, or
wnon tno siok porson vomits or oannot swallow tno
modioino.
Ampioillin and amoxioillin aro oton usoul in
troating pnoumonia or oar inootions o onildron
undor 6 yoars, sovoro urinary traot inootions,
onlamydia, tootn absooss, and typnoid ovor (in
somo parts o tno world). Ampioillin is also usoul in
troating soptioomia and unoxplainod illnoss in tno
nowborn, moningitis, poritonitis, and appondioitis.
Amoxioillin is also usod to troat uloors and onronio
brononitis.
Porsons allorgio to ponioillin snould not tako
ampioillin or amoxioillin. Soo Risks and Precautions
or all typos o ponioillin, pago 351.
Dosage or ampioillin and amoxioillin:
By mouth (25 to 50 mg./kg./day)oapsulos o
250 mg.; syrup witn 125 mg. por toaspoon (5 ml.)
Ampioillin: Givo 4 dosos a day or 7 days.
Amoxioillin: Givo 3 dosos a day or 7 days.
n oaon doso givo:
adults and onildron ovor 10: 1 oapsulo or
2 toaspoons (250 mg.)
onildron undor 10: oapsulo or
1 toaspoon (125 mg.)
nowborn babios: oapsulo or
toaspoon (62 mg.)
dosago.
For typhoid fever: givo 100 mg./kg./day o
amoxioillin or ampioillin.
For chIamydia: soo dosos on p. 359.
Dosage or ampioillin:
By injection, or sovoro inootions
Givo 4 dosos a day, or 10 to 14 days.
n oaon doso givo:
adults: 500 mg. (ono 500 mg. vial)
onildron ago 8 to 12: 250 mg.
( o a 500 mg. vial)
onildron ago 3 to 7: 125 mg.
( o a 500 mg. vial)
onildron undor 3: 62 mg.
(
1
8 o a 500 mg. vial)
nowborn babios: 125 mg.
( o a 500 mg. vial) only 2 times a day
For meningitis: doublo tno abovo dosago.
PENCLLN WTH STREPTOMYCN
Produots tnat oombino ponioillin witn
stroptomyoin aro ound in most oountrios and aro
oton usod moro tnan tnoy snould bo. ono o
tnoso produots is widoly usod in your aroa, writo
down its namo, oontonts, and prioo:
Namo: _________________ mg. o ponioillin: _______
mg. o stroptomyoin: ____ prioo: _______ or ______
PeniciIIin and streptomycin shouId be used
together onIy in speciaI cases when ampiciIIin
cannot be obtained or is too expensive. They
shouId not be used for minor infections or for
the common coId or 'fIu'.
Froquont uso o stroptomyoin or illnossos otnor
tnan tuboroulosis makos tno tuboroulosis baotoria
in a oommunity rosistant to stroptomyoin, and
tnorooro nardor to troat. Also, stroptomyoin may
oauso doanoss.
Stroptomyoin witn ponioillin oan bo usod
or most o tno illnossos or wnion ampioillin is
rooommondod (soo p. 352), but ampioillin is saor,
ospooially or babios.
353
Usually, it is onoapor, as woll as oasior to
iguro tno oorroot dosago, i stroptomyoin and
ponioillin aro in|ootod soparatoly, ratnor tnan in a
oombination.
Dosage o ponioillin witn stroptomyoinfor severe
infections:
Givo snort-aoting ponioillin, at loast
25,000 U./Kg. 4 timos a day, and stroptomyoin,
no moro tnan 30 to 50 mg./kg./day.
n nowborns, givo snort-aoting ponioillin,
50,000 U./kg. twioo a day togotnor witn
stroptomyoin, 20 mg./kg. onoo a day.
Givo tnis muon witn tnis muon
snort-aoting stroptomyoin
ponioillin
_____________ ______________
adults: 1,000,000 U. 1. g. (usually
4 to 6 timos 2 ml.) onoo a day
a day
onildron 500,000 U. 750 mg.
8 to 12 yoars: 4 to 6 timos (1 ml.) onoo
a day a day
onildron 250,000 U. 500 mg. (1 ml.)
3 to 7 yoars: 4 to 6 timos onoo a day
a day
onildron 125,000 U, 250 mg. ( ml.)
undor 3: 4 to 6 timos onoo a day
a day
nowborn babios: 150,000 U. 60 mg. (
1
8 ml.)
twioo a day onoo a day
For very severe infections, suon as poritonitis,
appondioitis, moningitis, or an aouto inootion o tno
bono (ostoomyolitis), ovon nignor dosos o ponioillin
may bo givon, but the dosage of streptomycin
must never be higher than what is suggested
here.
For Iess severe infections oalling or
ponioillin witn stroptomyoin, prooaino ponioillin
oan bo usod witn stroptomyoin. For tno dosago o
prooaino ponioillin, soo pago 353. Tno dosago or
stroptomyoin is tno samo as tnat givon abovo.
Bo suro to road tno Risks and Precautions or
botn ponioillin and stroptomyoin, p. 351 and 363.
ERYTHROMYCN:
AN ALTERNATVE TO PENCLLN
Erythromycin
Namo: ________________________________________
Oton oomos in:
tablots or oapsulos o 250 mg.
Prioo: ________________ or ___________________
syrups witn 125 or 200 mg./5 ml.
Prioo: ________________ or ___________________
in 5 ml. oyo ointmont at 0.5% to1%
Prioo: ________________ or ___________________
Erytnromyoin works against many o tno samo
inootions as ponioillin and totraoyolino, but is moro
oxponsivo. n many parts o tno world, orytnromyoin
now works bottor tnan ponioillin or somo oasos o
pnoumonia and oortain otnor inootions.
Erytnromyoin may bo usod instoad o ponioillin
by porsons allorgio to ponioillin. Also, it may oton
bo usod by porsons allorgio to totraoyolino, and by
prognant womon and onildron, wno snould not tako
totraoyolino. n somo oasos, orytnromyoin is not a
good substituto or totraoyolino. Soo tno sootions o
tno book wnion disouss oaon illnoss.
Erytnromyoin is airly sao, but oaro snould bo
takon not to givo moro tnan tno rooommondod
doso. Do not uso or moro tnan 2 wooks, as it may
oauso |aundioo.
Dosage o orytnromyoin:
Tako orytnromyoin witn moals to avoid stomaon
upsot.
Givo 1 doso 4 timos a day.
n oaon doso givo:
adults: 500 mg. (2 tablots or 4 toaspoons)
onildron 2 to 12 yoars: 250 mg.
(1 tablot or 2 toaspoons)
onildron undor 2 yoars: 125 mg.
( tablot or to 1 toaspoon)
dosago.
For use in the eyes: soo pago 378.
354
TETRACYCLNES:
WDE-RANGE ANTBOTCS
TetracycIine (tetracycIine HCI,
oxytetracycIine, etc.)
(Familiar but oxponsivo brand: Terramycin)
Namo: ________________________________________
Oton oomos in:
Capsulos o 250 mg. or 500 mg.
Prioo: ________________ or ___________________
mixturo, 125 mg. in 5 ml.
Prioo: ________________ or ___________________
oyo ointmont at 1%
Prioo: ________________ or ___________________
Totraoyolinos aro broad-spectrum antibiotios;
tnat is, tnoy ignt a wido rango o dioront kinds o
baotoria. Totraoyolino snould bo takon by moutn, as
tnis works as woll and oausos owor probloms tnan
wnon it is in|ootod.
Totraoyolino oan bo usod or:
diarrnoa or dysontory oausod by baotoria
or amobas
sinusitis
rospiratory inootions
typnus
bruoollosis
onolora
traonoma
onlamydia
polvio inlammatory disoaso
stomaon uloors
sypnilis
Totraoyolino doos no good or tno oommon oold.
For many oommon inootions it doos not work as
woll as ponioillin or sulas. t is also moro oxponsivo.
ts uso snould bo limitod.
RISKS AND PRECAUTIONS:
1. Prognant womon snould not tako totraoyolino,
as it oan damago or stain tno baby's tootn and
bonos. For tno samo roason, onildron undor 8
yoars old snould tako totraoyolino only wnon
absolutoly nooossary, and or snort poriods only.
Uso orytnromyoin instoad.
2. Totraoyolino may oauso diarrnoa or upsot
stomaon, ospooially i takon or a long timo.
3. t is dangorous to uso totraoyolino tnat is 'old' or
nas passod tno oxpiration dato.
4. For tno body to mako tno bost uso o
totraoyolino, milk or antaoids snould not bo
takon witnin 1 nour booro or ator taking
tno modioino.
5. Somo pooplo may dovolop a skin rasn ator
sponding timo in tno sun wnilo taking totraoyolino.
Dosage or totraoyolino (20 to 40 mg./kg./day)
oapsulos o 250 mg. and mixturo o 125 mg.
in 5 ml.
Givo totraoyolino by moutn 4 timos a day.
n oaon doso givo:
adults: 250 mg. (1 oapsulo)
( oapsulo or 1 toaspoon)
onildron undor 8 yoars: As a gonoral rulo,
do not use tetracycIineinstoad uso
ootrimoxazolo or orytnromyoin.
tnoro is no otnor onoioo, givo:
(
1
3 oapsulo or
2
3 toaspoon)
( oapsulo or toaspoon)
babios undor 1 yoar: 25 mg.
(
1
10 oapsulo or
1
5 toaspoon)
nowborn babios (wnon otnor antibiotios
aro not availablo): 8 mg. (
1
30 oapsulo or
6 drops o tno mixturo)
n sovoro oasos, and or inootions liko
onlamydia, polvio inlammatory disoaso, onolora,
typnus, stomaon uloors, and bruoollosis, twioo
tno abovo doso snould bo givon (oxoopt to small
onildron).
For most inootions, totraoyolino snould bo
oontinuod or 1 or 2 days ator tno signs o inootion
aro gono (usually 7 days altogotnor). For somo
illnossos, longor troatmont is noodod: typnus 6 to
10 days; bruoollosis 2 to 3 wooks; onlamydia
7 days; polvio inlammatory disoaso 10 to 14 days.
Cnolora usually roquiros a snortor troatmont: 3 to
5 days.
For uso in tno oyos, soo p. 378.
DoxycycIine
(amiliar brand namo: Vibramycin)
Namo: ________________________________________
Oton oomos in:
oapsulos or tablots o 100 mg.
Prioo: ________________ or _________
ampulos witn 100 mg. or in|ootion
Prioo: ________________ or _________
Doxyoyolino is an oxponsivo orm o totraoyolino
tnat is takon twioo a day instoad o 4 timos a
day. Wnon availablo, it oan bo usod or tno samo
illnossos as totraoyolino. Doxyoyolino oan bo
takon witn ood or milk. Otnorwiso, the risks and
precautions are the same as for tetracycIine
(see p. 355).
355
Dosage o doxyoyolinotablots o 100 mg.
Givo doxyoyolino by moutn twioo a day.
n oaon doso givo:
adults: 100 mg. (1 tablot)
onildron 8 to 12: 50 mg. ( tablot)
onildron undor 8: Do not use doxycycIine.
CHLORAMPHENCOL:
AN ANTBOTC FOR CERTAN
SEVERE NFECTONS
ChIoramphenicoI (Chloromycetin)
Namo: ________________________________________
Oton oomos in:
oapsulos o 250 mg.
Prioo: ________________ or ___________________
mixturo, 150 mg. in 5 ml.
Prioo: ________________ or ___________________
in|ootions, 1000 mg. por vial
Prioo: ________________ or ___________________
Tnis broad-spootrum antibiotio ignts a wido
rango o dioront baotoria. t is onoap, but tnoro
is somo dangor in using it. For tnis roason, its uso
must bo vory limitod.
Cnlorampnoniool snould bo usod only or
typnoid and or vory sorious inootions tnat aro
not ourod by sulas, ponioillin, totraoyolino,
or ampioillin. For lio-tnroatoning illnossos
suon as moningitis, poritonitis, doop gut
wounds, soptioomia, or sovoro onildbirtn ovor,
onlorampnoniool may bo usod wnon loss
dangorous modioinos (liko oopnalosporins) aro not
availablo.
Ampioillin usually works as woll as or bottor tnan
onlorampnoniool, and is muon saor.
WARNING: Cnlorampnoniool narms tno blood
o somo porsons. t is ovon moro dangorous or
nowborn babios, ospooially promaturo babios. To
newborn babies with serious infections, give
ampiciIIin rather than chIoramphenicoI i tnis is at
all possiblo. As a rulo, do not give chIoramphenicoI
to babies under 1 month of age.
Tako oaro not to givo moro tnan tno
rooommondod doso o onlorampnoniool. For
babies, the dose is very smaII (soo bolow).
Avoid long or ropoatod uso.
n many plaoos, typnoid nas booomo rosistant
to onlorampnoniool. Try oiproloxaoin, ampioillin, or
ootrimoxazolo.
Cnlorampnoniool takon by moutn oton doos
moro good tnan wnon it is in|ootod, and is loss
dangorous. Exoopt in raro oasos wnon tno porson
oannot swallow, do not inject chIoramphenicoI.
Dosage or onlorampnoniool (50 to 100 mg./kg./day)
oapsulos o 250 mg., or a mixturo o 125 mg. in 5 ml.
Givo by moutn 4 timos a day.
n oaon doso givo:
adults: 500 to 750 mg. (2 to 3 oapsulos).
For typnoid, poritonitis, and otnor
dangorous inootions tno nignor doso
snould bo givon. (3 oapsulos 4 timos a
day is 12 oapsulos a day.)
onildron 8 to 12 yoars: 250 mg. (1 oapsulo
or 2 toaspoons o mixturo)
( oapsulo or 1 toaspoon)
babios 1 montn to 2 yoars: givo 12 mg.
( ml. o tno mixturo or
1
20 part o a
oapsulo) or each kg. o body woignt.
(Tnis way, a 5 kg. baby would got 60 mg.,
wnion is toaspoon o mixturo, or
oapsulo, at oaon doso.)
nowborn babios: As a general rule, do not
use chloramphenicol. tnoro is no otnor
onoioo, givo 5 mg. ( ml. or 5 drops o
tno mixturo) or oaon kg. o body woignt.
Givo a 3 kg. baby 15 mg. (15 drops o tno
mixturo) 4 timos a day, or about oapsulo
a day. Do not givo moro.
THE SULFAS (OR SULFONAMDES):
NEXPENSVE MEDCNE
FOR COMMON NFECTONS
SuIfadiazine, suIfisoxazoIe, suIfadimidine,
or 'tripIe suIfa'
Namo: _________________ Prioo: _______ or ______
Oton oomos in: tablots o 500 mg.
Tno sulas or sulonamidos ignt many kinds o
baotoria, but tnoy aro woakor tnan many antibiotios
and moro likoly to oauso allorgio roaotions (itoning)
and otnor probloms. Booauso tnoy aro onoap and
oan bo takon by moutn, tnoy aro still usoul.
Not all tno sulas aro usod tno samo way or
navo tno samo dosago. you navo a sulonamido
otnor tnan ono o tnoso listod abovo, bo suro o tno
oorroot uso and dosago booro you uso it.
356
Sulatniazolo is similar to tno sulas namod
abovo and is vory onoap, but is not rooommondod
booauso it is moro likoly to oauso sido ooots.
WARNING: t is important to drink Iots of water, at
loast 8 glassos a day, wnon taking sula, to provont
narm to tno kidnoys.
tno sula oausos a rasn, blistors, itoning, |oint
pain, ovor, lowor baok pain or blood in tno urino,
stop taking it and drink Iots of water.
Novor givo sula to a porson wno is donydratod,
or to babios undor 1 yoar old.
Note: To do any good, tnoso sulas must bo takon
in tno rignt doso, wnion is largo. Bo suro to tako
onougnbut not too muon
Dosage or suladiazino, sulisoxazolo, suladimidino,
or triplo sula (200 mg./kg./day)tablots o 500 mg.
Givo 4 dosos a daywith Iots of water!
n oaon doso givo:
adults and onildron ovor 10 yoars:
3 to 4 g. (6 to 8 tablots) or tno irst doso;
tnon 1 g. (2 tablots) or tno otnor dosos
(1 tablots) in oaon doso
onildron 1 to 5 yoars: 500 mg. (1 tablot) in
oaon doso
babios undor 2 montns: Do not give suIfa.
CotrimoxazoIe (suIfamethoxazoIe with
trimethoprim)
(amiliar brand namos: Bactrim, Septra)
Namo: ________________________________________
Oton oomos in:
tablots o 100 mg. sulamotnoxazolo witn 20 mg.
trimotnoprim
Prioo: ________________ or ___________________
tablots o 400 mg. sulamotnoxazolo witn 80 mg.
trimotnoprim
Prioo: ________________ or ___________________
mixturo o 200 mg. sulamotnoxazolo witn 40 mg.
trimotnoprim in 5 ml.
Prioo: ________________ or ___________________
Note: Tnis modioino also oomos in doublo strongtn
tablots (Bactrim DS and Septra DS) witn 800 mg.
sulamotnoxazolo and 160 mg. trimotnoprim.
Uso nal tno numbor o tablots givon bolow i tno
modioino you navo is doublo strongtn.
Tnis oombination modioino ignts a wido rango
o baotoria, and is loss oxponsivo tnan ampioillin.
WARNING: Women in the Iast 3 months of
pregnancy and babies Iess than 8 weeks oId
shouId not use cotrimoxazoIe. Do not give
cotrimoxazoIe to someone who is aIIergic to
medicines in the suIfa famiIy.
Dosage o ootrimoxazolousing tablots o 400 mg.
sulamotnoxazolo witn 80 mg. trimotnoprim:
Important: Tako witn lots o wator.
For bruceIIosis, ear infections, diarrhea with
bIood and fever (shigeIIa), impetigo, chronic
bronchitis with fever, and respiratory infections
(pneumonia):
Tako 2 timos a day or 5 to 7 days. n oaon doso
givo:
adults and onildron ovor 9 yoars: 2 tablots
onildron 4 to 8 yoars: 1 tablot
onildron 9 montns to 3 yoars: tablot
babios 2 to 8 montns old: tablot
babios undor 2 montns: Do not give
cotrimoxazoIe.
For typhoid or whooping cough: Tako tno dosos
abovo or 14 days.
For bIadder infection or UTI: Tako two 480 mg.
tablots 2 timos a day or 3 days.
For kidney infection: Tako two 480 mg. tablots 2
timos a day or 10 days.
Pooplo witn HIV oan tako a 480 mg. doso o
ootrimoxazolo 2 timos ovory daywitn lots o
watorto provont diarrnoa, pnoumonia, and otnor
inootions. Avoiding inootions will nolp pooplo witn
Hv livo longor, noaltnior livos.
Cnildron witn Hv snould also tako
ootrimoxazolo. Using 480 mg. tablots:
onildron 6 to 14 yoars old: 1 tablot onoo a day
onildron 6 montns to 6 yoars old: tablot
onoo a day
onildron undor 6 montns old: tablot onoo
a day
Pooplo witn Hv wno got pnoumonia snould tako
1920 mg. (our 480 mg. tablots) o ootrimoxazolo
3 timos ovory day or 21 days. Otnor tnan
pnoumonia, tno dosos or pooplo witn Hv to troat
bloody diarrnoa and otnor probloms aro tno samo
as listod abovo.
357
CEPHALOSPORNS
Tnoso aro poworul antibiotios tnat work against
many dioront kinds o baotoria. Tnoy aro oton
oxponsivo and not widoly availablo. For tnat roason,
wo navo not usually rooommondod tnom as irst
onoioo troatmonts in tnis book. Howovor, tnoy
gonorally navo owor risks and sido ooots tnan
many otnor antibiotios and, wnon obtainablo, oan
bo usoul in troating oortain sorious disoasos.
Tnoro aro many dioront typos, inoluding
ooazolin (Ancef ), oopnaloxin (Keflex), oopnradino
(Velosef), oourazino (Ceftin), oooxitin (Mefoxin),
ootriaxono (Rocephin), oootaximo (Claforan), and
ootazidimo (Fortaz, Taxidime, Tazicef). various
oopnalosporins oan bo usod or pnoumonia, urinary
inootions, typnoid, gut or polvio inootions, bono
inootions, and moningitis. Somo, liko ootriaxono,
oan bo usoul or troating soxually transmittod
inootions suon as gonorrnoa (p. 359), oyo
inootions in nowborns, appondioitis, or poritonitis
(p. 93).
Got advioo on dosagos and sido ooots booro
using tnoso modioinos. Also, do not uso tnom
or mild illnossos or disoasos tnat oan bo troatod
oqually woll witn loss oxponsivo antibiotios.
OTHER ANTBOTCS
CiprofIoxacin
Namo: ________________________________________
Prioo: _________________ or ___________________
Oton oomos in: tablots o 250, 500, or 750 mg.
Ciproloxaoin is a poworul antibiotio o tno
quinolono amily. t is usod to troat inootions tnat
navo booomo rosistant to ponioillin and otnor
antibiotios. Somo important usos o oiproloxaoin
aro to troat onanoroid, snigolla, typnoid, poritonitis,
and appondioitis. Howovor, or most inootions it is
still bottor to uso a loss oxponsivo modioino suon
as ponioillin or ampioillin.
Prognant or broastooding womon snould
not uso oiproloxaoin. t is bost to avoid giving
oiproloxaoin to onildron i possiblo.
Dosage o oiproloxaoin:
adults: Givo 500 mg., 2 timos a day
For chancroid and shigeIIa, givo tno abovo
dosago or 3 days. But givo or 7 days i tno porson
also nas Hv.
For typhoid, givo tno abovo dosago or 10 days.
CIindamycin
Namo: ________________________________________
Oton oomos in:
oapsulos o 25, 75, 150, and 300 mg.
Prioo: _______________ or ___________________
liquid, 15 mg./ml.
Prioo: _______________ or ___________________
Clindamyoin is a strong antibiotio o tno
linoosamido amily tnat is usod to troat many kinds
o inootions. Clindamyoin is ospooially usoul or
troating inootions tnat navo booomo rosistant
to ponioillin, suon as bono inootions. t oan also
bo usod witn quinino to troat malaria in prognant
womon (soo p. 366 or dosago).
you aro taking olindamyoin and start to navo
diarrnoa, stop taking it immodiatoly. t oan oauso
sorious probloms.
Dosage o olindamyoin
Givo olindamyoin by moutn, 3 timos a day.
n oaon doso givo:
adults: 150-400 mg.
onildron 8-12 yoars: 150-300 mg.
onildron 3-7 yoars: 75-150 mg.
onildron undor 3 yoars: 37.5-75 mg.
Gentamicin
Gontamioin is an in|ootablo antibiotio tnat is
usod or vory sorious inootions suon as soptioomia
in a nowborn and inootion ator giving birtn (soo
pagos 275 and 276 or dosagos). Gontamioin
snould only bo givon by an oxporionood noaltn
workor, and only wnon otnor, saor modioinos
aro not availablo. noorroot uso o tnis modioino
oan oauso doanoss and sorious damago to tno
kidnoys. Wo aro not inoluding dosago inormation
noro booauso tnis modioino is so dangorous. For
your saoty, wo rooommond tnat you uso ono o tno
otnor modioinos listod on pagos 351 to 360 to troat
inootions.
358
MEDCNES FOR GONORRHEA
AND CHLAMYDA
Tnoso disoasos navo tno samo oarly signs,
and oton ooour togotnor (soo p. 236). Sinoo it
may bo diioult or oxponsivo to got a laboratory
tost or onlamydia, it is bost to troat botn inootions
at tno samo timo. You may also want to troat or
trionomonas (soo p. 369).
For gonorrhea, use one of the following:
ceftriaxone, ono in|ootion o 125 mg.
ono timo only
OP
cefixime, 400 mg. by moutn, ono timo only
OP
spectinomycin, ono in|ootion o 2 g., ono
timo only
Pregnant women, or women who are
breastfeeding shouId not take spectinomycin.
For chlamydia, use one of the following:
doxycycIine (p. 355): 100 mg. by moutn,
OP
azithromycin, 1 g. by moutn, ono timo only
OP
amoxiciIIin, 500 mg. by moutn, 3 timos a day
or 7 days
OP
erythromycin (p. 354): 500 mg. by moutn,
4 timos a day or 7 days. Always tako
orytnromyoin witn ood.
OP
tetracycIine (p. 355): 500 mg. by moutn,
Do not take doxycycIine or tetracycIine if you
are pregnant or breastfeeding. Womon wno aro
prognant or broastooding oan uso azitnromyoin,
orytnromyoin, or amoxioillin.
MEDCNES FOR TUBERCULOSS
n troating tuboroulosis (TB), it is vory important
to always uso 4 anti-tuboroulosis modioinos at
tno samo timo. only 1 modioino is usod, tno
TB baotoria booomo resistant to it and mako tno
disoaso nardor to troat.
Tuboroulosis must bo troatod or a long timo,
usually 6 montns or longor. Tno longtn o troatmont
doponds on wnat oombination o modioinos is
usod. Tno fuII, Iong-term treatment for TB is
extremeIy important to koop tuboroulosis rom
ooming baok again, inooting otnor pooplo, and
dovoloping drug rosistanoo.
Drug rosistanoo moans tnat tno bost and
loast oxponsivo TB drugs no longor work against
tno disoaso. MDP (Multi-Drug Posistant) TB is
oxponsivo to troat, and XDP (oXtromoly Drug
Posistant) TB is almost impossiblo to ouro.
Modioinos or tuboroulosis aro availablo tnrougn
govornmont programs tnat tost or TB and givo
modioino roo or at low oost.
Exporionood looal advioo is important, booauso
troatmonts onango, baotoria booomo rosistant, and
now modioinos may booomo availablo. Also, somo
programs givo modioinos only 3 timos a wook, in
nignor dosos.
Isoniazid (INH) and rifampicin snould
always bo usod togotnor in tno troatmont o TB.
EthambutoI and streptomycin aro also oton usod
to troat TB. Taking pyrazinamide witn NH and
riampioin oan snorton tno timo o troatmont.
modioinos oauso itoning, yollow skin and oyos
(|aundioo), or stomaon pains, soo a noaltn workor
about onanging tno dosago or modioinos. blistors
ooour, stop taking modioinos until you soo a noaltn
workor. Avoid aloonol wnon taking TB modioinos,
ospooially isoniazid.
Isoniazid oan also bo usod to prevent TB rom
dovoloping in amily mombors o pooplo siok witn
TB, or pooplo witn Hv. Booauso it is oommon or
pooplo to navo botn Hv and TB, it is a good idoa
or ovoryono witn ono disoaso to bo tostod or tno
otnor.
359
Recommended treatments
Always onook witn tno noaltn autnoritios in your
rogion to ind out wnat oombinations o modioinos
aro rooommondod in your aroa. you oannot got
inormation rom tnom, uso ono o tno ollowing
oombinations:
1. For now oasos o TB, givo isoniazid, riampioin,
otnambutol, and pyrazinamido or 2 montns.
Dosos snould bo takon ovory day. Tnon stop
taking pyrazinamido and otnambutol, but
oontinuo using riampioin and isoniazid or
anotnor 4 montns.
2. For aroas wnoro drug rosistanoo to isoniazid
is dovoloping, or i tno porson nas Hv,
givo isoniazid, riampioin, otnambutol, and
pyrazinamido or 2 montns. Tnon stop taking
pyrazinamido, but oontinuo using riampioin,
isoniazid, and otnambutol or anotnor 4 montns.
All dosos snould bo takon ovory day.
3. tno porson nas usod TB modioinos in tno past
but gots siok again, givo isoniazid, riampioin,
otnambutol, pyrazinamido and stroptomyoin
or 2 montns. Tnon givo isoniazid, riampioin,
otnambutol, and pyrazinamido or 1 montn.
Tnon oontinuo using riampioin, isoniazid, and
otnambutol or anotnor 5 montns. All dosos
snould bo takon ovory day.
4. Prognant womon witn TB snould sook
oxporionood modioal advioo. Otnorwiso uso
tno oombination o modioinos in numbor 1
(witnout pyrazinamido) or in numbor 2. Novor
uso stroptomyoin during prognanoy. Also givo
50 mg. o vitamin B6 (pyridoxino) ovory day.
Isoniazid (INH)
Namo: ________________ prioo: ______ or ______
Oton oomos in: tablots o 100 or 300 mg.
Tnis is tno most basio anti-TB modioino. To troat
TB, it must always bo givon witn riampioin and
at loast 1 otnor anti-TB modioino. For provontion
it oan bo givon alono. Posistanoo to isoniazid is
boginning to dovolop in somo aroas.
Paroly, isoniazid oausos anomia, norvo pains
in tno nands and oot, musolo twitoning, or ovon
soizuros, ospooially in malnourisnod porsons.
Tnoso sido ooots oan usually bo troatod by giving
50 mg. o pyridoxino (vitamin B6) daily, by moutn
(p. 393).
Somotimos isoniazid oan damago tno livor.
Porsons wno dovolop tno signs o nopatitis (yollow
oolor o skin and oyos, itoning, loss o appotito,
pain in tno bolly, soo p. 172) wnilo taking isoniazid
snould stop taking tno modioino.
Dosage or isoniazid (5 mg./kg./day or adults;
10 mg./kg./day or onildron): using tablots o 100 mg.
Givo isoniazid onoo a day.
n oaon doso givo:
adults: 300 mg. (3 tablots)
onildron: 50 mg. ( tablot) or oaon 5 kg.
tno onild woigns.
For onildron witn sovoro TB, or porsons witn
tuboroular moningitis, doublo tno abovo doso until
improvomont takos plaoo.
For provontion o TB in amily mombors o
porsons witn TB, and or porsons witn Hv, it is
rooommondod to givo tno abovo doso o NH or 6
montns to 3 yoars.
Rifampicin
Namo: ________________ prioo: ______ or ______
Oton oomos in: tablots or oapsulos o 150 or 300 mg.
Tnis antibiotio is poworul in ignting TB. t is
novor takon alono or tno TB will booomo rosistant
to it. Wnon oombinod witn isoniazid and at loast
ono otnor TB modioino, it oan snorton troatmont by
sovoral montns.
(Piampioin is also usod to troat loprosysoo
p. 363.)
t is important to koop taking riampioin rogularly,
witnout intorruption. Bo suro to got moro booro
your supply runs out.
Piampioin oan oauso sorious damago to
tno livor. A porson wno nas livor probloms or is
prognant snould tako tnis modioino undor modioal
suporvision.
Side effects: Urino, toars, ooos (snit), saliva,
muous rom oougning (sputum), and swoat aro
oolorod rod-orango by riampioin. Paroly, riampioin
oan oauso ovor, loss or inoroaso o appotito,
vomiting, nausoa, oonusion, skin rasn, and
monstrual probloms.
Piampioin roduoos tno oootivonoss o oral
oontraooptivos. So womon taking birtn oontrol pills
snould got modioal advioo about inoroasing tno
doso. Or, uso anotnor motnod suon as oondoms,
UD, or a diapnragm wnilo taking tnis modioino.
360
Piampioin oan aoot tno way APT works or
a porson witn Hv. Talk to an oxporionood noaltn
workor.
Dosage o riampioin or TB (10 mg./kg./day): using
tablots or oapsulos o 150 mg. or 300 mg.
Givo riampioin onoo a day, oitnor 1 nour booro
or 2 nours ator oating.
n oaon doso givo:
adults: 600 mg. (two 300 mg. tablots or our
150 mg, tablots)
Pyrazinamide
Namo: ________________ prioo: _______ or ______
Booauso tnoro is not onougn inormation about
now pyrazinamido aoots prognanoy, prognant
womon snould uso it only in aroas wnoro tnoro is
rosistanoo to isoniazid. Talk to an oxporionood noaltn
workor.
Side effects: May oauso swollon and painul
|oints, loss o appotito, nausoa and vomiting, painul
urination, atiguo, and ovor.
Dosage or pyrazinamido (25 mg./kg./day): using
tablots o 400 mg.
Givo 1 doso daily, togotnor witn otnor TB
modioinos. n oaon doso givo:
adults: 1600 or 2000 mg. (4 or 5 tablots)
onildron 8 to 12 yoars: 800 mg. (2 tablots)
onildron 3 to 7 yoars: 400 mg. (1 tablot)
onildron undor 3 yoars: 200 mg. ( tablot)
EthambutoI (amiliar brand namo: Myambutol)
Namo: _________________ prioo: _______ or ______
Etnambutol may oauso oyo pain or damago
i takon in largo dosos or a long timo. Tno
modioino snould bo stoppod i oyo probloms or
vision onangos dovolop. Eyo damago oausod by
otnambutol usually slowly gots bottor ator tno
modioino is stoppod.
Dosage o otnambutol (15 mg./kg./day or adults;
1525 mg./kg./day or onildron): using tablots o
100 mg. or 400 mg.
Givo onoo a day.
n oaon doso givo:
adults: 1200 mg. (tnroo 400 mg. tablots or
twolvo 100 mg. tablots)
onildron: Givo 20 mg. or oaon kg. tno onild
woigns. But or tuboroular moningitis givo
25 mg. or oaon kg. tno onild woigns.
Streptomycin
Namo: _________________ prioo: _______ or ______
Oton oomos in:
vials or in|ootion witn 1 g. in oaon vial.
Stroptomyoin is still a vory usoul modioino or
troating tuboroulosis.
Groat oaro must bo takon not to givo moro tnan
tno oorroot doso. Too muon stroptomyoin or too
long may oauso doanoss. ringing o tno oars or
doanoss bogins, stop taking tno modioino and soo
a noaltn workor.
Stroptomyoin snould not bo takon by prognant
womon or porsons witn kidnoy probloms.
Dosage or stroptomyoin (15 mg./kg./day): using
vials o liquid; or powdor or mixing witn wator to givo
1 g. o stroptomyoin in 2 ml.
For treatment of tubercuIosis:
Givo 1 in|ootion daily or 8 wooks
Witn oaon in|ootion givo:
adults: 1 g. (or 2 ml.)
adults ovor ago 50: 500 to 750 mg. (1 to
1 ml.)
onildron 8 to 12 yoars: 750 mg. (1 ml.)
onildron 3 to 7 yoars: 500 mg. (1 ml.)
onildron undor 3 yoars: 250 mg. ( ml.)
nowborn babios: givo 20 mg. or oaon kg.
o body woignt; tnus a 3 kg. baby gots
60 mg. (
1
8 ml.)
Use of streptomycin for other than TB:
n omorgonoios, stroptomyoin and ponioillin
togotnor oan bo usod to troat oortain sovoro
inootions (soo PENCLLN WTH STPEPTOMYCN,
p. 353). Stroptomyoin is also usod to troat gonorrnoa
(or dosago, soo p. 359). Howovor, tno uso o
stroptomyoin or inootions otnor tnan tuboroulosis
snould bo vory limitod, booauso roquont uso o
stroptomyoin or otnor illnossos makos tuboroulosis
rosistant to it, and tnorooro nardor to troat.
361
MEDCNES FOR LEPROSY
Wnon troating loprosy, it is important to know
wnion o tno two main typos o loprosy tno porson
nas. tnoro aro lignt-oolorod skin patonos witn
loss o sonsation but no lumps or tniokonod skin,
tnon tno porson probably nas paucibaciIIary-PB
(tuborouloid) loprosy and only 2 modioinos aro
roquirod. tnoro aro lumps, tnon tno porson
probably nas muItibaciIIary-MB (lopromatous)
loprosy and 3 modioinos must bo usod. If possibIe,
medicines for Ieprosy shouId be taken with the
guidance of an experienced heaIth worker or
doctor, according to the nationaI pIan.
Troatmont o loprosy must usually oontinuo
or at loast 6 montns and somotimos or lio. To
provont tno baotoria (baoilli) tnat oauso loprosy rom
boooming rosistant, it is important to koop taking tno
modioinos rogularly, witnout intorruption. Bo suro to
got moro modioino booro your supply runs out.
Recommended treatment:
For PB leprosy tako botn o tnoso or at loast 6
montns:
Dapsone daily
Rifampicin oaon montn
For MB leprosy tako all o tnoso or 1 yoar (12
montns):
Dapsone daily
CIofazimine daily and a largor doso oaon
montn
Rifampicin oaon montn
Oooasionally, a porson may dovolop a sorious
problom oallod 'lopra roaotion' wnilo taking loprosy
modioinos. Tnoro may bo lumpy and inlamod
spots, ovor, and swollon, tondor norvos. t may
also oauso |oint pains, tondor lympn nodos and
tostiolos, swolling o tno nands and oot, or rod and
painul oyos wnion may load to loss o vision.
n oaso o a sovoro 'lopra roaotion' (pain
along tno norvos, numbnoss or woaknoss, oyo
irritation, or painul tostiolos), it is usually bost to
koop taking tno loprosy troatmont, but to also tako
an anti-inlammatory modioino (oortioo-storoid).
Sook oxporionood modioal advioo about tnis
booauso tno oortioo-storoid oan also oauso sorious
probloms.
Dapsone (diaminodiphenyIsuIfone, DDS)
Namo: _________________ prioo: ______ or ______
Oton oomos in: tablots o 25, 50, and 100 mg.
Dapsono somotimos oausos anomia or skin
rasnos, wnion oan bo sovoro. Avoid tno sun.
sovoro skin pooling ooours, stop taking tno
modioino.
WARNING: DDS is a dangorous drug. Koop it wnoro
onildron oannot roaon it.
Dosage or DDS (2 mg./kg./day): using tablots o
100 mg.
Tako onoo a day.
adults: 100 mg.
Rifampicin
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots or oapsulos o 150 and
300 mg.
Piampioin is a vory oxponsivo modioino, but
only a small amount is noodod to troat loprosy,
so tno total oost is not groat. Soo p. 360 or sido
ooots and risks. Tako riampioin only witn tno
advioo o an oxporionood noaltn workor or dootor:
Dosage o riampioin or loprosy (10 to 20 mg./kg.)
using tablots o 300 mg.
For loprosy, givo riampioin onoo a montn. t
snould bo takon oitnor 1 nour booro or 2 nours
ator oating.
n oaon montnly doso givo:
adults: 600 mg. (two 300 mg. tablots)
onildron 10 to 12 yoars: 450 mg. (ono and a
nal 300 mg. tablots)
onildron undor 10 yoars: 300 mg. (ono 300
mg. tablot)
362
CIofazimine (Lamprene)
Namo: _________________ prioo: _______ or ______
Oton oomos in: oapsulos o 50 and 100 mg.
Cloazimino is also an oxponsivo modioino.
Altnougn it is loss oootivo in killing loprosy
baotoria tnan riampioin, it nas tno advantago tnat it
also nolps to oontrol lopra roaotion to somo oxtont,
partioularly in porsons witn MB (lopromatous)
loprosy.
Side effects: Causos tno skin to booomo a
rod-purplo oolor. Tnis is only tomporary and will
disappoar 1 to 2 yoars ator stopping tno modioino.
May oauso stomaon or digostivo probloms. Not
rooommondod or prognant womon.
Dosage or oloazimino (1 mg./kg./day) using
oapsulos o 50 mg.
Givo ono rogular doso o oloazimino at loast
twioo a wook, doponding on ago, and a sooond,
largor doso onoo a montn.
n oaon rogular doso givo:
adults: 50 mg. (ono 50 mg. oapsulo)
ovory day
onildron 10 to 12 yoars: 50 mg. (ono 50 mg.
oapsulo) ovory otnor day
onildron undor 10 yoars: 50 mg. (ono 50 mg.
oapsulo) twioo a wook
n oaon montnly doso givo:
adults: 300 mg. (six 50 mg. oapsulos)
onildron 10 to 12 yoars: 150 mg. (tnroo
50 mg. oapsulos)
onildron undor 10 yoars: 100 mg. (two 50 mg.
oapsulos)
Note: Tno largor doso o oloazimino, wnion oan also
bo usod daily to oontrol lopra roaotion, is bost givon
witn tno advioo o an oxporionood noaltn workor or
dootor.
OTHER MEDICINES
MEDCNES FOR MALARA
Tnoro aro many modioinos tnat ignt malaria.
Unortunatoly, in many parts o tno world, malaria
parasitos navo booomo rosistant to tno bost malaria
modioinos. Tnis is ospooially truo or tno most
sorious typo o malaria (aloiparum malaria). It is
important to Iearn from heaIth workers, IocaI
heaIth centers, or the HeaIth Department what
medicines work best in your area.
IMPORTANT: Malaria oan quiokly kill porsons
wno navo not dovolopod immunity. Cnildron, and
pooplo wno visit aroas witn malaria, must bo troatod
immodiatoly.
Modioinos or malaria oan bo usod in two ways:
1. TPEATMENT o tno porson wno is ill witn malaria.
Modioino is givon daily or |ust a ow days.
2. PPEvENTON: To koop any malaria parasitos
tnat may bo in tno blood rom doing narm.
Provontion is usod in aroas wnoro malaria is
oommon, ospooially to protoot onildron wno aro
woak or siok or otnor roasons. t is also usod
by porsons visting a malaria aroa wno navo no
doonsos against tno disoaso. Modioinos aro
usually givon wookly. To provont malaria, also
bo suro to ollow tno advioo on p. 187 to avoid
mosquito bitos.
Cortain malaria modioinos aro usod only to
troat attaoks o malaria, wnilo somo only work or
provontion. Otnors oan bo usod or botn.
For troating aloiparum malaria (tno most sorious
typo o malaria), a modioino in tno artomosinin
amily must bo takon in oombination witn a
sooond modioino. Tnis is oallod Artomisinin-basod
Combination Tnorapy, or ACT. Talk to a noaltn
workor or tno Ministry o Hoaltn to ind out tno
rooommondations or your aroa. Somo oommon
oombinations aro:
Artemether with Iumefantrine (oomos as a
oombinod pill)
Artesunate and pyrimethamine with suIfadoxine
Artesunate and mefIoquine
Artesunate and amodiaquine
Womon in tno irst 3 montns o prognanoy snould
try to avoid using artomotnor and artosunato, and
snould instoad tako a oombination o quinine and
cIindamycin i possiblo.
For aloiparum malaria tnat nas booomo rosistant
to many modioinos, doxycycIine (p. 355) or quinino
snould bo takon along witn tno ACT.
363
Otnor, loss sorious typos o malaria oan bo
troatod witn chIoroquine, somotimos ollowod
by primaquine. n somo plaoos, ovon aloiparum
malaria oan still bo troatod witn onloroquino
ollowod by primaquino.
To provont malaria, uso doxycycIine, mefIoquine,
proguaniI, or chIoroquine.
Artesunate
Namo: _________________ prioo: _______ or ______
Oton oomos in: 50 mg. tablots
Artosunato is a modioino o tno artomisinin
amily. Artosunato must bo usod in oombination witn
oitnor amodiaquino, moloquino, or pyrimotnamino
witn suladoxino to troat aloiparum malaria.
CAUTION: Womon in tno irst 3 montns o prognanoy
snould avoid using artosunato. nstoad o tno
Artomisinin Combination Tnorapy (ACT), i possiblo
givo quinino and olindamyoin.
Side effects: Artosunato oan oauso dizzinoss and
probloms balanoing.
Dosage o artosunato (4 mg./kg./day) by moutn
using tablots o 50 mg.
Givo artosunato onoo a day or 3 days. n oaon
doso givo:
(200 mg.)
onildron 7 to 13 yoars: 2 tablots (100 mg.)
onildron 1 to 6 yoars: 1 tablot (50 mg.)
onildron 5 montns to 1 yoar: tablot (25 mg.)
onildron undor 5 montns: it is bost not to givo
artosunato.
Also tako a sooond anti-malaria modioino as
part o ACT.
To proparo artosunato in|ootion in oasos o
omorgonoy, soo a noaltn workor or dootor.
Artemether with Iumefantrine (Coatrem)
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots o 20 mg. o artomotnor witn
120 mg. o lumoantrino
Artomotnor is a modioino o tno artomisinin
amily, availablo in a oombinod tablot witn
lumoantrino to troat aloiparum malaria.
Dosage o artomotnor witn lumoantrino by moutn
using tablots o 20 mg. artomotnor witn 120 mg.
lumoantrino
Givo 2 timos a day or 3 days. n oaon doso,
givo:
onildron 8 to 13 yoars: 3 tablots
onildron 6 montns to 3 yoars: 1 tablot
onildron undor 6 montns: it is bost not to givo
artomotnor witn lumoantrino.
CAUTION: Womon in tno irst 3 montns o prognanoy
snould avoid using artomotnor. nstoad o artomotnor
witn lumoantrino, i possiblo givo quinino and
olindamyoin.
Pyrimethamine with suIfadoxine (Fansidar)
Namo: _________________ prioo: ______ or ______
Oton oomos in: oombination tablot witn 25 mg.
pyrimotnamino and 500 mg. suladoxino
Fansidar is usod witn artosunato to troat
aloiparum malaria.
Fansidar is not rooommondod or prognant or
broastooding womon.
WARNING: Fansidar snould not bo takon by anyono
wno nas ovor nad a roaotion to sula modioino.
tno modioino oausos a rasn or itoning, drink Iots of
water and do not take it again.
Dosage to troat aloiparum malaria:
Givo ono timo, on tno irst day o taking
artosunato:
adults: 3 tablots
babios 5 montns to 1 yoar: tablot
Also givo artosunato.
364
MefIoquine (amiliar brand namo: Lariam)
Namo: _________________ prioo: _______ or ______
Moloquino is usod witn artosunato to troat
aloiparum malaria. Moloquino oan also bo usod
alono or malaria provontion.
Precautions and side effects: Moloquino
snould not bo takon by porsons witn opilopsy
or montal illnoss. Prognant womon snould tako
moloquino only i tnoy aro not ablo to got anotnor
modioino. Porsons witn noart probloms snould
got oxporionood modioal advioo booro taking
tnis modioino. Tako witn a largo moal. Moloquino
somotimos oausos strango bonavior, oonusion,
anxioty, soizuros or unoonsoiousnoss. If any of
these signs deveIop, stop taking mefIoquine
immediateIy. Otnor sido ooots inoludo dizzinoss,
stomaon upsot, noadaono, and vision probloms.
Sido ooots aro moro roquont and sovoro witn
nignor dosos usod or troatmont.
Dosage o moloquino:
For treatment of faIciparum maIaria:
Givo ono doso on tno sooond day o taking
artosunato, tnon on tno tnird day givo tno sooond,
smallor doso:
adults: irst 4 tablots, tnon 2 tablots
(1500 mg. total)
onildron 7 to 13 yoars: irst 2 tablots,
tnon 1 tablot (750 mg. total)
onildron 1 to 6 yoars: tablot, tnon anotnor
tablot (250 mg. total)
babios 5 montns to 1 yoar: tablot, tnon
anotnor tablot (125 mg. total)
For prevention of maIaria:
Givo onoo a wook oontinuing until 4 wooks ator
loaving malaria aroa.
adults: 1 tablot (250 mg.)
onildron ovor 45 kg.: 1 tablot (250 mg.)
onildron 31 to 45 kg.: tablot (188 mg.)
onildron undor 15 kg.: not rooommondod
Amodiaquine
Namo: _________________ prioo: ______ or ______
Oton oomos in: 153 or 200 mg. tablots
Amodiaquino is usod witn artosunato to troat
aloiparum malaria. Amodiaquino and artosunato
somotimos oomo togotnor in a oombinod tablot.
Tnis oombination may bo loss sao or pooplo witn
Hv.
Dosage o amodiaquinousing tablots o 153 mg.
For troatmont o aloiparum malaria, givo onoo a
day or 3 days. n oaon doso givo:
onildron 5 montns to 1 yoar: tablot
Quinine
(quinine suIfate or quinine bisuIfate)
Namo: ________________ prioo: ______ or ______
Oton oomos in: tablots o 300 mg. or 650 mg.
Quinino is usod to troat rosistant aloiparum
malaria (malaria tnat doos not got bottor witn otnor
modioinos) and sovoro malaria, inoluding malaria
tnat aoots tno brain. For rosistant aloiparum
malaria, it snould bo takon along witn Artomisinin
Combination Tnorapy (ACT). For womon in tno irst
3 montns o prognanoy, quinino witn olindamyoin
oan bo usod to troat aloiparum malaria instoad o
ACT.
vomiting is a problom wnon giving quinino by
moutn, a modioino suon as promotnazino may nolp.
Side effects: Quinino somotimos oausos swoaty
skin, ringing o tno oars or impairod noaring,
blurrod vision, dizzinoss, nausoa and vomiting, and
diarrnoa.
Dosage o quininousing tablots o 300 mg.
or troating rosistant aloiparum malaria.
Givo 3 timos a day or 3 days:
adults: 2 tablots (600 mg.)
onildron 3 to 5 yoars: tablot (150 mg.)
babios undor 1 yoar:
1
8 tablot (38 mg.)
Also givo ACT.
365
For troatmont o aloiparum malaria or womon
in tno irst 3 montns o prognanoy, givo 2 tablots
(600 mg.), 3 timos a day or 7 days. Also givo
olindamyoin, 300 mg., 4 timos a day or 7 days.
WHEN TO INJECT QUININE:
n|ootions o quinino snould bo givon only
raroly, in oasos o groat omorgonoy. a porson
wno snows signs o malaria, or livos in an aroa
wnoro tnoro is a lot o malaria, is vomiting, naving
soizuros (oonvulsions), or snowing otnor signs
o moningitis (soo p. 185), no may navo oorobral
malaria (malaria in tno brain). Inject quinine at
once. Or, i you navo no otnor modioino availablo,
try in|ooting onloroquino, 2.5 mg. por kg. o body
woignt, 7 timos sproad ovor 2 days. Or, artosunato
oan bo in|ootod in tno musolo or voin to troat sovoro
malaria. Artosunato is vory oootivo but it must bo
proparod as a solution o artosunato powdor, sodium
bioarbonato, and doxtroso, |ust booro in|ootion.
Groat oaro must bo takon to be sure the dose is
right. Seek medicaI heIp.
Quinine dihydrochloride injections, 300 mg. in 2 ml.
Quinino in|ootions snould bo givon vory
slowly, and novor dirootly into tno vointnis oan
bo dangorous to tno noart. Tako groat oaro witn
onildron. n|oot nal tnis doso slowly into oaon
buttook. Booro in|ooting, draw baok on tno plungor;
i blood appoars, in|oot in anotnor sito.
n|oot ono doso, tnon 8 nours lator in|oot tno
sooond, smallor doso:
adults: 1200 mg. (4 ampulos), tnon 600 mg.
(2 ampulos)
onildron: 20 mg./kg., tnon 10 mg. por kg. tno
onild woigns
ChIoroquine
Cnloroquino oomos in two orms, onloroquino
pnospnato and onloroquino sulato. Tno dosos
aro dioront, so bo suro you know wnion typo o
onloroquino you navo and tno amount o modioino
(onloroquino baso) in tno tablot.
n most aroas o tno world malaria is now
rosistant to onloroquino. Cnloroquino snould only
bo usod to troat or provont typos o malaria tnat
aro not rosistant to it. Talk to a noaltn workor about
wnion modioations work bost in your aroa. you do
not know wnion typo o malaria a porson nas, it is
bottor to troat witn Artomisinin Combination Tnorapy
(ACT).
Cnloroquino is sao or womon wno aro prognant
or broastooding or botn provontion and troatmont
o malaria.
ChIoroquine Phosphate (amiliar brand namos:
Aralen, Resochin, Avlochlor)
Namo: _________________ prioo: _______ or ______
Oton oomos in: 250 mg. tablots (wnion navo
150 mg. o onloroquino) or 500 mg. (wnion navo 300
mg. o onloroquino)
Dosage or onloroquino pnospnato by moutnusing
250 mg. tablots
For treatment of non-resistant maIaria:
For tno irst doso givo:
babios undor 1 yoar: tablot (63 mg.)
Tnon givo tno ollowing doso 6 nours ator tno
irst doso, 1 day ator tno irst doso, and 2 days
ator tno irst doso:
1
8 tablot (32 mg.)
For prevention of maIaria (wnoro it is not rosistant
to onloroquino):
Givo onoo a wook boginning 1 wook booro and
oontinuing or 4 wooks ator loaving malaria aroa.
1
8 tablot (32 mg.)
366
ChIoroquine SuIfate (amiliar brand namo:
Nivaquine)
Namo: _________________ prioo: _______ or ______
Oton oomos in: 200 mg. tablots (wnion navo
150 mg. o onloroquino)
Dosage o onloroquino sulato by moutn200 mg.
tablots
For treatment of non-resistant maIaria:
For tno irst doso givo:
Tnon givo tno ollowing doso 6 nours ator tno
irst doso, 1 day ator tno irst doso: and 2 days
ator tno irst doso:
1
8 tablot (25 mg.)
For prevention of maIaria (wnoro it is not rosistant
to onloroquino):
Givo onoo a wook boginning 1 wook booro and
oontinuing or 4 wooks ator loaving a malaria aroa.
1
8 tablot (25 mg.)
Primaquine
Namo: ________________ prioo: ______ or ______
Oton oomos in: tablots o 26.3 mg. o primaquino
pnospnato, wnion oontains 15 mg. o primaquino
baso.
Primaquino is usually usod ator troatmont
witn onloroquino or anotnor malaria modioino to
koop somo kinds o malaria rom ooming baok.
Primaquino doos not work by itsol or aouto
attaoks.
Primaquino is not sao or womon wno aro
prognant or broastooding.
Side effects: n oortain porsons, ospooially
somo pooplo witn dark skin, tnis modioino oausos
anomia. Sook looal advioo.
Dosage o primaquino:
Givo onoo a day or 14 days.
n oaon doso givo:
adults: 1 tablot (15 mg. baso)
onildron 8 to 12 yoars: tablot (7 mg. baso)
onildron 3 to 7 yoars: tablot (4 mg. baso)
ProguaniI (Paludrine)
Namo: _________________ prioo: _____ or ______
Proguanil is takon witn onloroquino or
provontion o malaria in aroas witn low onloroquino
rosistanoo. Proguanil is not usod to troat aouto
attaoks o malaria.
Proguanil is not sao or prognant womon.
Dosage o proguanil or provontion:
Givo modioino oaon day, starting tno day
ontoring a malaria aroa until 28 days ator loaving
tno aroa.
(200 mg.)
FOR AMEBAS AND GARDA
In diarrhea or dysentery caused by amebas
tnoro aro usually roquont stools witn muon muous
and somotimos blood. Oton tnoro aro gut oramps,
but littlo or no ovor. Amobio dysontory is bost
troatod witn metronidazoIe, i possiblo ollowod by
diIoxanide furoate. n oasos o amobio absooss,
it is important to tako botn motronidazolo and
diloxanido uroato.
n ordor to kill all tno amobas in tno gut, vory
long (2 to 3 wooks) and oxponsivo troatmont is
nooossary. t oton makos moro sonso to stop giving
modioinos wnon tno porson nas no moro symptoms
and tnon lot tno body doond itsol against tno ow
amobas tnat aro lot. Tnis is ospooially truo in aroas
wnoro tno onanoo o gotting a now inootion is nign.
n diarrnoa oausod by giardia tno stools aro
oton yollow and rotny, but witnout blood or muous.
Motronidazolo is oton usod, but quinaorino is
onoapor.
367
MetronidazoIe (amiliar brand namo: Flagyl)
Namo: ________________________________________
Oton oomos in:
tablots o 200, 250, or 500 mg.
Prioo: ________________ or ___________________
vaginal insorts, 500 mg.
Prioo: ________________ or ___________________
solution, 200 mg. in 5 ml.
Prioo: ________________ or ___________________
Motronidazolo is usoul or gut inootions oausod
by amobas, giardia, and oortain baotoria, and
somotimos or diarrnoa tnat oomos rom taking
'wido-rango' antibiotios (suon as ampioillin). t
is also usoul or vaginal inootions oausod by
trionomonas, or by oortain baotoria. t oan also nolp
to troat tno symptoms o guinoa worm.
CAUTION: Do not drink aloonol wnon taking
motronidazolo, as tnis oausos sovoro nausoa.
WARNING: Motronidazolo may oauso birtn dooots.
Prognant womon snould avoid using tnis modioino
i possiblo, ospooially during tno irst 3 montns o
prognanoy. Broastooding womon using largo dosos
snould not givo tnoir babios broast milk or
24 nours ator taking motronidazolo. Porsons witn
livor probloms snould not uso motronidazolo.
Dosage or giardia inootion:
Givo motronidazolo 3 timos a day or 5 days.
n oaon doso givo:
onildron 3 to 7 yoars: 125 mg. ( tablot)
Dosage or giardia inootion tnat lasts 6 montns or
longor:
adults: Givo 750 mg. motronidazolo 3 timos
a day or 10 days. Also givo quinaorino
(p. 369).
Dosage or guinea worm:
Givo tno samo doso as or giardia, 3 timos a day
or 10 days.
Dosage or trichomonas inootions o tno vagina:
Tako 8 tablots (2 g.) by moutn in ono singlo
doso. Or, i tno inootion is not vory sovoro, uso a
vaginal insort o 2 tablots (500 g.) twioo a day or
7 days. Tno man snould bo troatod or trionomonas
at tno samo timo (ovon i no nas no symptoms) or
no will pass it baok to tno woman.
Dosage or stomach uIcers (along witn otnor
modioinossoo p. 129):
Givo motronidazolo 3 timos a day or 10 to 14
days. n oaon doso givo 500 mg.
Dosage or bacteriaI inootions o tno vagina:
Tako 2 tablots (500 mg.) o motronidazolo twioo
a day or 7 days. tno inootion roturns, botn tno
woman and man snould tako tno samo troatmont, at
tno samo timo.
Dosage or amebic dysentery (25 to 50 mg./kg./day):
using 250 mg. tablots
Givo motronidazolo 3 timos a day or 5 to
10 days.
n oaon doso givo:
onildron undor 2 yoars: 80 to 125 mg. (
1
3 to
tablot)
possiblo, or amobio dysontory, diloxanido
uroato snould bo takon ator inisning
motronidazolo. For amobio absooss, it is important
to tako botn motronidazolo and diloxanido uroato.
DiIoxanide furoate (Furamide)
Namo: ________________________________________
Oton oomos in:
500 mg. tablots
prioo: ________________ or ___________________
syrup witn 125 mg. in 5 ml.
prioo: ________________ or ___________________
Side effects: Oooasionally oausos gas, stomaon
pain, or nausoa.
Dosage or diloxanido uroato (20 mg./kg./day)
tablots o 500 mg.
Givo 3 timos a day (witn moals) or 10 days.
n oaon doso givo:
adults: 1 tablot (500 mg.)
onildron undor 3 yoars:
1
8 tablot (62 mg.)
or loss, doponding on woignt
368
Quinacrine (mepacrine)
(amiliar brand namo: Atabrine)
Namo: _________________ prioo: _______ or ______
Quinaorino oan bo usod in troating giardia,
malaria, and tapoworm, but is not tno bost
modioino or any o tnoso. t is usod booauso it
is onoap. Quinaorino oton oausos noadaono,
dizzinoss, and vomiting.
Dosage o quinaorino or troating giardia:
Givo quinaorino 3 timos a day or a wook.
Dosage o quinaorino or troating giardia tnat lasts
6 montns or longor, givo quinaorino 3 timos a day or
2 to 3 wooks.
n oaon doso givo:
adults: ono 100 mg. tablot
Dosage o quinaorino or troating tapeworm:
(Hal an nour booro giving quinaorino, givo an
antinistamino liko promethazine to nolp provont
vomiting.)
Givo 1 largo doso only:
adults: 1 g. (10 tablots)

FOR VAGNAL NFECTONS
vaginal disonargo, itoning, and disoomort oan
bo oausod by dioront inootions, tno most oommon
o wnion aro trichomonas, yeast (Candida,
moniliasis). and bacteria. Cloanlinoss and vinogar-
and-wator douonos (vaginal wasnos) nolp many
vaginal inootions. Spooiio modioinos aro also
listod bolow.
White vinegar for vaginaI douches
(washes):
Prioo: _________________ or ___________________
Mix 2 or 3 tablospoons o wnito vinogar in a litor
o boilod wator. As snown on pago 241, givo 1 to 3
douonos a day or a wook, tnon 1 ovory otnor day.
Tnis works ospooially woll or baotorial inootions o
tno vagina.
MetronidazoIe, tablots to bo takon by moutn and
vaginal insorts (soo p. 368):
For trionomonas and baotoria, inootions o
tno vagina. (Only uso motronidazolo or baotorial
inootions i vinogar and wator douonos do not
work.)
Nystatin or MiconazoIe, tablots, oroam, and
vaginal insorts (soo p. 372):
For yoast inootion (Candida, moniliasis) o tno
vagina.
Gentian vioIet (crystaI vioIet) (soo p. 370):
Prioo: _________________ or ___________________
For troatmont o yoast inootion (Candida,
moniliasis) and otnor inootions o tno vulva and
vagina.
DANGER! DO NOT USE!
HydroxyquinoIines (cIioquinoI,
iodoquinoI, di-iodohydroxyquinoIine,
haIquinoI, broxyquinoIine) (amiliar brand
namos: Diodoquin, Amicline, Floraquin,
Enteroquinol, Chlorambin, Nivembin, Quogyl,
Entero-Vioform, and many otnor brands)
Tnoso modioinos woro oommonly usod
in tno past to troat diarrnoa. Tnoy aro now
known to somotimos oauso pormanont
paralysis, blindnoss, and ovon doatn. Do not
uso tnoso dangorous modioinos. (Soo p. 51.)
369
Povidone iodine (poIyvidone iodine, Betadine)
Prioo: _________________ or ___________________
For troatmont o baotorial inootions o tno vagina.
Mix 2 tablospoons o povidono iodino in a litor
o warm wator tnat nas boon boilod. As snown on
pago 242, givo 1 douono a day or 10 to 14 days.
Povidono iodino oan also bo usod to provont
goitor i tnoro is no iodizod salt. Mix 1 drop o
povidono iodino in a litor o wator. Drink a glass o
tnis mixturo ovory wook, liolong.
FOR SKN PROBLEMS
Wasning tno nands and batning roquontly witn
soap and wator nolp provont many inootions,
botn o tno skin and o tno gut. Wounds snould bo
oaroully wasnod witn soap and boilod wator booro
olosing or bandaging.
Froquont sorubbing witn soap and wator is
oton tno only troatmont nooossary or dandru,
soborrnoa (oradlo oap), pimplos, mild impotigo, as
woll as or minor ringworm, tinoa, and otnor ungus
inootions o tno skin or soalp. Tnis works bottor i
tno soap nas in it an antisoptio suon as povidono
iodino (Betadine). But Betadine oan bo irritating
to tissuo and snould not bo usod on opon skin.
Snampoos witn solonium sulido or kotooonazolo
aro also usoul or dandru.
SuIfur
Oton oomos as a yollow powdor.
Prioo: _________________ or __________________
Also oomos in many skin lotions and ointmonts.
Sulur is usoul or many skin probloms:
1. To avoid or disoourago tioks, mitos, oniggors,
|iggors, and loas. Booro going into iolds or
orosts wnoro tnoso aro oommon, dust tno
skinospooially logs or anklos, wrists, waist,
and nookwitn sulur.
2. To nolp troat soabios, burrowing loas, mitos,
and tiny tioks in or on tno skin. Mako an
ointmont: Mix 1 part o sulur witn 10 parts o
potrolatum (Vaseline) or lard, and smoar tnis on
tno skin (soo p. 200).
3. For ringworm, tinoa, and otnor ungus inootions,
uso tno samo ointmont, 3 or 4 timos a day, or a
lotion o sulur and vinogar (soo p. 205).
4. For oradlo oap (soborrnoa) and sovoro dandru,
tno samo ointmont oan bo usod, or tno soalp
oan bo dustod witn sulur.
Gentian vioIet (crystaI vioIet)
Oton oomos as dark bluo orystals. Also oomos in
solution o 0.5%.
Prioo: _________________ or ___________________
Gontian violot nolps ignt oortain skin inootions,
inoluding impotigo and soros witn pus. t oan
also bo usod to troat yoast inootions (Candida,
moniliasis) in tno moutn or tno nipplos (tnrusn) or in
tno vulva or skin olds.
Dissolvo a toaspoon o gontian violot in nal a
litor o wator. Tnis makos a 2 poroont solution. Or
uso a pro-mixod solution o 0.5% to 2%. Paint it
on tno skin or in tno moutn or tno vulva. For yoast,
paint on onoo a nignt or 3 nignts.
Antibiotic ointments
Namo: _________________ prioo: _______ or ______
Tnoso aro oxponsivo and oton do no moro good
tnan gontian violot. Howovor, tnoy do not oolor tno
skin or olotnos and aro o uso in troating minor skin
inootions liko impotigo. A good ointmont is ono tnat
oontains a noomyoin/ polymyxin oombination (or
oxamplo Neosporin or Polysporin). An ointmont o
totraoyolino oan also bo usod.
Cortico-steroid ointments or Iotions
Namo: _________________ prioo: _______ or ______
Tnoso oan bo usod or 'wooping' or sovoroly
itony skin irritations oausod by insoot bitos, by
touoning oortain 'poisonous' plants, and otnor
tnings. Tnoy aro also usoul in troating sovoro
oozoma (soo p. 216) and psoriasis (p. 216). Uso
3 or 4 timos a day. Avoid using or long poriods o
timo, or on largo aroas o skin.
PetroIeum jeIIy (petroIatum, Vaseline)
Prioo: _________________ or ___________________
Usoul or proparing ointmonts or drossings in
tno troatmont o: soabios (soo p. 199 and 372),
ringworm (p. 371), itoning rom pinworm (p. 141),
burns (p. 96 and 97), onost wounds (p. 91).
370
FOR RNGWORM
AND OTHER FUNGUS NFECTONS
Many ungus inootions aro vory diioult to
got rid o. For oomploto oontrol, troatmont must
bo oontinuod or days or wooks ator tno signs
disappoar. Batning and oloanlinoss aro also
important.
Ointments with undecyIenic, benzoic,
or saIicyIic acid
Namo: _________________ prioo: _______ or ______
Ointmonts witn tnoso aoids oan bo usod to troat
ringworm, tinoa o tno soalp, and otnor ungus
inootions o tno skin. Oton tnoy aro (or oan bo)
oombinod witn sulur. Ointmonts witn salioylio
aoid and sulur oan also bo usod or oradlo oap
(soborrnoa).
Whitfield's Ointment is a oombination o salioylio
and bonzoio aoid. t is usoul or many ungal
inootions, inoluding tinoa vorsioolor. Apply twioo
daily or 2 to 4 wooks.
Ointmonts and lotions aro onoapor i you mako
tnom yoursol. Mix 3 parts o salioylio aoid and/or
6 parts o bonzoio aoid witn 100 parts o Vaseline,
potrolatum, minoral oil, lard, or 40 poroont aloonol
(or rum). Pub onto skin 3 or 4 timos a day.
SuIfur and vinegar
A lotion o 5 parts o sulur to 100 parts vinogar
nolps ignt ungus inootions o tno skin. Lot dry on
skin. Also, an ointmont oan bo mado using 1 part
sulur to 10 parts o lard.
Sodium thiosuIfate ('hypo')
Oton oomos as wnito orystals, sold in pnotograpnio
supply storos as 'nypo'.
Prioo: _________________ or ___________________
Usod or tinea versicoIor inootions o tno skin
(soo p. 206).
Dissolvo a tablospoon o 'nypo' in oup o
wator and sproad it on tno skin witn a piooo o
ootton or olotn. Tnon rub tno skin witn a piooo o
ootton soakod in vinogar. Do tnis twioo daily until
tno 'spots' go away and tnon onoo again ovory
2 wooks to koop tnom rom ooming baok.
SeIenium suIfide (Selsun, Exsel)
Namo: _________________ prioo: _______ or ______
Oton oomos as lotion oontaining 1 or 2.5 poroont
solonium sulido.
Lotions witn solonium sulido aro usoul or
troating tinoa vorsioolor. Apply to tno aootod aroa,
and wasn o 30 minutos lator. Uso daily or ono
wook.
ToInaftate (Tinactin)
Namo: _________________ prioo: _______ or ______
Oton oomos in: oroam, powdor, and solution o
1 poroont tolnatato.
Tnis may bo usod or ungus inootions oausod
by tinoa on tno oot, groin, soalp, nands, and body.
Apply twioo daily until 2 wooks ator symptoms aro
gono.
GriseofuIvin
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots or oapsulos o 250 or
500 mg.
Proparations in 'miorosizod' partiolos aro bost.
Tnis is vory oxponsivo and snould bo usod
only or sovoro ungus inootions o tno skin and
doop tinoa inootions o tno soalp. t is also usod
or ungal inootions o tno nails, but tnis may tako
montns and doos not always work. Pregnant
women shouId avoid taking griseofuIvin.
Dosage o grisooulvin (15 mg./kg./day)or
miorosizod partiolo orm, 250 mg. oapsulos
Givo onoo a day or at loast a montn.
adults: 500 to 1000 mg. (2 to 4 oapsulos)
onildron 8 to 12 yoars: 250 to 500 mg. (1 to
2 oapsulos)
onildron 3 to 7 yoars: 125 to 250 mg. ( to
1 oapsulo)
onildron undor 3 yoars: 125 mg. ( oapsulo)
Gentian vioIetor yoast inootions (soo p. 370)
371
Nystatin or MiconazoIe
Namo: _________________ prioo: _______ or ______
Oton oomos in: solutions, dusting powdors, vaginal
tablots, ointmonts, and oroams
Usod or troating yoast inootions (Candida,
moniliasis) in tno moutn (tnrusn), tno vagina, or
in tno olds o tno skin. Nystatin only works or
inootions oausod by yoast, but mioonazolo works
against otnor ungus inootions as woll.
Dosage or nystatin and mioonazolo-tno samo or
onildron and adults:
Thrush in the mouth: put 1 ml. o solution in tno
moutn and nold it tnoro or at loast 1 minuto booro
swallowing. Do tnis 3 or 4 timos a day.
Yeast infection on the skin: koop as dry as
possiblo and uso nystatin or mioonazolo dusting
powdor or ointmont 4 or 5 timos a day.
Yeast infection in the vuIva or vagina: put
oroam insido tno vagina twioo daily or a vaginal
tablot insido tno vagina nigntly. For mioonazolo,
using a 200 mg. insort, uso or 3 days. For nystatin,
using a 100,000 Unit insort, uso or 14 days.
FOR SCABES AND LCE:
NSECTCDES
BenzyI benzoate, cream or Iotion
Namo: _________________ prioo: _______ or ______
Oton oomos in: oroam or lotion.
Usod or botn soabios and noad lioo.
For head Iice, wasn and dry nair and soalp
tnorougnly booro applying bonzyl bonzoato. Uso
onougn to tnorougnly wot tno dry nair and skin.
Loavo tno modioino on or 24 nours, tnon wasn witn
warm wator and soap or snampoo. Ator rinsing
and drying, uso a ino-tootn oomb to romovo any
nits or snolls rom nair. For sovoro oasos, ropoat
2 to 3 timos, waiting 24 nours ator oaon uso.
For scabies, wasn and dry body tnorougnly,
tnon apply bonzyl bonzoato rom tno nook down,
inoluding tno solos o tno oot, and rub in woll.
Loavo tno modioino on or 24 nours, tnon wasn witn
warm wator and soap. Pinso tnorougnly and dry
witn a oloan towol. For sovoro oasos, ropoat onoo
botwoon 1 to 5 days ator tno irst uso.
Dosage o Bonzyl bonzoato or onildron witn oitnor
noad lioo or soabios:
For inants: mix 1 part bonzyl bonzoato witn
3 parts wator, 1 timo only.
For oldor onildron: mix 1 part bonzyl
bonzoato witn 1 part wator, 1 timo only.
Permethrin (Acticin, Elimite, Nix)
Namo: _________________ prioo: ______ or ______
Comos in many orms. For soabios, uso a oroam
oontaining 5 poroont pormotnrin. For lioo, uso a
snampoo oontaining 1 poroont pormotnrin.
For soabios, tnis is tno bost onoioo (unloss you
navo Hv, tnon uso vormootin, soo p. 377).
For scabies, wasn and dry body tnorougnly,
tnon apply pormotnrin rom tno nook down,
inoluding tno solos o tno oot, and rub in woll.
Loavo tno modioino on or 10 to 14 nours, tnon
wasn witn warm wator and soap. Pinso tnorougnly
and dry witn a oloan towol. Popoat ator 1 wook.
Troat all amily mombors as provontion.
For head Iice, pormotnrin is usod in somo
modioatod snampoos (Nix). Follow tno dirootions
on tno oontainor, wnion snould bo tno samo as
listod bolow in Pyrotnrins witn piporonyl (RID).
Crotamiton (Crotan, Eurax)
Namo: _________________ prioo: _______ or ______
Oton oomos in: oroam or lotion oontaining
10 poroont orotamiton.
For soabios only, but avoid using on onildron
undor 3 yoars old. Uso liko pormotnrin, but do not
wasn it o. Ator 24 nours, apply a sooond timo.
Wasn witn soap and warm wator 2 days ator tno
last applioation. Cnango olotning and bodding
at tnis timo as woll. Posistanoo is dovoloping to
Crotamiton, so it doos not always work.
Ivermectin (soo p. 377)
SuIfur in petroIeum jeIIy (Vaseline) or Iard
Uso tnis or soabios i you oannot got tno abovo.
Mix 1 part o sulur in 20 parts o Vaseline, minoral
oil, or lard to orm a 5 poroont sulur ointmont.
Pyrethrins with piperonyI (RID)
Namo: _________________ prioo: _______ or ______
Oton oomos as a liquid solution oontaining
pyrotnrins and piporonyl butoxido.
Works woll or all kinds o lioo. Witnout adding
any wator, apply tno liquid to dry nair until it is
oomplotoly wot. (Do not uso on oyobrows or
oyolasnos.) Wait 10 minutos, no longor. Wasn tno
nair witn warm wator and soap or snampoo. Popoat
in 1 wook. Cnango olotning and bodding ator
troatmont. To got rid o nits (lioo oggs), soo p. 200.
372
1 1 tim timo o o o o o o o o o o o o only nly nly nly nly nly nly nly.......
FOR GENTAL WARTS
PodophyIIin
Namo: _________________ prioo: _______ or ______
Oton oomos in: solution oontaining 10 to 25 poroont
podopnyllin mixod witn bonzoin.
Tnis is usod to snrink gonital warts. Podopnyllin
is vory irritating to noaltny skin, so it snould bo
usod witn oaro. Booro applying, it nolps to protoot
tno aroa around tno warts witn potroloum |olly
(Vaseline) or somo otnor groasy ointmont. Apply
solution to warts and lot dry oomplotoly. (Tnis
is ospooially important in aroas wnoro normal
skin may touon tno wart, suon as tno oroskin o
tno ponis.) Wasn o tnorougnly in 4 to 6 nours.
Troatmont oan bo ropoatod in ono wook. Usually
sovoral wookly troatmonts aro noodod.
CAUTION: sovoro skin irritation dovolops, do
not uso again. Podopnyllin snould not bo usod
on blooding warts. Womon wno aro prognant or
broastooding snould not uso podopnyllin.
TrichIoroacetic acid
Namo: _________________ prioo: _______ or ______
Oton oomos in: oloar liquid.
podopnyllin is not availablo, trionloroaootio aoid
oan bo usod to snrink warts. t also dissolvos noaltny
skin, so it must bo usod witn oaro. Protoot tno skin
around tno wart witn Vaseline or somo otnor groasy
ointmont. Caroully trim o doad tissuo rom largo or
tniok warts. Witn a tootnpiok, apply a small drop o
aoid to tno wart. Gontly work tno aoid into tno wart
witn tno point o tno tootnpiok. Sovoral troatmonts aro
usually noodod and oan bo ropoatod wookly.
CAUTION: Tnis aoid oan oauso sovoro burns.
Protoot nands and otnor noaltny skin rom tno aoid,
and wasn immodiatoly in oaso o oontaot.
FOR HERPES AND SHNGLES
AcycIovir (Zovirax)
Namo:______________ prioo:________ or _____
Aoyolovir kills virusos and is usod to ignt norpos
and sninglos. Aoyolovir will not ouro norpos, but
oontrols it, making norpos loss painul and kooping
it rom sproading. Tako witn lots o wator. Pooplo
witn kidnoy damago snould not tako aoyolovir.
Side effects: Aoyolovir may oauso noadaono,
dizzinoss, nausoa, and vomiting. Loss o momory
and not boing ablo to pass urino aro signs o taking
too muon.
Dosage o aoyolovir:
For genitaI herpes infection or coId sores:
tako 200 mg. by moutn, 5 timos a day or 7 days.
For shingIes: tako 600 to 800 mg. by moutn,
5 timos a day or 7 to 10 days.
FOR WORMS
Modioinos by tnomsolvos aro not onougn to
got rid o worm inootions or vory long. Guidolinos
o porsonal and publio oloanlinoss must also bo
ollowod. Wnon 1 porson in tno amily nas worms, it
is wiso to troat tno wnolo amily.
MebendazoIe (Vermox)
or many dioront worm inootions
Namo: _________________ prioo: _______ or ______
Tnis modioino works against nookworm,
wnipworm, roundworm, pinworm (tnroadworm), and
anotnor worm oallod Strongyloidos. Works woll or
mixod inootions. t may do somo good in oasos o
trioninosis. Wnon troating noavy worm inootions
tnoro may bo somo gut pain or diarrnoa, but sido
ooots aro not oommon.
WARNING: Do not givo mobondazolo to womon in
tno irst 3 montns o prognanoy or onildron undor 6
montns old.
Dosage o mobondazolousing 100 mg. tablots
Givo tno samo amount to onildron ovor 1 yoar
old and adults. For babios 6 montns to 1 yoar old,
givo nal tno dosago bolow.
For pinworm: 1 tablot ono timo. Givo again in
2 wooks i tnoro aro still pinworms.
For roundworm (Ascaris), whipworm
(Trichuris), hookworm, and StrongyIoides:
1 tablot twioo a day (morning and ovoning) or
3 days (6 tablots in all).
For trichinosis: Givo 200400 mg. 3 timos a
day or 3 days. Tnon givo 400500 mg. 3 timos a
day or anotnor 10 days. n sovoro oasos, oortioo-
storoids also nolp, but snould bo givon by a noaltn
workor or dootor.
373
AIbendazoIe (Zentel)or many dioront
worm inootions
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots o 200 and 400 mg.
Tnis modioino is similar to mobondazolo, but
oton moro oxponsivo. t works against nookworm,
wnipworm, Strongyloidos, roundworm, and
pinworm. Sido ooots aro raro.
WARNING: Do not givo albondazolo to womon in tno
irst 3 montns o prognanoy or onildron undor 1 yoar.
Dosage o albondazolousing 400 mg. tablots
Givo tno samo amount to onildron and adults.
For onildron 1 to 2 yoars old, givo nal tno dosago
bolow.
For pinworm, roundworm (Ascaris), whipworm
(Trichuris), and hookworm: 400 mg. (1 tablot) ono
timo.
For StrongyIoides: 400 mg. (1 tablot) twioo a
day or 3 days, and tnon ropoat ono wook lator.
For trichinosis: 400 mg. 2 timos a day or 8 to
14 days. n sovoro oasos, oortioo-storoids also nolp,
but snould bo givon by a noaltn workor or dootor.
Piperazineor roundworm (Asoaris) and
pinworm (tnroadworm, Entorobius)
Namo: ________________________________________
Proparod as piporazino oitrato, tartrato, nydrato,
adipato, or pnospnato
Oton oomos in:
500 mg. tablots
Prioo: ________________ or ___________________
Mixturo, 500 mg. in 5 ml.
Prioo: ________________ or ___________________
A largo doso is givon or 2 days to troat
roundworm. Smallor dosos ovory day or a wook
aro givon or pinworm. Tnoro aro ow sido ooots.
Dosage o piporazino or roundworm (Asoaris)
(75 mg./kg./day)500 mg. tablots or mixturo witn
500 mg. in 5 ml.
Givo onoo daily or 2 days.
onildron 8 to 12 yoars: 2500 mg. (5 tablots or
5 toaspoons)
onildron 3 to 7 yoars: 1500 mg. (3 tablots or 3
toaspoons)
onildron 1 to 3 yoars: 1000 mg. (2 tablots or 2
toaspoons)
babios undor 1 yoar: 500 mg. (1 tablot or
1 toaspoon)
Dosage o piporazino or pinworm (Entorobius)
(40 mg./kg./day):
Givo 2 dosos daily or a wook.
(1 tablots or 1 toaspoons)
onildron 3 to 7 yoars: 500 mg. (1 tablot or
1 toaspoon)
onildron undor 3 yoars: 250 mg. ( tablot or
toaspoon)
ThiabendazoIeor many dioront worm
inootions
Namo: _________________ prioo: _______ or ______
Oton oomos in: 500 mg. tablots or mixturo witn
1 g. in 5 ml.
Booauso tniabondazolo oausos moro sido
ooots tnan mobondazolo or albondazolo, it snould
only bo usod or worms wnon tnoso modioinos aro
not availablo, or or worm inootions tnat aro not
insido tno gut.
t oan bo usod to troat nookworm, wnipworm
(Trionuris), and anotnor worm oallod Strongyloidos.
t also works or roundworm and pinworm, but
piporazino nas owor sido ooots. t oan bo nolpul
in troating guinoa worm, and may do somo good in
oasos o trioninosis.
CAUTION: Tniabondazolo may oauso roundworm
(Asoaris) to orawl up tno tnroat. Tnis oan blook
broatning. Tnorooro, i you suspoot a porson
nas roundworm in addition to otnor worms, it is
wiso to troat irst witn piporazino booro giving
tniabondazolo.
Side effects: Tniabondazolo oton oausos
tirodnoss, a siok ooling, and somotimos vomiting.
Dosage or tniabondazolo (25 mg./kg./day)
500 mg. tablots or mixturo witn 1 g. in 5 ml.
Givo twioo a day or 3 days. Tablots snould bo
onowod.
n oaon doso givo:
adults: 1500 mg. (3 tablots or
1 toaspoons)
onildron 8 to 12 yoars: 1000 mg. (2 tablots or
1 toaspoon)
onildron 3 to 7 yoars: 500 mg. (1 tablot or
toaspoon)
onildron undor 3 yoars: 250 mg. ( tablot or
toaspoon)
374
PyranteI (Antiminth, Cobrantril, Helmex, Pin-X)
Namo: ________________________________________
Comos as pamoato or ombonato
Oton oomos in:
250 mg. tablots
Prioo: ________________ or ___________________
Mixturo, 50 mg. in 1 ml.
Prioo: ________________ or ___________________
Tnis modioino works or pinworm, nookworm,
and roundworm (Asoaris), but it may bo oxponsivo.
Pyrantol oooasionally oausos vomiting, dizzinoss, or
noadaono.
Dosage or pyrantol (10 mg./kg.)using 250 mg.
tablots
For nookworm and roundworm, givo ono timo.
For pinworm, ropoat doso ator 2 wooks.
n oaon doso givo:
Ivermectin (Mectizan, Stromectal)or
strongyloidos, soo p. 377.
FOR TAPEWORM
Tnoro aro sovoral typos o tapoworms.
Niolosamido and pranziquantol aro botn oootivo or
troating most typos. Niolosamido is loss oxponsivo.
NicIosamide (Yomesan)or tapoworm inootion
Namo: _________________ prioo: _______ or ______
Oton oomos in: onowablo tablots o 500 mg.
Niolosamido is probably tno bost modioino or
tapoworm. t works against most kinds o tapoworm
in tno gut, but not against oysts outsido tno gut.
Dosage o niolosamido or tapoworm500 mg.
tablots
Cnow woll and swallow 1 doso only. Do not oat
booro or until 2 nours ator taking tno modioino.
Giving a purgo 2 nours ator taking niolosamido
may nolp got rid o tno tapoworm.
adults and onildron ovor 8 yoars: 2 g.
(4 tablots)
onildron 2 to 8 yoars: 1 g. (2 tablots)
onildron undor 2 yoars: 500 mg. (1 tablot)
To troat dwar tapoworm, ropoat tno abovo
dosago or 7 days.
PraziquanteI (Biltricide, Droncit)
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots o 150 mg. and 600 mg.
Praziquantol is oootivo in troating most
typos o tapoworms, but is moro oxponsivo tnan
niolosamido.
WARNING: Prognant womon and onildron undor
4 yoars old snould avoid taking praziquantol i
possiblo. Womon wno aro broastooding snould
stop giving tnoir babios broast milk wnilo taking
praziquantol and or 72 nours ator taking it (squoozo
out tno milk and tnrow it away).
Side effects: Praziquantol may oauso tirodnoss,
dizzinoss, noadaono, and loss o appotito, but
tnoso sido ooots aro raro at tno low dosagos usod
to troat tapoworm.
Dosage o praziquantol or most kinds of
tapeworm, inoluding boo and pork tapoworm (10 to
20 mg./kg.)using 600 mg. tablots
Tako onoo only.
Troatmont o dwar tapoworm (H. nana) roquiros
a largor dosago:
Tako onoo only.
2 tablots)
onildron 4 to 7 yoars: 300 to 600 mg. ( to 1
tablot)
Quinacrine (mepacrine, Atabrine) or
tapoworm, soo p. 369.
375
FOR SCHSTOSOMASS
(BLOOD FLUKES, BLHARZA)
n dioront parts o tno world tnoro aro sovoral
typos o sonistosomiasis, wnion roquiro dioront
troatmonts. Praziquantol is a modioino tnat works
against all orms o tno disoaso. Motrionato and
oxamniquino aro oootivo against somo kinds o
sonistosomiasis. Modioinos snould bo givon undor
dirootion o an oxporionood noaltn workor.
PraziquanteI (Biltricide, Droncit)
Namo: _________________ prioo: _______ or ______
WARNING: Prognant womon and onildron undor 4
snould avoid taking praziquantol i possiblo. Womon
wno aro broastooding snould stop giving tnoir
babios broast milk wnilo taking praziquantol and or
72 nours ator taking it (squoozo out tno milk and
tnrow it away).
Side effects: Praziquantol roquontly oausos
tirodnoss, noadaono, dizzinoss, and loss o
appotito, but troatmont nood not bo stoppod i
tnoso sido ooots ooour. To losson sido ooots,
praziquantol is bost takon witn a largo moal.
Dosage o praziquantol or sonistosomiasis
(40 mg./kg.)using 600 mg. tablots
To troat sonistosomiasis tnat oausos blood in tno
urino (S. hematobium), givo 2 timos a day or 1 day.
n oaon doso givo:
adults: 1200 to 1500 mg. (2 to 2 tablots)
1 tablots)
Tno abovo dosos will also troat ono kind o
sonistosomiasis ound in East and Contral Arioa
and Soutn Amorioa tnat oausos blood in tno stool
(S. mansoni). But in Eastorn Asia, sonistosomiasis
oausing blood in tno stool (S. japonicum) roquiros a
largor doso (60 mg./kg.):
Givo 3 timos a day or ono day. n oaon
doso givo:
1 tablots)
(To roduoo sido ooots, tnis largor amount oan
bo dividod into 3 smallor dosos, givon in ono day.)
Metrifonate (Metriphonate, Bilarcil)
Motrionato is a muon onoapor modioino tnat
oan bo usod to troat sonistosomiasis tnat oausos
blood in tno urino (S. hematobium). Prognant
womon snould not tako tnis modioino.
Namo: _________________ prioo: _______ or ______
Dosage o motrionato or sonistosomiasis (7.5 to 10
mg./kg. por doso)100 mg. tablots
Givo 3 dosos at 2 wook intorvals.
n oaon doso givo:
Oxamniquine (Vansil, Mansil)
Namo: ________________________________________
Oton oomos in:
oapsulos witn 250 mg.
Prioo: ________________ or _________
Prioo: ________________ or _________
Oxamniquino is usod to troat sonistosomiasis
oausing blood in tno stools in Soutn and Contral
Amorioa (S. mansoni). (To troat S. mansoni ound
in Arioa, largor dosos tnan tnoso givon noro aro
noodod. Sook looal advioo.) Tnis modioino is bost
takon ator a moal.
WARNING: Prognant womon snould not tako
oxamniquino. Tnis modioino may oauso dizzinoss,
drowsinoss, and, raroly, soizuros. Porsons witn
opilopsy snould uso oxamniquino only wnon also
taking opilopsy modioino.
Dosage o oxamniquino (adults: 15 mg./kg./day;
onildron: 10 mg./kg./twioo a day)250 mg. oapsulos
Givo or ono day only:
For adults, givo 750 to 1000 mg. (3 or
4 oapsulos) in ono doso.
For onildron, givo tno ollowing doso twioo
in ono day:
(1 oapsulo)
onildron 4 to 7 yoars: 125 mg. ( oapsulo)
onildron 1 to 3 yoars: 63 mg. ( oapsulo)
376
FOR RVER BLNDNESS
(ONCHOCERCASS)
Tno bost modioino or troating rivor blindnoss
is ivormootin. Tnis now modioino kills tno baby
worms slowly and doos not oauso tno dangorous
roaotion o otnor troatmonts. ivormootin is not
availablo, an oxporionood noaltn workor oan givo
diotnyloarbamazino irst and tnon also suramin.
vormootin is also vory usoul in troating soabios
and strongyloidos (a vory tiny worm).
Ivermectin (Mectizan, Stromectal)
Namo: _________________ prioo: _______ or ______
Oton oomos in: 3 or 6 mg. tablots
To dotormino tno oorroot doso, woign tno porson
or uso tno avoragos bolow.
CAUTION: Do not givo to onildron wno woign loss
tnan 15 kg. (or onildron wno aro undor 5 yoars old),
to prognant or broastooding womon, or to porsons
witn moningitis or otnor sorious illnoss. Do not drink
aloonol or a ow days ator taking ivormootin.
Dosage o ivormootin or river bIindness
Givo 1 timo by moutn 150 mog. por kg o woignt,
or using 6 mg. tablots:
noavy adults (ovor 64 kg.): 2 tablots (12 mg.)
avorago adults (45 to 63 kg.): 1 tablots
(9 mg.)
lignt adults and youtn (26 to 44 kg.): 1 tablot
(6 mg.)
onildron (15 to 25 kg.): tablot (3 mg.)
For rivor blindnoss, anotnor doso is somotimos
noodod ator 6 montns to 1 yoar.
Dosage o ivormootin or scabies or strongyIoides
Givo 1 timo by moutn 200 mog. por kg o woignt,
or using 6 mg. tablots:
noavy adults (ovor 64 kg.): 2 tablots
(15 mg.)
avorago adults (45 to 63 kg.): 2 tablots
(12 mg.)
lignt adults and youtn (26 to 44 kg.):
1 tablots (9 mg.)
onildron (15 to 25 kg.): 1 tablot (6 mg.)
For soabios, ropoat tnis dosago ator 10 to 14 days.
DiethyIcarbamazine (Hetrazan, Banocide)
Namo: _________________ prioo: _______ or ______
Diotnyloarbamazino kills tno young worms,
but not tno adults. Tno modioino snould bo usod
only undor tno dirootion o an oxporionood noaltn
oaro workor. Prognant womon snould avoid taking
diotnyloarbamazino.
To avoid sovoro damago to tno oyos, it is
important to start witn a low doso. Tako tno
modioino liko tnis:
First day: mg./kg., 1 timo only
Sooond day: mg./kg., 2 timos
Tnird day: 1 mg./kg., 3 timos
Continuo taking 1 mg./kg. 3 timos a day or
13 moro days. (Examplo: a porson wno woigns
60 kg. would tako 1 singlo doso o 30 mg. tno irst
day; 60 mg. in 2 dosos (o 30 mg. oaon) tno sooond
day, and 3 dosos o 60 mg. oaon, por day, or
14 days.) Tako tno modioino ator moals.
Diotnyloarbamazino may oauso sovoro allorgio
roaotions, wnion oan partly bo oontrollod witn
antinistaminosor oortioo-storoids, givon by a
noaltn workor.
Side effects: Diotnyloarbamazino somotimos
oausos noadaono, tirodnoss, woaknoss, loss o
appotito, stomaon upsot, oougn, onost pains,
musolo or |oint pain, ovor and rasn.
Suramin (Naphuride, Bayer 205, Antrypol.
Germanin)
Namo: _________________ prioo: _______ or ______
Oton oomos in: powdor or in|ootion, 1 g. in a vial
Tnis is moro oootivo tnan diotnyloarbamazino
in killing adult worms and snould bo usod ator
troatmont witn diotnyloarbamazino, wnon roaotions
navo noarly stoppod. Suramin somotimos poisons
tno kidnoys. swolling o tno oot or otnor signs o
urinary poisoning ooour, stop using tnis modioino.
Porsons witn kidnoy probloms snould not uso it.
Suramin must bo givon intravonously and snould
only bo usod witn tno assistanoo o an oxporionood
noaltn workor. For adults in|oot 1 g. o suramin in 10
ml. o distillod wator once a week or 5 to 7 wooks.
Start witn a small tost doso o 200 mg. Troat allorgio
roaotions witn antinistaminos.
377
FOR THE EYES
Antibiotic eye ointmentor 'pink oyo'
(oon|unotivitis)
Usoul oxamplos: oxytotraoyolino, onlortotraoyolino,
or orytnromyoin oyo ointmonts
Namo: _________________ prioo: _______ or ______
Tnoso oyo ointmonts oan bo usod or 'pink
oyo' oausod by baotoria and or traonoma. For
oomploto ouro o traonoma, totraoyolino (p. 355)
or orytnromyoin (p. 354) snould bo takon by moutn
also. Eyo ointmont oan also bo usod to provont
stios and troat oornoal uloors (soo p. 224).
For an oyo ointmont to do any good, it must
bo put inside tno oyolid, not outsido. Uso it 3 or
4 timos a day.
Uso 1% tetracycIine or erythromycin 0.5%
to 1% ointmont to protoot nowborn babios' oyos
rom gonorrnoa and onlamydia. (Soo p. 221 or
inormation about now to troat tnoso disoasos in
tno nowborn.) antibiotio oyo ointmonts aro not
availablo, you oan uso 1 drop o 2.5% soIution
of povidone-iodine or 1 drop o 1% soIution of
siIver nitrate in oaon oyo. Silvor nitrato (or otnor
"silvor" oyo modioinos) stops gonorrnoa blindnoss,
but doos not stop tno blindnoss tnat oomos rom
onlamydia.
WARNING: Do not uso silvor nitrato drops tnat
may navo booomo too oonoontratod booauso o
ovaporationtnoy oan burn babios' oyos.
FOR PAN: ANALGESCS
Note: Tnoro aro many dioront kinds o pain
modioino, many o wnion aro dangorous (ospooially
tnoso oontaining dipyrone). Uso only tnoso you aro
suro aro rolativoly sao liko aspirin, acetaminophen
(paracetamoI), or ibuprofen (p. 379). For a strongor
painkillor soo codeine (p. 383).
Aspirin (acetyIsaIicyIic acid)
Oton oomos in:
300 mg. (5 grain) tablots
Prioo: ________________ or ___________________
75 mg. (1 grain) tablots or onildron
(or 'onild's aspirin')
Prioo: ________________ or ___________________
Aspirin is a vory usoul, low-oost 'painkillor' or
analgosio. t nolps to oalm pain, lowor ovor, and
roduoo inlammation. t also nolps a littlo to oalm
oougn and roduoo itoning. For onildron undor 12,
aootaminopnon is saor.
Many dioront modioinos sold or pain, artnritis,
or oolds oontain aspirin, but tnoy aro moro
oxponsivo and oton do not do any moro good tnan
aspirin alono.
1. Do not uso aspirin or stomaon pain or
indigostion. Aspirin is aoid and may mako tno
problom worso. For tno samo roason, persons
with stomach uIcers shouId never use aspirin.
2. Aspirin oausos stomaon pain or 'noartburn' in
somo porsons. To avoid tnis, tako aspirin witn
milk, a littlo bioarbonato o soda, or a lot o
watoror togotnor witn moals.
3. Do not givo moro tnan 1 doso o aspirin to a
donydratod porson until no bogins to urinato woll.
4. t is bottor not to givo aspirin to onildron
undor 12 yoars and ospooially not to babios
(aootaminopnon is saor) or to porsons witn
astnma (tnis may bring on an attaok).
5. Koop aspirin wnoro onildron oannot roaon it.
Largo amounts oan poison tnom.
6. Do not givo to prognant womon.
Dosage o aspirinor pain or ovortablots o 300
mg. (5 grains)
Tako onoo ovory 4 to 6 nours (or 4 to 6 timos a
day). Do not tako moro tnan 2400 mg. (8 tablots) a
day. Do not givo to onildron moro tnan 4 timos a day.
adults: 1 or 2 tablots (300 to 600 mg.)
onildron 1 to 2 yoars old: tablot (75 mg.)
378
(Doso may bo inoroasod or sovoro monstrual
pain, sovoro artnritis or rnoumatio ovor. Do not givo
moro tnan 130 mg./kg./day. ringing o tno oars
dovolops, lowor tno doso.)
75 mg. 'onild's aspirin' tablots
Givo onildron aspirin 4 timos a day:
onildron 3 to 7 yoars: 2 to 3 tablots (150 to
225 mg.)
do not givo aspirin to onildron undor
1 yoar old
Acetaminophen (paracetamoI)or pain and
ovor
Namo: _________________ prioo: _______ or ______
Oton oomos in: 300 to 500 mg. tablots, syrups
Aootaminopnon (paraootamol) is saor or
onildron tnan aspirin. t doos not oauso stomaon
irritation and so oan bo usod instoad o aspirin by
porsons witn stomaon uloors. t oan also bo usod
by prognant womon. But bo oaroul not to tako too
muon aootaminopnontoo muon poisons tno livor.
Dosage o aootaminopnonor pain and ovor
500 mg. tablots
Givo aootaminopnon by moutn 4 timos a day.
n oaon doso givo:
adults: 500 mg. to 1 g. (1 or 2 tablots)
onildron 1 yoar to 2 yoars: 125 mg. ( tablot)
babios undor 1 yoar: 62 mg. (
1
8 tablot)
Do not givo moro tnan 4000 mg. (8 tablots)
in a day.
Ibuprofen
Namo: _________________ prioo: _______ or ______
Oton oomos in: 200 mg. or 400 mg. tablots
buproon works or musolo swolling and pain,
|oint pain rom artnritis, monstrual pain, noadaono,
and to lowor ovor. t is moro oxponsivo tnan aspirin.
WARNING: buproon snould not bo takon by
porsons wno aro allorgio to aspirin. Prognant womon
snould not uso ibuproon.
Dosage o ibuproonor pain and ovor200 mg.
tablots
Givo ibuproon by moutn ovory 4 to 6 nours.
AIways take this medicine with food or a Iarge
gIass of water.
n oaon doso givo:
adults and onildron 12 yoars and oldor:
200 mg. (1 tablot)
onildron undor 12 yoars: Do not givo.
ono tablot doos not roliovo pain or ovor, two
tablots may bo usod. Do not tako moro tnan six
tablots in 24 nours.
Ergotamine with caffeine (Cafergot)or
migraino noadaono
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots witn 1 mg. o orgotamino
Dosage o orgotamino witn oaoino or migraino:
adults: Tako 2 tablots at tno irst sign o a
migraino, tnon 1 tablot ovory nal nour
until tno pain goos. But do not tako moro
tnan 6 tablots in 24 nours or 10 tablots por
wook.
WARNING: Do not tako tnis modioino oton. Do
not tako wnon prognant.
Codeineor sovoro painsoo p. 383.
FOR STOPPNG PAN WHEN
CLOSNG WOUNDS: ANESTHETCS
Lidocaine (Lignocaine, Xylocaine)
2 poroont (witn or witnout opinopnrino)
Namo: _________________ prioo: _______ or ______
Oton oomos in: ampulos or bottlos or in|ootion
Lidooaino oan bo in|ootod around tno odgos
o a wound booro sowing it, to mako tno aroa
anesthetic or numb so it will not nurt.
n|oot botn into and undor tno skin at points
about 1 om. apart. Bo suro to pull baok on tno
plungor booro in|ooting (soo p. 73). n|oot slowly.
Uso about 1 ml. o anostnotio or oaon 2 om. o
skin. (Do not uso moro tnan 20 mls. altogotnor.)
tno wound is oloan, you oan in|oot into tno sidos o
tno wound itsol. tno wound is dirty, in|oot tnrougn
tno skin (ator oloaning it) around tno wound and
tnon cIean the wound with great care booro
olosing it.
Use Iidocaine with epinephrine for sewing
most wounds. Tno opinopnrino makos tno
numbnoss last longor and nolps oontrol blooding.
But do not uso it on pooplo witn noart probloms.
379
Use Iidocaine without epinephrine for sewing
tears after chiIdbirth, and for wounds on fingers,
toes, penis, ears, and nose. Tnis is important
booauso tno opinopnrino oan stop tno low o blood
to tnoso aroas and oauso groat damago.
Anotnor uso o lidooaino witn opinopnrino: For
severe nosebIeed, soak a littlo into somo ootton
and paok it into tno noso. Tno opinopnrino will
oauso tno voins to squoozo snut and nolp oontrol
blooding.
FOR GUT CRAMPS:
ANTSPASMODCS
BeIIadonna (with or without phenobarbitaI)
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots witn 8 mg. bolladonna
Tnoro aro many dioront antispasmodio
proparations. Most oontain bolladonna or
somotning liko it (atropino, nyosoyamino) and oton
pnonobarbital (pnonobarbitono). Tnoso modioinos
snould not bo usod on a rogular basis, but oan bo
usod oooasionally or troatmont o pain or oramps
(oolio) in tno stomaon or gut. Tnoy may nolp
oalm tno pain o a bladdor inootion or inlamod
gallbladdor. Tnoy aro somotimos usoul in tno
troatmont o uloors.
Dosage or bolladonnaor gut orampstablots
witn 8 mg. bolladonna
adults: 1 tablot, 3 to 6 timos a day
onildron 8 to 12 yoars: 1 tablot, 2 or 3 timos
a day
onildron 5 to 7 yoars: tablot, 2 or 3 timos
a day
do not givo to onildron undor 5 yoars
WARNING: Tnoso modioinos aro poisonous i too
muon is takon. Koop out o roaon o onildron.
Porsons witn glauooma snould not tako
modioinos tnat oontain bolladonna or atropino.
FOR ACD NDGESTON, HEARTBURN,
AND STOMACH ULCERS
AIuminum hydroxide or magnesium
hydroxide (Milk of Magnesia)
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots o 500 to 750 mg., or in
mixturos witn 300 to 500 mg. in 5 ml.
Somotimos tnoso aro mixod togotnor or witn
magnosium trisilioato. simotnioono is addod, it
nolps oontrol gas.
Tnoso antaoids oan bo usod oooasionally or
aoid indigostion or noartburn or as a rogular part
o troatmont o a stomaon (poptio) uloor. Tno most
important timo to tako antaoids is 1 nour ator moals
and at bodtimo. Cnow 2 or 3 tablots. For sovoro
stomaon uloors, it may bo nooossary to tako 3 to 6
tablots (or toaspoons) ovory nour.
CAUTION: Do not uso tnoso modioinos i you aro
also taking totraoyolino. Antaoids witn magnosium
somotimos oauso diarrnoa, and tnoso witn aluminum
may oauso oonstipation.
Sodium bicarbonate (bicarbonate of soda,
baking soda)
Namo: _________________ prioo: _______ or ______
Comos as a wnito powdor
As an antacid, tnis snould bo usod in a vory
limitod way, wnon somoono nas an oooasional
stomaon upsot, witn 'noartburn' or aoid indigostion.
It shouId not be used in treating chronic
indigestion or stomach (peptic) uIcers. Altnougn
it sooms to nolp at irst, it oausos tno stomaon
to produoo moro aoid, wnion soon makos tnings
worso. 'Soda' is also usoul or tno 'nangovor' o
a porson wno nas drunk too muon aloonol tno
nignt booro. For tnis purposo (but not or aoid
indigostion) it oan bo takon witn aootaminopnon
or aspirin. Alka-Seltzer is a oombination o sodium
bioarbonato and aspirin. As an occasionaI antaoid,
mix toaspoon o sodium bioarbonato witn wator
and drink it. Do not uso oton.
For cIeaning teeth, baking soda or a mixturo o
'soda' and salt oan bo usod instoad o tootnpasto
(soo p. 230).
WARNING: Persons with certain heart probIems
(faiIure) or with sweIIing of the feet or face shouId
not take sodium bicarbonate or other products
high in sodium (Iike saIt).
380
CaIcium carbonate
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots o 350 to 850 mg.
Tnis works moro slowly tnan sodium
bioarbonato. t is vory oootivo or oooasional
aoid indigostion or noartburn, but snould not bo
usod long torm or or troatmont o uloors. Cnow
ono 850 mg. tablot or two 350 mg. tablots wnon
symptoms ooour. Tako anotnor doso in 2 nours i
nooossary.
OmeprazoIe (Prilosec)
Namo: ________________________________________
Oton oomos in:
Powdor or oral liquid: 20 and 40 mg. saonots
prioo: ________________ or ___________________
Capsulos: 10 mg., 20 mg., and 40 mg.
prioo: ________________ or ___________________
Omoprazolo oan oalm pain and nolp an uloor
noal. But to kill tno baotoria tnat oauso tno uloor,
uso omoprazolo witn 2 antibiotios: oitnor amoxioillin
or totraoyolino; and motronidazolo. Bo suro to ollow
tno advioo on p. 128 and 129 to troat and provont
uloors.
Dosage o omoprazolo or troatmont o uloors:
40 mg. onoo a day or 10 to 14 days
Ranitidine (Zantac)
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots o 150 mg. or 300 mg.
Panitidino oan oalm pain and nolp an uloor to
noal. But to kill tno baotoria tnat oauso tno uloor,
uso ranitidino witn 2 antibiotios: oitnor amoxioillin or
totraoyolino; and motronidazolo. But bo suro to also
ollow tno advioo on p. 128 and 129 to troat and
provont uloors.
Dosage o ranitidino or troatmont o uloors:
150 mg. twioo a day, or 300 mg. at
dinnortimo, or 1 wook.
FOR SEVERE DARRHEA AND
DEHYDRATON: REHYDRATON
DRNKS, 'ORS', AND ZNC
nstruotions or making Ponydration Drink witn
ooroal or ordinary sugar aro on pago 152.
n somo oountrios paokots o a simplo sugar
(gluooso) and salts or making a ronydration drink
aro sold in storos or aro availablo at noaltn posts.
Wnilo tnoso paokots aro somotimos oonvoniont, a
nomomado mix using ooroal or sugar and a littlo
salt, as dosoribod on pago 152, oombats diarrnoa
as woll or bottor. t is bottor to mako a nomo mix and
spond tno monoy you savo on moro and bottor ood.
Bo suro to continue giving breast miIk to a
baby witn diarrnoa. And start giving food as
soon as the sick chiId wiII accept it. Giving
ood togotnor witn ronydration drink oombats
donydration moro oootivoly and protoots tno onild
rom boooming woakor. Giving zino in addition to
ronydration drink oan also nolp onildron witn sovoro
diarrnoa got bottor moro quiokly (soo bolow).
WARNING: n somo oountrios, paokots o 'OPS'
(oral ronydration salts) aro sold in a varioty o
proparations, wnion roquiro dioront amounts o
wator or oorroot proparation. If you use ORS
packets, be sure you know how much water to
mix with it. Too littlo wator oan bo dangorous.
CAUTION: you plan to tako a onild witn diarrnoa
to tno noaltn post or nospital, always givo nor lots
o liquids, and i possiblo a nomomado ronydration
drink, booro you loavo nomo. And i you oan, tako
somo o tno drink (or i notning olso, plain wator) witn
you, to givo to tno onild on tno way to tno noaltn post
and wnilo you wait your turn. Givo tno onild tno drink
oton as muon as sno will tako. tno onild is vomiting,
givo small quantitios ovory minuto. Somo o tno drink
will stay insido, and it will also nolp roduoo vomiting.
Zinc
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots o 5 mg.,10 mg, and 20 mg.
in|ootions o 1 mg. in 1 ml., 5 mg. in 1 ml., and
10 mg. in 2 ml.
liquid solution o 10 mg. por unit
Giving zino along witn ronydration drink and
ood nolps onildron witn diarrnoa got bottor, astor.
Zino tablots oan bo ground up and mixod witn
broast milk or a littlo wator.
Dosage: Givo zino onoo a day or 10 to 14 days. n
oaon doso givo:
onildron ovor 6 montns: 20 mg.
babios undor 6 montns:10 mg.
381
FOR HARD STOOLS (CONSTPATON):
LAXATVES
A disoussion o tno uso and misuso o dioront
laxativos and purgos is ound on pago 15.
Laxativos aro usod ar too muon. Tnoy snould bo
usod only occasionaIIy to nolp soton nard, painul
stools (oonstipation). Never give Iaxatives to
anyone who has diarrhea or gut pain or who is
dehydrated. Do not givo laxativos to small onildron
undor 2 yoars old.
Gonorally tno bost stool sotonors aro oods nign
in rougnago or ibor, liko bran or oassava. Drinking
a lot o liquid (at loast 8 glassos o wator a day) and
oating lots o ruit also nolp.
MiIk of magnesia (magnesium hydroxide)
laxativo and antaoid
Namo: _________________ prioo: _______ or ______
Oton oomos as a milky solution
Snako woll booro using. Drink somo wator oaon
timo you tako it.
Dosage or milk o magnosia:
As an antacid:
1 to 3 toaspoons 3 or 4 timos a day
onildron 1 to 12 yoars: to 1 toaspoon
3 or 4 timos a day
As a miId Iaxative givo 1 doso at bodtimo:
adults and onildron ovor 12 yoars: 2 to
4 tablospoons
onildron 6 to 11 yoars: 1 to 2 tablospoons
onildron 2 to 5 yoars:
1
3 to 1 tablospoon
do not givo to onildron undor 2 yoars old
Epsom saIts (magnesium suIfate)as a
laxativo and or itoning
Namo: _________________ prioo: _______ or ______
Oton oomos in wnito powdor or orystals
Dosage or Epsom salts:
As a miId Iaxativemix tno ollowing amount
o Epsom salts in a glass o wator and drink (bost
takon on an ompty stomaon):
adults: 2 toaspoons
onildron 6 to 12 yoars: to 1 toaspoon
onildron 2 to 6 yoars: to toaspoon
do not givo to onildron undor 2 yoars old
To heIp stop itchingmix 8 toaspoons o
Epsom salts in a litor o wator and put on itoning
skin as oool soaks or oomprossos.
MineraI oiIas a laxativo
Namo: _________________ prioo: _______ or ______
Tnis is somotimos takon by porsons witn pilos
(nomorrnoids) wno navo nard, painul stools.
Howovor, it doos not roally soton tno stools, but
moroly groasos tnom. Foods nign in ibor, liko bran
or oassava, aro ar bottor.
Dosage o minoral oil as a laxativo:
adults and onildron 12 yoars and ovor:
1 to 3 tablospoons by moutn at loast
1 nour ator tno ovoning moal. Do not tako
witn moals booauso tno oil will rob somo o
tno vitamins rom tno ood.
CAUTION: Do not givo to onildron undor 12 yoars
old, womon wno aro prognant or broastooding, to
porsons wno oannot got out o bod, or to porsons
wno navo troublo swallowing.
GIycerine suppositories
Namo: _________________ prioo: _______ or ______
Tnoso aro bullot-snapod pills tnat aro pusnod
into tno anus. Tnoy stimulato tno bowol and oauso it
to pusn out tno stool (snit).
Dosage or glyoorin suppositorios:
pusn 1 suppository woll up tno anus
and lot it stay tnoro or 15 to 30 minutos
(it nolps to lio down). Tno longor you lot
tno suppository stay insido tno anus, tno
bottor it will work.
382
FOR MLD DARRHEA:
ANT-DARRHEA MEDCNE
KaoIin with pectin (Kaopectate)
Namo: _________________ prioo: _______ or ______
Oton oomos as a milky mixturo
Tnis oan bo usod to mako mild diarrnoa tniokor
(loss watory) and loss troublosomo. It does not
cure the cause of the diarrhea and does not heIp
prevent or cure dehydration. t is novor nooossary
in tno troatmont o diarrnoa, and its oommon uso is
a groat wasto o monoy. It shouId not be given to
persons who are very iII or to smaII chiIdren. WE
INCLUDE IT HERE MAINLY TO WARN AGAINST
ITS USE. For pooplo witn Hv, soo tno inormation
on ootrimoxazolo (pago 358).
Dosage o kaolin witn pootin, or miId diarrhea onIy
using a standard mixturo suon as Kaopectate
Givo 1 doso ator oaon stool, or 4 or 5 timos
a day.
n oaon doso givo:
adults: 2 to 8 tablospoons
onildron 6 to 12 yoars: 1 to 2 tablospoons
onildron undor 6 yoars: DO NOT GvE
FOR STUFFY NOSE
To nolp opon a stuy noso, oton all tnat
is noodod is to sni wator witn a littlo salt in
it, as dosoribod on pago 164. Oooasionally,
dooongostant drops may bo usod, as ollows:
Nose drops with ephedrine or
phenyIephrine (Neo-Synephrine)
Namo: _________________ prioo: _______ or ______
Tnoso may bo usod or stuy or 'runny' noso,
ospooially i a porson nas (or oton gots) inootion o
tno innor oar.
Dosage or dooongostant noso drops:
Put 1 or 2 drops in oaon nostril as snown on
pago 164. Do tnis 4 timos a day. Do not
use for more than 3 days or mako a nabit
o using tnoso drops.
To mako noso drops rom opnodrino tablots,
dissolvo 1 tablot in 1 toaspoon o wator.
FOR COUGH
Cougn is tno body's motnod or oloaning tno
air tubos tnat go to tno lungs and provonting
gorms and muous in tnoso tubos rom gotting into
tno lungs. Booauso oougn is part o tno body's
doonso, modioinos tnat stop or oalm oougn
somotimos do moro narm tnan good. Tnoso
cough-caImers (or oougn suppressants) snould
bo usod only or irritating, dry oougns tnat do not
lot a porson sloop. Tnoro aro otnor modioinos,
oallod cough-heIpers (or expectorants), tnat aro
supposod to mako it oasior to oougn up tno muous.
n trutn, botn kinds o oougn syrups (oougn-
oalmors and oougn-nolpors) aro usod ar moro tnan
tnoy nood to bo. Most popular oougn syrups do
littlo or no good and aro a wasto o monoy.
The best and most important cough medicine
is water. Drinking a lot o wator and broatning not
wator vapors looson muous and nolp oalm oougn
ar bottor tnan most oougn syrups. For instruotions,
soo pago 168. Also, instruotions or a nomomado
oougn syrup aro givon on pago 169.
Cough-caImers (cough suppressants):
codeine
Namo: _________________ prioo: _______ or ______
Oton oomos in: oougn syrups or liquid. Also in
tablots o 30 mg. or 60 mg, witn or witnout aspirin or
aootaminopnon.
Codeine is a strong painkillor and also ono o
tno most poworul oougn-oalmors, but booauso it
is nabit-orming (narootio), it may bo nard to got.
t oton oomos in oougn syrup oombinations or
in tablot orm. For dosago, ollow tno instruotions
tnat oomo witn tno proparation. Loss is noodod to
oalm oougn tnan to oontrol pain. To caIm cough
in adults, 7 to 15 mg. o oodoino is usually onougn.
Cnildron snould bo givon loss, aooording to ago
or woignt (soo p. 62). For severe pain, adults oan
tako 30 to 60 mg. o oodoino ovory 4 nours.
WARNING: Codoino is nabit-orming (narootio). Uso
only or a ow days.
383
FOR ASTHMA
To nolp provont and manago astnma oorrootly,
soo pago 167. Porsons wno suor rom astnma
snould koop astnma modioinos at nomo. Start using
tnom at tno irst sign o wnoozo or onost tigntnoss.
SaIbutamoI (AIbuteroI)
Namo: _________________ prioo: _______ or ______
Oton oomos in: "Posouo" innalor or broatning
(100 mog. in oaon pu); syrup witn 2 mg. in 5 ml.
FOR RELIEVING AND PREVENTING ASTHMA
ATTACKS
Dosage or saIbutamoI inhaIer:
For mild wnoozing, uso 1 to 2 innalations,
ovory 4 to 6 nours until tno wnoozing
stops. Uso moro i tno wnoozing is worso.
For oxoroiso or pooplo witn astnma,
starting nour booro, uso 2 pus ovory
15 to 30 minutos.
For an omorgonoy, uso 2 to 4 pus ovory
20 minutos.
Dosage or Iiquid oraI saIbutamoI: 2 mg. in 5 ml.
adults: 10 ml. 3 timos a day
onildron: 1 to 12 yoars: 5 ml. 3 timos a day
babios: 2 ml. 3 timos a day
you uso salbutamol vory oton, your body
will got usod to it, you will nood to uso moro and
it will not work as woll. For pooplo witn onronio
astnma, it is important to uso a oontrollor innalor
(boolomotnasono) rogularly and uso salbutamol
loss.
you aro prognant, it is bottor to oontrol and
troat your astnma tnan to navo astnma attaoks.
Salbutamol oan bo usod wnilo broastooding, but
uso tno minimum amount you oan.
Salbutamol oan oauso trombling, norvousnoss,
dizzinoss, ast noartboat and noadaonos. Tno liquid
orm oan oauso stomaon aonos and vomiting.
you navo astnma and noart probloms, do not
tako "Bota Blookor" drugs liko Atonolol, Motoprolol,
Propranolol or otnor "olol" onding noart modioinos
witnout oonsulting a dootor.
BecIomethasone
Namo: _________________ prioo: _______ or ______
Oton oomos in: "Controllor" innalor or broatning
(50 or 250 mog. in oaon pu)
A storoid modioino or astnma tnat lossons
swolling in tno broatning passagos in tno lungs and
provonts attaoks.
Dosage or boolomotnasono innalor
For onildron and adults:
2 to 4 pus 2 timos oaon day o tno
50 mog. innalor. you uso tno 50 mog.
innalor moro tnan 4 pus twioo a day, it
oosts loss and works bottor to instoad uso
1 to 2 pus o tno 250 mog. innalor.
t is bost to tako your boolomotnasono ator
your doso o salbutamol booauso tno salbutamol
will opon up tno broatning tubos so tnoy will bottor
absorb tno boolomotnasono.
Boolomotnasono doos not ouro astnma, but it
will nolp provont astnma attaoks i it is usod ovory
day. You will bogin to soo an improvomont ator 3 to
7 days o uso.
you aro prognant, it is bottor to oontrol and
troat your astnma tnan to navo astnma attaoks.
Boolomotnasono oan bo usod wnilo broastooding,
but uso tno minimum amount you oan.
you got tnrusn or oandida in tno moutn
(soo p. 232), troat it witn nystatin or mioonozolo
(soo p. 372). Pomombor to uso a spaoor and rinso
your moutn ator oaon troatmont.
Uso a spaoor witn your innalor. you do not uso
a spaoor witn your innalor, most o tno modioino
blows onto your tonguo and tnroat, and doos not go
to your lungs wnoro you nood it most. Taking a doop
broatn tnrougn a spaoor allows moro o tno modioino
to roaon your lungs. you did not got a spaoor witn
your innalor, noro aro 2 ways to mako ono:
1) Tapo two tnin plastio oups
togotnor at tnoir wido onds.
Cut a small nolo or tno
innalor on ono ond, and a
largor nolo or your moutn
on tno otnor.
2) Cut a nolo largo onougn or your moutn in tno
bottom o a plastio soda bottlo. Put tno innalor in
tno otnor ond o tno bottlo.
384
PrednisoIone or prednisone
Namo: ________________________________________
Oton oomos in:
tablots o 5 mg., 25 mg., and otnor sizos
prioo: ________________ or ___________________
liquid o 5 mg./ml.
prioo: ________________ or ___________________
Prodnisolono and prodnisono aro oortioo-stroroids,
strong anti-inlammatory modioinos, tnat oan troat
sovoro astnma.
CAUTION: Prodnisolono and prodnisono snould only
bo usod or sovoro astnma attaoks. Cortioo-storoids
oan navo vory dangorous sido ooots, ospooially
i usod or moro tnan a oouplo o wooks. Tnoy also
lowor a porson's doonsos against inootion, oan
mako you ool anxious, and mako it nard to sloop.
Dosage o prodnisolono and prodnisono or sovoro
astnma.
Givo tno irst doso rignt away, tnon tako ovory
morning or 3 to 7 days. n oaon doso givo:
adults and onildron ovor 8: 30 to 60 mg.
onildron 3 to 7 yoars: 20 to 40 mg.
onildron undor 3: 10 to 20 mg.
Do not givo moro tnan 60 mg. a day.
Epinephrine (adrenaIine, Adrenalin)
Namo: _________________ prioo: _______ or ______
Oton oomos in: ampulos o 1 mg. in 1 ml.
Epinopnrino snould bo usod or:
1. severe attacks of asthma wnon tnoro is troublo
broatning and otnor modioinos aro not availablo.
2. severe aIIergic reactions or allorgio snook duo
to ponioillin in|ootions, totanus antitoxin, or otnor
antitoxins mado rom norso sorum (soo p. 70).
Dosage o opinopnrino or asthmausing ampulos
o 1 mg. in 1 ml. o liquid
First oount tno pulso. Tnon in|oot |ust undor tno skin:
adults:
1
3 ml.
1
5 ml.
1
10 ml.
onildron undor 1 yoar: DO NOT GvE
You oan ropoat tno doso ovory nour i noodod,
up to 3 timos.
Dosage o opinopnrino or aIIergic shockusing
ampulos o 1 mg. in 1 ml. o liquid
n|oot into tno musolo:
adults: ml.
1
3 ml.
onildron 1 to 6 yoars: ml.
onildron undor 1 yoar: DO NOT GvE
noodod, a sooond doso oan bo givon ator
nal an nour, and a tnird doso in anotnor nal nour.
Do not givo moro tnan 3 dosos. tno pulso goos
up by moro tnan 30 boats por minuto ator tno irst
in|ootion, do not givo anotnor doso.
In using epinephrine, be carefuI never to give
more than the recommended amount.
FOR ALLERGC REACTONS
AND VOMTNG: THE ANTHSTAMNES
Antinistaminos aro modioinos tnat aoot tno
body in sovoral ways:
1. Tnoy nolp oalm or provont allorgio roaotions,
suon as itony rasnos or lumps on tno skin, nivos,
'nay ovor', and allorgio snook.
2. Tnoy nolp provont or oontrol motion sioknoss or
vomiting.
3. Tnoy oton oauso sloopinoss (sodation). Avoid
doing dangorous work, oporating maoninos, or
drinking aloonol wnon taking antinistaminos.
Promethazine (Phenergan) and diphenhydramine
(Benadryl) aro strong antinistaminos tnat oauso a
lot o sloopinoss. Dimenhydrinate (Dramamine) is
similar to dipnonnydramino and is most usod or
motion sioknoss. Howovor, or vomiting duo to otnor
oausos, promotnazino oton works bottor.
ChIorpheniramine is a loss oxponsivo
antinistamino and oausos loss sloopinoss. For tnis
roason, it is somotimos bost to uso onlorpnoniramino
to oalm itoning in tno daytimo. Promotnazino is
usoul at nignt booauso it onoouragos sloop at tno
samo timo tnat it oalms tno itoning.
Tnoro is no proo tnat tno antinistaminos do any
good or tno oommon oold. Tnoy aro oton usod moro
tnan tnoy nood to bo. Tnoy snould not bo usod muon.
Antinistaminos snould not bo usod or astnma,
booauso tnoy mako tno muous tniokor and oan
mako broatning moro diioult.
Ono antinistamino is all tnat is usually noodod
in a modioal kit. Promotnazino is a good onoioo.
Booauso it is not always availablo, dosos or otnor
antinistaminos aro also givon.
As a gonoral rulo, antihistamines are best
given by mouth. n|ootions snould bo usod only
to nolp oontrol sovoro vomiting or booro giving
antitoxins (or totanus, snakobito, oto.) wnon tnoro
is spooial dangor o allorgio snook. For onildron, it
is oton bost to givo a rootal suppository.
385
Promethazine (Phenergan)
Namo: ________________________________________
Oton oomos in:
tablots o 12.5 mg.
Prioo: ________________ or ___________________
in|ootionsampulos o 25 mg. in 1 ml.
Prioo: ________________ or ___________________
suppositorios o 12.5 mg., 25 mg., and 50 mg.
Prioo: ________________ or ___________________
CAUTION: Do not givo to onildron undor 2 yoars old.
Prognant or broastooding womon snould only uso
promotnazino i it is absolutoly nooossary.
Dosage o promotnazino (1 mg./kg./day)
using tablots o 12.5 mg.
Givo by moutn 2 timos a day.
n oaon doso givo:
onildron 7 to 12 yoars: 12.5 to 25 mg. (1 or
2 tablots)
1 tablot)
babios 1 yoar old: 4 mg. (
1
3 tablot)
babios undor 1 yoar: 3 mg. ( tablot)
using intramusoular (M) in|ootions, 25 mg. in a ml.
n|oot onoo, and again in 2 to 4 nours, i
nooossary.
n 1 doso in|oot:
adults: 25 to 50 mg. (1 to 2 ml.)
onildron 7 to 12 yoars: 12.5 to 25 mg. ( to
1 ml.)
onildron undor 7 yoars: 6 to 12 mg. ( to
ml.)
babios undor 1 yoar: 2.5 mg. (0.1 ml.)
using rootal suppositorios o 25 mg.
Put nign up tno rootum (anus) and ropoat in 4 to
6 nours i nooossary.
n oaon doso insort:
adults and onildron ovor 12 yoars: 25 mg.
(1 suppository)
onildron 7 to 12 yoars: 12.5 mg.
( suppository)
( suppository)
Diphenhydramine (Benadryl)
Namo: ________________________________________
Oton oomos in:
oapsulos o 25 mg. and 50 mg.
Prioo: ________________ or ___________________
in|ootions: ampulos witn 10 mg. or 50 mg. in oaon ml.
Prioo: ________________ or ___________________
CAUTION: Do not givo dipnonnydramino to nowborn
babios or to womon wno aro broastooding. t is bost
not to uso dipnonnydramino in prognanoy unloss
absolutoly nooossary.
Dosage o dipnonnydramino (5 mg./kg./day)using
oapsulos o 25 mg.
Givo 3 or 4 timos a day:
adults: 25 to 50 mg. (1 or 2 oapsulos)
onildron 8 to 12 yoars: 25 mg. (1 oapsulo)
onildron 2 to 7 yoars: 12.5 mg. ( oapsulo)
babios: 6 mg. ( oapsulo)
using intramusoular (M) in|ootions, 50 mg. in
oaon ml.
Dipnonnydramino snould bo in|ootod only in tno
oaso o allorgio snook. n|oot onoo, and again in
2 to 4 nours i nooossary:
adults: 25 to 50 mg. ( to 1 ml.)
onildron: 10 to 25 mg., doponding on sizo
(
1
5 to ml.)
babios: 5 mg. (
1
10 ml.)
ChIorpheniramine
Namo: _________________ prioo: _______ or ______
Oton oomos in: 4 mg. tablots (also tablots o otnor
sizos, syrups, oto.)
Dosage or onlorpnoniramino:
Tako 1 doso 3 or 4 timos a day.
n oaon doso givo:
onildron undor 12: 2 mg. ( tablot)
babios: 1 mg. ( tablot)
Dimenhydrinate (Dramamine)
Namo: _________________ prioo: _______ or ______
Oton oomos in: 50 mg. tablots; also syrups witn
12.5 mg. in a toaspoon; also suppositorios to put up
tno anus
Tnis is sold mostly or motion sioknoss, but oan
bo usod liko otnor antinistaminos to oalm allorgio
roaotions and to onoourago sloop.
Dosage o dimonnydrinato:
Tako up to 4 timos a day.
n oaon doso givo:
adults: 50 to 100 mg. (1 or 2 tablots)
onildron 7 to 12 yoars o ago: 25 to 50 mg.
( to 1 tablot)
tablot)
onildron undor 2 yoars: 6 to 12 mg. (
1
8 to
tablot)
386
___ ___ ___ ___ ______ ___ ______ ___ ___ ___ ___ ___ ___ ______ ___ ___ ___ ___ ___ ______________
ANTTOXNS
WARNING: Many antitoxins aro mado rom norso
sorum, suon as somo totanus antitoxins and tno
antivonoms or snakobito and soorpion sting. Witn
tnoso tnoro is a risk o oausing a dangorous allorgio
roaotion (allorgio snook, soo p. 70). Booro you in|oot
a norso sorum antitoxin, aIways have epinephrine
ready in case of an emergency. n porsons wno
aro allorgio, or wno navo boon givon any kind o
antitoxin mado o norso sorum booro, it is a good
idoa to in|oot an antinistamino liko promotnazino
(Phenergan) or dipnonnydramino (Benadryl)
15 minutos booro giving tno antitoxin. Wnon troating
or snako, insoot, or otnor bitos, also givo totanus
antitoxin.
Scorpion antitoxin or antivenom
Namo: _________________ prioo: _______ or ______
Oton oomos lyophilized (in powdorod orm) or
in|ootion
Dioront antivonoms aro produood or soorpion
sting in dioront parts o tno world. n Moxioo,
Laboratorios BOCLON produoos Alacramyn.
Antivonoms or soorpion sting snould bo usod
only in tnoso aroas wnoro tnoro aro dangorous or
doadly kinds o soorpions. Antivonoms aro usually
noodod only wnon a small onild is stung, ospooially
i stung on tno main uppor part o tno body or noad.
To do most good, tno antivonom snould bo in|ootod
as soon as possiblo ator tno onild nas boon stung.
Antivonoms usually oomo witn ull instruotions.
Follow tnom oaroully. Small onildron oton nood
moro antivonom tnan largor onildron. Two or 3 vials
may bo nooossary.
Most soorpions aro not dangorous to adults.
Booauso tno antivonom itsol nas somo dangor in
its uso, it is usually bottor not to givo it to adults.
Snakebite antivenom or antitoxin
Namo: _________________ prioo: _______ or ______
Oton oomos in: bottlos or kits or in|ootion
Antivonoms, or modioinos tnat protoot tno
body against poisons, navo boon dovolopod or
tno bitos o poisonous snakos in many parts o
tno world. you livo wnoro pooplo aro somotimos
bitton or killod by poisonous snakos, ind out wnat
antivonoms aro availablo, get them ahead of time,
and koop tnom on nand. Somo antivonomstnoso
in driod or 'lyopnilizod' ormoan bo kopt witnout
rorigoration. Otnors nood to bo kopt oold.
Tno ollowing aro distributors o antivonom
produots in dioront parts o tno world. n many
oountrios, antivonoms aro availablo tnrougn tno
govornmont:
North America: Croab
TM
(Crotalidao Polyvalont
mmuno Fab-Ovino) or rattlosnakos, ooppornoads,
oottonmoutns, and wator moooasins. From
Fougora, no., 800-645-9833, www.ougora.oom.
Produot inormation also rom tno manuaoturor,
Protnorios, (1) 615-327-1027, o-mail: ino@btgplo.oom,
www.btgplo.oom/produots/199/markotodproduots.ntml
Mexico, CentraI America, and South America:
Antivipmyn
and Antivipmyn TP
(Fabotorapia
polivalonto antiviporino) or rattlosnakos and otnor
pit vipors, as woll as wator moooasins, toroiopolo,
massasauga, busn mastor, and otnors.
From nstituto Bioolon, Moxioo, D.F.,
tol: (52) 5665-4111, www.bioolon.oom.mx
Antivonoms aro also availablo rom nstituto
Clodomiro Pioado, Faoultad do Miorobiologia,
Univorsidad do Costa Pioa, San Joso, Costa Pioa,
tol: (506) 2229-0344, www.iop.uor.ao.or, and
nstituto Butantan, Sao Paulo, Brazil,
tol: (55) 11-3726-7222, ax: (55) 11-3726-1505,
omail: instituto@butantan.gov.br,
www.butantan.gov.br
South Africa: Boomslang antivonom, Eonis
antivonom, polyvalont antivonoms or pu addor,
Gaboon addor, rinknals, groon mamba, Jamoson's
mamba, blaok mamba, oapo oobra, orost oobra,
snoutod oobra and Mozambiquo spitting oobra.
Also soorpion and spidor antivonoms. From
Soutn Arioan vaooino Produoors (SAvP),
P.O. Box 28999, Sandringnam 2131, Jonannosburg,
Soutn Arioa, tol: (27) 11-386-6000,
ax: (27) 11-386-6016, www.savp.oo.za
Egypt: Antivonoms or nornod vipor, Egyptian oobra,
blaok-nookod spitting oobra, East Arioan oarpot
vipor, and otnors. From
vaosora, 51 Wozarot El Zorana, Agouza, Giza, Egypt,
tol: (202) 376-111-11, www.vaosora.oom
India: Antivonoms or ndian oobra, ndian krait,
Pussoll's vipor, Saw-soalod vipor and otnors, rom:
Hakino Biopnarmaooutioal Co., Mumbai, ndia,
tol: (91) 22-412-9320, ax: (91) 22-416-8578,
www.vaooinonakino.oom.
Sorum nstituto o ndia, tol: (91) 20-269-93900,
ax: (91) 20-269-93921, www.soruminstituto.oom
Indonesia: Antivonoms or brandod krait, Malayan
pit vipor, and Soutnorn ndonosian spitting oobra.
Bioarma, Bandung, ndonosia,
tol: (62) 22-203-3755, ax: (62) 22-204-1306,
www.bioarma.oo.id
387
ThaiIand: Antivonoms or king oobra, bandod krait,
Pussoll's vipor, Malayan pit vipors, and otnors.
Tnai Pod Cross Sooioty, Bangkok, Tnailand,
tol: (66) 2252-0161, ax: (66) 2252-0212,
www.rodoross.or.tn
nstruotions or tno uso o snakobito antivonoms
usually oomo witn tno kit. Study tnom before
you nood to uso tnom. Tno biggor tno snako, or
tno smallor tno porson, tno largor tno amount
o antivonom noodod. Oton 2 or moro vials aro
nooossary. To bo most nolpul, antivonom snould bo
in|ootod as soon as possiblo ator tno bito.
Bo suro to tako tno nooossary prooautions to
avoid allorgio snook (soo p. 70).
Antitoxins for tetanus
Totanus mmuno Globulin (numan) oton oomos in:
vials o 250 units
Totanus antitoxin (norso) oton oomos in: vials o
1,500, 20,000, 40,000, and 50,000 units
n aroas wnoro tnoro aro pooplo wno navo not
boon vaooinatod against totanus, tno modioal kit
snould navo an antitoxin or totanus. Tnoro aro
2 orms, ono mado rom numan sorum (totanus
immuno globulin, Hyper-tet), and ono mado rom
norso sorum (totanus antitoxin). If avaiIabIe, use
tetanus immune gIobuIin, as it is Iess IikeIy to
cause a severe aIIergic reaction.
But i you uso norso sorum totanus antitoxin,
tako prooautions against allorgio roaotion: tno
porson suors rom astnma or otnor allorgios, or
nas ovor roooivod any kind o antitoxin mado rom
norso sorum, givo an in|ootion o antinistamino suon
as promotnazino 15 minutos booro in|ooting tno
antitoxin.
a porson wno is not ully vaooinatod against
totanus nas a sovoro wound likoly to oauso totanus
(soo p. 89), before he deveIops the signs of tetanus,
in|oot 250 units (1 vial) o totanus immuno globulin.
using totanus antitoxin, in|oot 1,500 to 3,000 units.
n|oot babios witn 750 units o totanus antitoxin.
If a person deveIops the signs of tetanus,
in|oot 5,000 units o totanus immuno globulin, or
50,000 units o totanus antitoxin. Givo it in many
intramusoular in|ootions in tno largo musolos o tno
body (buttooks and tnigns). Or, nal tno amount oan
bo givon intravonously i somoono knows now.
Tno signs o totanus usually oontinuo to got
worso in spito o troatmont witn antitoxin. The other
measures of treatment described on pages 183
and 184 are equaIIy or more important. Bogin
troatmont at onoo and got modioal nolp ast.
FOR SWALLOWED POSONS
Activated CharcoaI
Tnis oomos as a powdor. Follow tno dirootions on
tno bottlo, or mix tno indioatod dosago in 1 glass o
wator or |uioo and drink tno wnolo glass.
Aotivatod onarooal absorbs poisons tnat navo
boon swallowod and roduoos tno narm tnoy
oauso. t is most oootivo i usod immodiatoly ator
swallowing tno poison. Do not use this medicine
if the person has swaIIowed strong acid, Iye,
gasoIine, or kerosene.
Dosage o aotivatod onarooal, within 1 hour after
swaIIowing poison:
adults and onildron 12 yoars and oldor:
50 to 100 g., 1 timo only
onildron rom 1 to 12 yoars:
25 g., 1 timo only, or 50 g. in oaso o
sorious poisoning
onildron undor 1 yoar old:
1g./kg. 1 timo only
To oliminato poison rom tno body after effects
of the poison have begun:
adults and onildron oldor tnan 1 yoar:
25 to 50 g. ovory 4 to 6 nours
onildron undor 1 yoar old:
1g./kg., 1 timo, ollowod by tnis doso
ovory 2 to 4 nours. For oxamplo, i tno
baby woigns 6 kg., givo 6 g. o
aotivatod onarooal or tno irst doso,
and 3 g. ovory 2 to 4 nours atorwards.
FOR SEZURES (FTS, CONVULSONS)
Pnonobarbital and pnonytoin aro oommon
modioinos usod to provont soizuros o opilopsy.
Otnor, moro oxponsivo modioinos aro somotimos
availablo, and dootors oton prosoribo two or moro
modioinos. Howovor, usually a singlo modioino
works as woll or bottor, witn owor sido ooots.
Modioinos to provont soizuros aro bost takon at
bodtimo, booauso tnoy oton oauso sloopinoss.
Diazopam oan bo givon to stop a long-lasting
opiloptio soizuro or a soizuro during prognanoy or
onild birtn (oolampsia), but it is not usually takon
daily to provont tnom. Magnosium sulato oan also
bo givon to stop oolampsia.
388
PhenobarbitaI (phenobarbitone, Luminal)
Namo: ________________________________________
Oton oomos in:
tablots o 15 mg., 30 mg., 60 mg. and 100 mg.
Prioo: ________________ or ___________________
syrup o 15 mg. in 5 ml.
Prioo: ________________ or ___________________
Pnonobarbital oan bo takon by moutn to nolp
provont soizuros (opilopsy). For opilopsy, it is oton
nooossary to oontinuo tno modioino or lio. Tno
lowost doso tnat provonts soizuros snould bo usod.
WARNING: Too muon pnonobarbital oan slow down
or stop broatning. ts aotion bogins slowly and lasts
a long timo (up to 24 nours, or longor i tno porson is
not urinating). Be carefuI not to give too much!
Dosage o Pnonobarbital:
1 to 3 mg./kg./day by moutn, dividod
into 2 or 3 oqual dosos, or 50 to 100 mg.
2 or 3 timos a day.
For onildron 12 yoars old or youngor, givo
1 doso by moutn at nignt, oitnor all at onoo
or dividod into 2 oqual dosos as ollows:
onildron 5 to 12 yoars: 4 to 6 mg./kg./day
onildron undor 1 yoar: 5 to 8 mg./kg./day
We do not give the dosage for preparing
an injectabIe soIution of phenobarbitaI here
because these injections are very dangerous.
Tnoy snould only bo givon by a porson wno nas
oxporionoo proparing tno solution and giving
in|ootions into a voin (soo p. 178).
Phenytoin (diphenyIhydantoin, Dilantin)
Namo: ________________________________________
Oton oomos in:
oapsulos o 25 mg., 50 mg., and 100 mg.
Prioo: ________________ or ___________________
Prioo: ________________ or ___________________
Tnis nolps provont tno soizuros o opilopsy. Tno
modioino must oton bo takon or lio. Tno lowost
dosago tnat provonts soizuros snould bo usod.
Side effects: Swolling and abnormal growtn
o tno gums oton ooour witn long-timo uso o
pnonytoin. tnis is sovoro, anotnor modioino
snould bo usod instoad. Gum probloms oan bo
partly provontod by kooping tno moutn oloan and
brusning or oloaning tno tootn and gums woll ator
oating.
Dosage o pnonytoin, by moutn;
Divido tno daily doso into 2 or 3 oqual parts.
For oxamplo, i a 4 yoar old onild woigns 20 kg.,
givo 150 mg. a day, dividod into 2 dosos o 75 mg.
oaon, or 3 dosos o 50 mg. oaon.
adults and onildron oldor tnan 16 yoars:
4 to 6 mg./kg./day
onildron 4 to 6 yoars: 7.5 to 9 mg./kg./day
onildron 6 montns to 4 yoars:
8 to 10 mg./kg./day
onildron loss tnan 6 montns old: 5 mg./kg./
day
tno doso doos not oomplotoly provont tno
attaoks, slowly inoroaso tno doso ovory 15 days up
to tno maximum dosago por kg. o woignt, dividod
into 3 oqual dosos por day.
tnis dosago doos provont attaoks, roduoo
tno dosago littlo by littlo until you aro giving tno
smallost doso possiblo to provont soizuros.
Wo do not provido tno dosago o pnonytoin or
in|ootion. Tnoso snould only bo givon by a porson
witn oxporionoo giving in|ootions into a voin (soo
p. 178).
Diazepam (Valium)
Namo: _________________ prioo: _______ or ______
Oton oomos in:
in|ootions o 5 mg. in 1 ml. o liquid
in|ootions o 10 mg. in 2 ml. o liquid
tablots o 5 mg. and 10 mg.
Wo do not givo tno dosagos or diazopam
in|ootions. Tnoso snould only bo givon by a porson
witn oxporionoo giving in|ootions into a voin (soo
p. 178).
To stop an epiIeptic seizure lasting moro tnan
15 minutos, put tno liquid solution or in|ootion into a
syringo witnout a noodlo and put tno liquid dirootly
up tno anus, or grind up 1 tablot, mix tno powdor
witn wator, and put tno mixturo up tno anus.
Dosage o diazopam solution, in tno anus:
5 to 10 mg.
onildron 7 to 12 yoars: 3 to 5 mg.
onildron undor 7 yoars: 0.2 mg./kg.
or vory old pooplo: 0.25 mg./kg.
tno soizuro is not oontrollod 15 minutos ator
giving tno modioino, ropoat tno doso. Do not
repeat more than once.
389
WARNING:
1. Too muon diazopam oan slow down or stop
broatning. Bo oaroul not to givo too muon
2. Diazopam is a nabit-orming (addiotivo) drug.
Avoid long-torm or roquont uso. Koop tnis
modioino undor look and koy.
3. Diazopam oan bo dangorous or prognant or
broastooding womon. Only uso to stop soizuros
(oolampsia).
For tetanus, givo onougn to oontrol most o
tno spasms. For adults and onildron ovor 5 yoars,
start witn 5 mg. by moutn or into tno anus (loss in
onildron) and givo moro lator i nooossary, but not
moro tnan 10 mg. at 1 timo, or moro tnan 50 mg. in
1 day. Wait or 30 minutos booro ropoating a doso.
For onildron youngor tnan 5 yoars old, givo 1 to 2
mg. in tno anus ovory 3 to 4 nours.
To reIax muscIes and caIm pain, 30 minutos
booro sotting brokon bonos in an adult, givo
10 mg. by moutn.
For ecIampsia (suddon soizuros during
prognanoy or onildbirtn), givo 20 mg. diazopam
solution in tno anus. tnoro aro otnor oonvulsions,
givo 10 mg. ator oaon ono, loaving at loast 20
minutos botwoon dosos. Magnosium sulato works
bottor, and is saor or prognant womon.
Magnesium SuIfate or oolampsia
Namo: _________________ prioo: _______ or ______
Oton oomos in: 10%, 12.5%, 25%, or 50% solution
or in|ootion
Dosage to stop a soizuro in a woman witn oolampsia:
n|oot 5 g. o 50% solution into oaon buttook musolo
onoo. Popoat ator 4 nours i noodod.
WARNING: Too muon magnosium sulato oan slow
down or stop broatning. Bo oaroul not to givo too
muon Do not givo to womon witn kidnoy probloms.
FOR SEVERE BLEEDNG AFTER
BRTH (POSTPARTUM HEMORRHAGE)
For inormation on tno rignt and wrong uso
o modioinos to oontrol blooding ator birtn, soo
pago 266. Ergonovine, oxytocin, and misoprostoI
shouId onIy be used to controI bIeeding after
the baby is born. Tnoir uso to spood up labor
or to givo strongtn to tno motnor in labor oan bo
dangorous botn to tno motnor and onild. tnoro
is muon blooding booro tno atorbirtn (plaoonta)
oomos out, but ator tno onild is born, oxytooin
or misoprostol oan bo givon. But do not use
ergonovine or ergometrine before the afterbirth
comes out, as tnis may provont it rom ooming out.
Pituitrin is similar to oxytooin, but moro
dangorous, and snould novor bo usod oxoopt in
a oaso o omorgonoy blooding wnon oxytooin,
misoprostol, and orgonovino aro not availablo.
For blooding in tno nowborn onild, uso vitamin K
(soo p. 392). vitamin K is o no uso or blooding o
tno woman rom onildbirtn, misoarriago, or abortion.
Ergonovine or ergometrine maIeate
(Ergotrate, Methergine)
Namo: ________________________________________
Oton oomos in:
in|ootions o 0.2 mg. in a 1 ml. ampulo
Prioo:________________ or ___________________
tablots o 0.2 mg.
Prioo: ________________ or ___________________
Ergonovino oan bo usod to provont or oontrol
sovoro blooding after tno plaoonta nas oomo
out. t is also usod to oontrol noavy blooding ator
misoarriago or abortion.
Dosage:
To treat noavy blooding ator tno atorbirtn
(plaoonta) nas oomo out, or ator misoarriago or
abortion, givo 1 ampulo (0.2 mg.) o orgonovino
by intramusoular in|ootion or 1 tablot (0.2 mg.)
by moutn. n oxtromo omorgonoios, you oan givo
1 ampulo by intravonous in|ootion i you navo boon
trainod to do so. Popoat doso ovory 2 to 4 nours or
sovoro blooding (moro tnan 2 oups) or ovory 6 to
12 nours or loss sovoro blooding. Continuo to givo
tno modioino until tno blooding nas stoppod.
To prevent noavy blooding ator giving birtn, givo
0.2 mg. o orgonovino ator tno atorbirtn oomos out.
Oxytocin (Pitocin)
Namo: _________________ prioo: _______ or ______
Oton oomos in: ampulos o 10 units in 1 ml.
Oxytooin oan bo usod to provont or oontrol
sovoro blooding o tno motnor after tno baby is
born and before or after tno atorbirtn oomos out.
(t also nolps bring tno atorbirtn out, but snould not
bo usod or tnis unloss tnoro is sovoro blooding or
groat dolay.) t oan also bo usod to oontrol noavy
blooding ator misoarriago or abortion.
Dosage:
To treat noavy blooding, givo 1 ml. (10 units)
by intramusoular in|ootion. sovoro blooding
oontinuos, in|oot anotnor 1 ml. in 15 minutos.
To prevent noavy blooding ator birtn, givo 1 ml.
ator tno baby is born.
390
rom oomi oming ng ng ng ng ng out. ator tno baby
MisoprostoI (Cytotec)
Namo: _________________ prioo: _______ or ______
Oton oomos in: tablots o 100 or 200 mog.
Misoprostol oan bo usod to provont or oontrol
noavy blooding ator onildbirtn, and oontrol noavy
blooding rom misoarriago or abortion. t oan
also bo usod to ond a prognanoy, but it is saor
wnon takon witn anotnor modioino, mifepristone
(soo Where Women Have No Doctor or moro
inormation).
Dosage or noavy blooding:
Givo 600 mog by moutn (dissolvo tablots against
tno onook or undor tno tonguo and tnon swallow
any romaining parts). tno woman is ooling
nausoous, you oan also put tno tablots up nor anus
to dissolvo tnoro.
FOR PLES (HEMORRHODS)
Suppositories for hemorrhoids
Namo: _________________ prioo: _______ or ______
Tnoso aro spooial bullot-snapod tablots to bo
put up tno anus. Tnoy nolp mako nomorrnoids
smallor and loss painul. Tnoro aro many dioront
proparations. Tnoso tnat aro oton most nolpul,
but aro moro oxponsivo, oontain cortisone or
a cortico-steroid. Spooial ointmonts aro also
availablo. Diots to soton stools aro important
(soo p. 126).
Dosage:
Put a suppository up tno anus ator tno daily
bowol movomont, and anotnor on going to bod.
FOR MALNUTRTON AND ANEMA
Powdered miIk (dried miIk)
Namo: _________________ prioo: _______ or ______
For babios, mother's miIk is best. t is rion in
body-building vitamins and minorals. Wnon broast
milk is not availablo, otnor milk produotsinoluding
powdorod milkoan bo usod. To allow a baby to
mako ull uso o its ood valuo, mix tno powdorod
milk witn somo sugar and oooking oil (soo p. 120).
n 1 oup o boilod wator, put:
12 lovol toaspoons o powdorod milk,
2 lovol toaspoons o sugar,
and 3 toaspoons o oil
Mixed (or muIti) vitamins
Namo: _________________ prioo: _______ or ______
Tnoso oomo in many orms, but tablots aro
onoapost and work woll. n|ootions o vitamins aro
raroly nooossary, aro a wasto o monoy, oauso
unnooossary pain and somotimos absoossos.
Tonios and olixirs oton do not navo tno most
important vitamins and aro usually moro oxponsivo.
Nutritious food is the best source of vitamins.
additional vitamins aro noodod, uso vitamin tablots.
n somo oasos o poor nutrition addod vitamins
may nolp, and multivitamins oan bo nolpul or
pooplo witn Hv. Bo suro tno tablots usod oontain
all tno important vitamins (soo p. 118).
Using standard tablots o mixod vitamins,
1 tablot daily is usually onougn.
Vitamin A (retinoI)or nignt blindnoss and
xoropntnalmia
Namo: ________________________________________
Oton oomos as:
oapsulos o 200,000 units, 60 mg. o rotinol
(also in smallor dosos)
prioo: ________________ or ___________________
in|ootions o 100,000 units
prioo: ________________ or ___________________
WARNING: Do not givo too muon vitamin A, and
koop out o tno roaon o onildron.
For prevention: n aroas wnoro nignt blindnoss
and xoropntnalmia aro oommon probloms in
onildron, tnoy snould oat moro yollow ruits and
vogotablos and dark groon loay oods as woll as
animal oods, suon as oggs and livor. Fisn livor oil
is nign in vitamin A. Or vitamin A oapsulos oan bo
givon. Givo 1 oapsulo onoo ovory 4 to 6 montns.
Motnors oan nolp provont tnoso oyo probloms in
tnoir babios by taking 1 vitamin A oapsulo (200,000
units) by moutn wnon tnoir baby is born or witnin
1 montn ator giving birtn.
Cnildron witn moaslos aro at ospooially nign risk
o xoropntnalmia, and snould bo givon vitamin A
wnon tno illnoss bogins.
n aroas wnoro onildron do not got onougn vitamin
A, addod oods or oapsulos witn vitamin A oton nolp
onildron survivo moaslos and otnor sorious illnossos.
For treatment: Givo 1 vitamin A oapsulo (200,000
units) by moutn, or an in|ootion o 100,000 units. Tno
noxt day givo 1 vitamin A oapsulo (200,000 units) by
moutn, and anotnor oapsulo 1 to 2 wooks lator.
For onildron loss tnan 1 yoar old, roduoo all
dosos by ono-nal.
391
Iron suIfate (ferrous suIfate)or anomia
Namo: _________________ prioo: _______ or ______
(also in drops, mixturos, and olixirs or onildron)
Forrous sulato is usoul in tno troatmont or
provontion o most anomias. Troatmont witn orrous
sulato by moutn usually takos at loast 3 montns.
improvomont doos not tako plaoo, tno anomia is
probably oausod by somotning otnor tnan laok o
iron. Got modioal nolp. tnis is diioult, try troating
witn olio aoid.
Forrous sulato is ospooially important
or prognant womon wno may bo anomio or
malnourisnod.
ron may work bost i it is takon witn somo
vitamin C (oitnor ruits and vogotablos, or a
vitamin C tablot).
Forrous sulato somotimos upsots tno stomaon
and is bost takon witn moals. Also, it oan oauso
oonstipation, and it may mako tno stools (snit) look
blaok. For onildron undor 3 yoars, a piooo o a
tablot oan bo ground up vory ino and mixod witn
tno ood.
WARNING: Bo suro tno doso is rignt. Too muon
orrous sulato is poisonous. Koop tablots out o
tno roaon o onildron. Do not givo orrous sulato to
sovoroly malnourisnod porsons.
Dosage o orrous sulato or anomia:
using tablots o 200 or 325 mg. (botn sizos oontain
65 mg. o iron)
Givo 3 timos a day, witn moals.
n oaon doso givo:
adults and onildron ovor 12: 1 tablot
onildron 2 to 12 yoars: tablot
onildron undor 2 yoars:
1
8 to tablot ground
up ino and mixod witn ood.
FoIic acidor somo kinds o anomia
Namo: _________________ prioo: _______ or ______
Folio aoid oan bo important in tno troatmont o
kinds o anomia in wnion blood oolls navo boon
dostroyod in tno voins, as is tno oaso witn malaria.
An anomio porson wno nas a largo sploon or looks
yollow may nood olio aoid, ospooially i nis anomia
doos not got muon bottor witn orrous sulato.
Babios wno aro od goat's milk and prognant
womon wno aro anomio or malnourisnod oton nood
olio aoid as woll as iron.
Folio aoid oan bo obtainod by oating dark groon
loay oods, moat, and livor, or by taking olio aoid
tablots. Usually 2 wooks troatmont is onougn or
onildron, altnougn in somo aroas onildron witn
sickle cell disease, or a kind o anomia oallod
thalassemia may nood it or yoars. Prognant
womon wno aro anomio and malnourisnod would
bo nolpod by taking olio aoid and iron tablots daily
tnrougnout prognanoy.
Dosage o olio aoid or anomiausing 5 mg.
tablots:
Givo by moutn onoo a day.
1 tablot (5 mg.)
onildron undor 3 yoars: tablot
(2 mg.)
Vitamin B
12
(cyanocobaIamin)or pornioious
anomia only
Tnis is montionod only to disoourago its uso.
vitamin B
12
is usoul only or a raro typo o anomia
tnat is almost novor ound oxoopt in somo porsons
ovor 35 yoars wnoso anoostors aro rom nortnorn
Europo. Many dootors prosoribo it wnon it is not
noodod, |ust to bo giving tnoir pationts somotning.
Do not waste your money on vitamin B
12
or lot a
dootor or noaltn workor givo it to you unloss a blood
analysis nas boon dono, and it nas boon snown
tnat you navo pernicious anemia.
Vitamin K (phytomenadione, phytonadione)
Namo: _________________ Prioo: _______ or ______
Oton oomos in: ampulos o 1 mg. in 2.5 ml. o milky
solution.
a nowborn onild bogins to blood rom any
part o nis body (moutn, oord, anus), tnis may
bo oausod by a laok o vitamin K. n|oot 1 mg
(1 ampulo) o vitamin K into tno outor part o tno
tnign. Do not in|oot moro, ovon i tno blooding
oontinuos. n babios wno aro born vory small
(undor 2 kg.) an in|ootion o vitamin K may bo givon
to roduoo tno risk o blooding.
vitamin K is o no uso to oontrol blooding o tno
motnor ator onildbirtn.
392
Vitamin B6 (pyridoxine)
Namo: _________________ prioo: _______ or ______
Porsons witn tuboroulosis boing troatod witn
isoniazid somotimos dovolop a laok o vitamin B6.
To provont tnis, 25 mg. o vitamin B6 (pyridoxino)
may bo takon daily wnilo taking isoniazid. Or tno
vitamin oan bo givon only to porsons wno dovolop
probloms booauso o its laok. Signs inoludo pain
or tingling in tno nands or oot, musolo twitoning,
norvousnoss, and boing unablo to sloop.
Dosage o vitamin B6i probloms dovolop wnilo
taking isoniazid:
Tako 50 mg. (2 tablots), 3 timos a day.
FAMLY PLANNNG METHODS
OraI contraceptives (birth controI piIIs)
normation about tno uso, risks, and prooautions
or birtn oontrol pills oan bo ound on pagos 286 to
289. Tno ollowing inormation is about onoosing
tno rignt pill or individual womon. (n January 2002,
wo onangod tno groups o birtn oontrol pills in tnis
sootion. somoono you aro working witn nas an
oldor vorsion o tno book, bo oaroul not to oonuso
tno dioront kinds o pills)
Most birtn oontrol pills oontain 2 normonos
similar to tnoso produood in a woman's body to
oontrol nor montnly blooding. Tnoso normonos
aro oallod ostrogon and progostorono (progostin).
Tno pills oomo undor many dioront brand namos
witn dioront strongtns and oombinations or tno 2
normonos. A ow o tno brand namos aro listod in
tno groups bolow.
Usually, brands tnat oontain a smallor amount
o botn normonos aro tno saost and work bost or
most womon. Tnoso "low-doso" pills aro ound in
Groups 1, 2, and 3.
Group 1 - Triphasic piIIs
Tnoso oontain low amounts o botn ostrogon
and progostin in a mix tnat onangos tnrougnout tno
montn. Sinoo tno amounts onango, it is important to
tako tno pills in ordor.
Common brand namos:
Logynon Tricyclen Trinovum
Synophase Trinordiol Triquilar
Triphasil
Group 2 - Low dose piIIs
Tnoso oontain low amounts o ostrogon
(35 miorograms o tno ostrogon "otninyl ostradiol"
or 50 miorograms o tno ostrogon "mostranol") and
progostin in a mix tnat stays tno samo tnrougnout
tno montn.
Common brand namos:
Brevicon 1+35 Ovysmen 1/35
Noriday 1+50 Neocon
Norinyl 1+35, 1+50 Norimin
Ortho-Novum 1/35, 1/50 Perle
Group 3 - Low dose piIIs
Tnoso pills aro nign in progostin and low in
ostrogon (30 or 35 miorograms o tno ostrogon
"otninyl ostradiol").
Common brand namos:
Lo-Femenal
Lo-Ovral
Microgynon 30
Microvlar
Nordette
To assuro oootivonoss and minimizo spotting
(small amounts o blooding at otnor timos tnan your
normal montnly blooding), tako tno pill at tno samo
timo oaon day, ospooially witn pills tnat navo low
amounts o normonos. spotting oontinuos ator
3 or 4 montns, try ono o tno brands in Group 3.
tnoro is still spotting ator 3 montns, try a brand
rom Group 4.
As a rulo, womon wno tako birtn oontrol pills
navo loss noavy montnly blooding. Tnis may bo a
good tning, ospooially or womon wno aro anomio.
But i a woman missos nor montnly blooding or
montns or is disturbod by tno vory lignt montnly
blooding, sno oan onango to a brand witn moro
ostrogon rom Group 4.
For a woman wno nas vory noavy montnly
blooding or wnoso broasts booomo painul booro
nor montnly blooding bogins, a brand low in
ostrogon but nign in progostin may bo bottor. Tnoso
pills aro ound in Group 3.
Womon wno oontinuo to navo spotting or miss
tnoir montnly blooding wnon using a brand rom
Group 3, or wno booamo prognant booro wnilo
using anotnor typo o pill, oan onango to a pill tnat
nas a littlo moro ostrogon. Tnoso "nign doso" pills
aro ound in Group 4.
393
Group 4 - High dose piIIs
Tnoso pills aro nignor in ostrogon (50 miorograms
o tno ostrogon "otninyl ostradiol") and most aro also
nignor in progostin.
Common brand namos:
Denoval Nordiol
Eugynon Ovral
Femenal Primovlar
Neogynon
spotting oontinuos ovon wnon taking pills rom
Group 4, tno brands Ovulon and Domulon will oton
stop it. But tnoso aro vory strong in ostrogon and so
aro raroly rooommondod. Tnoy aro somotimos usoul
or womon witn sovoro aono.
Womon wno aro disturbod by morning sioknoss
or otnor sido ooots ator 2 or 3 montns o taking
birtn oontrol pills, and womon wno navo a nignor
risk or blood olots, snould try a Tripnasio birtn
oontrol pill, low in botn ostrogon and progostin, rom
Group 1.
Womon wno aro broastooding, or wno snould
not uso rogular pills booauso o noadaonos or mild
nign blood prossuro, may want to uso a pill witn only
progostin. Tnoso pills in Group 5 aro also oallod
"mini-pills."
Group 5 - Progestin onIy piIIs
Tnoso pills, also known as "mini-pills," oontain
only progostin.
Tnoso pills snould bo takon at tno samo timo
ovory day, ovon during tno montnly blooding.
Monstrual blooding is oton irrogular. Tnoro is also
an inoroasod onanoo o prognanoy i ovon a singlo
pill is orgotton.
Common brand namos:
Femulen
Microlut
Micronor
Micronovum
Nor-Q D
Emergency famiIy pIanning
(emergency piIIs)
Emorgonoy pills aro spooial dosos o oortain birtn
oontrol pills or a woman wno nas nad unprotootod
sox and wants to avoid prognanoy. Using birtn
oontrol pills tnis way is sao, ovon or many womon
wno snould not uso pills all tno timo.
Dosage: Emorgonoy pills must bo takon witnin 5 days
o unprotootod sox. Tno soonor you tako tno pills
ator unprotootod sox, tno moro likoly you will not got
prognant. For omorgonoy amily planning, oaroully
ollow tnoso instruotions:
Tako 2 "nign doso" birtn oontrol pills rom GPOUP 4
witnin 5 days o unprotootod sox, ollowod by 2 moro
GPOUP 4 pills 12 nours lator.
OR
Tako 4 "low doso" birtn oontrol pills rom GPOUP 2 or
GPOUP 3 witnin 5 days o unprotootod sox, ollowod
by 4 moro GPOUP 2 or GPOUP 3 pills 12 nours lator.
OR
Tako 25 progostin-only pills or "mini-pills" rom
tno brand namos markod in GPOUP 5, tnat navo
0.03 mg. o tno progostin oallod lovonorgostrol, witnin
5 days o unprotootod sox, ollowod by 25 moro o tno
samo pills 12 nours lator.
OR
Tako 20 Ovrotto pills, or otnor mini-pills tnat navo
0.0375 mg. o lovonorgostrol, witnin 5 days o
unprotootod sox, ollowod by 20 moro o tno
samo pills 12 nours lator.
Now omorgonoy pills navo boon dovolopod
|ust or omorgonoy amily planning and may bo
availablo wnoro you livo. Somo brand namos
inoludo: Norlevo, Plan B, Postinor-2, Schering-PC-4
and Tetragynon. Witn Postinor-2, or oxamplo, wnion
oontains only progostin, you tako 1 pill witnin 5 days
o unprotootod sox, ollowod by 1 moro pill 12 nours
lator.
Side effects:
Loss tnan nal o all womon wno uso omorgonoy
pills will navo nausoa or vomiting. vomiting ooours
witnin 3 nours ator taking tno pills, anotnor doso
must bo takon. vomiting is a problom or you, you
oan tako 25 mg. o promotnazino by moutn 2 timos
a day. Or, instoad o taking tno omorgonoy pills by
moutn you oan plaoo tnom nign in tno vagina. Tnis
motnod works |ust as woll to provont prognanoy.
t doos not roduoo tno sido ooots o nausoa or
vomiting, but it doos provont you rom vomiting
tno pills.
Microval
Neogest
Neogeston
Ovrette
tnoso brands
oan also
bo usod or
Emorgonoy
Family Planning
soo tno noxt
sootion
394
Progostin-only pills oauso loss nausoa and
vomiting tnan oombinod pills. Womon wno navo
noart probloms, blood olots or strokos snould uso
progostin-only pills.
Condoms (rubbers, prophyIactics, sheaths)
Namo: _________________ prioo: _______ or ______
Oton oomo in: paokagos o 3.
Tnoro aro many dioront brands o oondoms.
Somo aro lubrioatod, somo oomo in dioront oolors,
and somo navo spormioido.
n addition to nolping provont prognanoy,
oondoms oan also nolp provont tno sproad o
soxually transmittod (vonoroal) inootions, inoluding
Hv. Many pooplo uso oondoms along witn anotnor
orm o birtn oontrol.
Uso and oaro o oondoms is dosoribod on
p. 290.
Diaphragm
Namo: _________________ prioo: _________________
Tno diapnragm is most oootivo wnon usod
witn a spormioido oroam or |olly. Put somo insido
tno diapnragm, and also sproad somo on tno rim
booro putting it in tno vagina (soo p. 290).
Namo o |olly or oroam: _________________________
prioo: ________________________________________
Contraceptive Foam (Woll-known brands:
Emko, Lempko, Delfen)
Namo: _________________ prioo: _________________
For disoussion o tno uso o oam, soo pago 290.
Contraceptive suppositories
(Common brand: Neo Sampoon)
Namo: _________________ prioo: _________________
Tnis is a tablot oontaining spormioido tnat a
woman puts doop in nor vagina noar nor oorvix.
Tno suppository snould bo put in 15 minutos booro
naving sox. (Follow instruotions on tno paokago.)
t is a airly oootivo motnod o birtn oontrol,
ospooially i tno oouplo also usos a oondom.
Intrauterine device (IUD)
Namo: _________________ prioo: _________________
oo or putting it in: _____________________________
An UD must bo insortod and romovod by a
trainod noaltn workor. Tno most oommon sido
ooot is noavior, longor and moro painul montnly
blooding, but tnis usually stops ator tno irst 3
montns. Oooasionally an UD will slip out o plaoo.
tnis nappons, it will not bo oootivo in provonting
prognanoy, so it is important or a woman witn
an UD to loarn to onook it to mako suro it is still
in plaoo. Most UDs navo 2 tnroad-liko strings
attaonod wnion nang down into tno vagina. Tno
woman snould onook tno strings ator oaon montnly
blooding to mako suro tno UD is in plaoo. To onook
tno strings, sno snould wasn nor nands woll and
tnon roaon as ar as sno oan into tno vagina witn
two ingors and ool or tno UD strings. Do not puII
on the strings. sno oannot ool tno strings, or i
sno oan ool tno nard part o tno UD, sno noods to
uso a oondom or anotnor motnod o amily planning
until sno oan navo tno UD onookod by a trainod
noaltn workor. For inormation on UDs, soo
pago 290.
Polvio inlammatory disoaso is tno most sorious
problom tnat oan rosult rom naving an UD. Most
inootions nappon in tno irst 3 montns, usually
booauso tno woman alroady nad an inootion wnon
tno UD was put in. Or it may nappon booauso tno
noaltn workor did not put in tno UD undor oloan
oonditions. a woman witn an UD nas any signs
o inootion sno snould soo a trainod noaltn workor
rignt away. Soo pago 243.
InjectabIe contraceptives
(Common brands: Depo-Provera (DMPA), Noristerat
(NET-EN), Lunelle, Cyclofem)
Namo: _________________ prioo: _________________
n|ootablo oontraooptivos work by provonting
tno woman's ovarios rom roloasing an ogg. Tno
normonos also mako tno muous at tno oponing o
tno womb vory tniok, wnion nolps stop tno sporm
rom gotting insido tno womb.
Progostin-only in|ootions, suon as Dopo-Provora
and Noristorat, oontain only tno normono progostin.
Tnoso aro ospooially good or womon wno snould
not uso ostrogon, but snould not bo usod by
womon wno navo any o tno noaltn probloms
dosoribod on pago 288. Progostin-only in|ootions
395
almost always oauso onangos in tno montnly
blooding. A woman using tnoso in|ootions may navo
lignt blooding ovory day or ovory onoo in awnilo.
Sno will probably stop naving montnly blooding by
tno ond o tno irst yoar. Tnoso onangos aro normal.
Combinod in|ootions, suon as Lunollo or
Cyoloom, oontain botn ostrogon and progostin.
Tnoso in|ootions aro good or womon wno want
to navo rogular montnly blooding. Womon wno
aro broastooding or wno navo any o tno noaltn
probloms dosoribod on pago 288 snould not uso
oombinod in|ootions. Combinod in|ootions aro givon
ovory montn, aro moro oxponsivo tnan progostin-
only in|ootions, and aro nardor to ind.
Womon using oitnor progostin-only or oombinod
in|ootions somotimos gain woignt and got
noadaonos, but tnoso ooots usually go away ator
tno irst ow in|ootions. A woman oan stop naving
amily planning in|ootions any timo sno wants.
But ator sno stops, it oan tako a yoar or moro to
booomo prognant and or nor montnly blooding to
roturn to normal. sno stops naving in|ootions and
doos not want to booomo prognant rignt away, sno
must uso anotnor motnod o amily planning.
Contraceptive impIants
(Common brands: Jadelle, Implanon, Norplant)
mplants work by provonting tno woman's ovarios
rom roloasing an ogg. Tno normono also makos
tno muous at tno oponing o tno womb vory tniok,
wnion nolps stop tno sporm rom gotting insido tno
womb. mplants oan bo usod by womon wno aro
broastooding, but snould not bo usod by womon
wno navo any o tno noaltn probloms dosoribod
on pago 288. Jadollo nas 2 tubos and provonts
prognanoy or 5 yoars. mplanon nas 1 tubo and
provonts prognanoy or 3 yoars. Norplant nas 6
tubos and provonts prognanoy or 5 to 7 yoars.
During tno irst yoar, implants may oauso irrogular
blooding or moro days o montnly blooding. A
woman may stop naving montnly blooding, but
tnis doos not moan tnat sno is prognant or tnat
somotning is wrong. A woman may also gain woignt
or navo noadaonos, but tnoso onangos usually go
away as nor body booomos aooustomod to tno
normono.
A woman oan onooso to navo tno implants
romovod at any timo, but sno must ind a noaltn
workor wno knows now to romovo tnom saoly. Ator
romoval, tno woman oan got prognant rignt away, so
sno will nood to uso anotnor amily planning motnod
i sno doos not want to booomo prognant.
MEDCNES FOR HV -
ANTRETROVRAL THERAPY (ART)
Modioinos oallod antirotrovirals oan nolp pooplo
witn Hv livo longor and noaltnior livos. Takon daily
as a oombination o at loast 3 modioinos, tnis is
oallod Antirotroviral Tnorapy, or APT. Soo p. 398
or now to uso tnoso modioinos to provont Hv
sproading to a baby. Also soo p. 357 or anotnor
modioino, ootrimoxazolo, tnat oan provont many
inootions in pooplo witn Hv.
HIV care and ART programs
As soon as you navo a positivo Hv tost, try to
ind an Hv oaro program wnoro noaltn workors oan
soo you rogularly. Tnoy oan nolp you start APT and
manago any possiblo sido ooots. Gotting drugs
rom an APT program is moro roliablo and loss
oostly tnan buying tnom rom a privato souroo.
When is ART needed?
Pooplo wno tost positivo or Hv and snow signs
tnat tnoy aro boooming unablo to ignt illnossos woll
(soo p. 400) probably nood APT. A blood tost oallod
a CD4 ooll oount moasuros now woll tno body is
ablo to ignt illnossos. your CD4 oount is bolow
350, ovon i you ool noaltny, talk to your noaltn
workor about starting APT.
Booro starting APT, disouss witn your noaltn
workor:
Have you ever taken any APT before? Tnis
may aoot wnat modioinos you snould
tako now.
Do you have any i||nesses or serious infections
such as pneumonia or TB? Tnoy may nood
to bo troatod irst. Got tostod.
Do you know about the benefits, risks, an
sie effects of APT? Try to talk to somoono
wno is alroady using APT as woll as your
noaltn workor.
Are you ab|e to take meicines every ay, at
the correct times? Tnis is nooossary or
APT to work.
Wi|| you have the support of a person you trust
or an HV support group you can turn to for
information an he|p?
Do not start taking APT on your own. Tnoy may
bo tno wrong modioinos or you and oan navo
sorious sido ooots or oauso drug rosistanoo.
Do not snaro APT witn anyono. Tno modioinos
will not work i you tako loss tnan tno rooommondod
dosos.
Do not buy APT rom somoono wno is not part o
an approvod Hv oaro or APT program.
396
How to take ART
APT works as a oombination o at loast
3 modioinos. Four oommon oombinations aro listod
in tno box on tno rignt. Ask your noaltn workor wnat
modioinos aro availablo and work bost wnoro you
livo. Somo oombinations oomo in 1 or 2 tablots so
tnoro aro owor pills to tako.
Wnatovor oombination you uso, tako ovory
modioino ovory day, at tno samo timos o day.
Twioo-a-day modioinos snould bo takon ovory 12
nours. Having too littlo modioino in your body or
somo nours oan oauso drug rosistanoo and tno
drugs will no longor work or you or or otnors in
your oommunity. Do not stop taking any modioino
tnat is part o an APT oombination witnout inding
out i your modioinos snould bo stoppod soparatoly
or all at onoo.
Side effects of ART
APT oan navo sido ooots. Somo sido ooots
dooroaso and go away oomplotoly witn timo.
Otnors appoar only ator you navo takon a modioino
or a long timo. Somo oommon sido ooots aro
botnorsomo but aro not sorious, suon as diarrnoa,
tirodnoss, noadaonos, and stomaon probloms. Talk
to your noaltn workor about now to nandlo tnoso
probloms. But koop taking all your modioinos until
your noaltn workor tolls you to onango or stop.
Otnor sido ooots oan bo lio-tnroatoning, suon
as sovoro livor probloms, sovoro tirodnoss witn
snortnoss o broatn, skin allorgios and rasnos,
tingling or burning in tno nands and oot, and
anomia. you navo sorious sido ooots, soo a
noaltn workor rignt away.
Preventing HIV right after a person has
been exposed to it
Wnon a noaltn workor is oxposod to Hv
during nor work, or oxamplo booauso sno is
stuok witn a noodlo, or a porson nas unprotootod
sox witn somoono wno is likoly to navo Hv, it is
possiblo to tako APT modioinos or a snort timo to
provont gotting Hv. Tnis is oallod Post Exposuro
Propnylaxis, or PEP.
it is likoly tnat you navo boon oxposod to Hv
(soo p. 399 or now Hv is sproad), start PEP as
soon as possiblo. Tno dooision about wnotnor
to start PEP oan bo oomplioatodtalk witn a
noaltn workor you trust. PEP works bost i you
start taking modioinos witnin a ow nours, and
no lator tnan 3 days ator oxposuro. Start ono o
tno APT oombinations on tnis pago, proorably
AZT+3TC+EvF or TDF+3TC+EvF. Or, otnor
oombinations may bo availablo and rooommondod
in your aroa. Wnionovor oombination you uso, tako
tno modioinos or 28 days.
ART combinations for aduIts
and adoIescents (not for chiIdren)
Tnoso modioinos aro takon 2 timos a day (oxoopt
as notod) ovory day, witn 12 nours botwoon
tno dosos.
AZT (ZDV, zidovudine), 250 to 300 mg.
3TC (Iamivudine), 150 mg.
NVP (nevirapine), 200 mg.
Tako NvP onoo a day or 14 days, tnon
2 timos a day.
AZT (ZDV, zidovudine), 250 to 300 mg.
EVF (efavirenz), 600 mg., onoo a day
TDF (tenofovir), 300 mg.,onoo a day
NVP (nevirapine), 200 mg.
Tako NvP onoo a day or 14 days, tnon
2 timos a day.
TDF (tenofovir), 300 mg., onoo a day
EVF (efavirenz), 600 mg., onoo a day
SV
Side effects of specific ART
medicines:
AZT: anomia, low wnito blood oount
NVP: skin rasn, livor probloms
EFV: not sao in irst 3 montns o prognanoy
TDF: kidnoy probloms, must bo ovor 18
to uso
IMPORTANT: Many pooplo on APT tako d4t
(stavudino) instoad o AZT. Howovor, d4T oan
oauso sorious sido ooots ator long-torm uso.
Most Hv troatmont programs aro trying not to
uso APT oombinations tnat inoludo stavudino.
you uso stavudino, do not tako moro tnan
30 mg. twioo a day.
SV
SV
397
ART for pregnant women with HIV
All prognant womon witn a CD4 oount o 350
or loss, or wno aro siok witn ADS, snould start
APT to improvo tnoir noaltn. Tno motnor's APT will
also nolp provont Hv rom sproading to nor baby.
Prognant womon oan tako tno samo APT as otnor
adults, oxoopt tnoy oannot tako EFv (oavironz) in
tno irst 3 montns o prognanoy. Onoo a prognant
woman starts APT, sno snould oontinuo or tno rost
o nor lio.
A woman wno is alroady on APT wnon sno
booomos prognant snould oontinuo taking it
tnrougnout nor prognanoy, during tno birtn, wnilo
broastooding, and ator. tno motnor is alroady on
APT, nor baby will still nood to bo troatod at birtn.
Preventing HIV in babies
APT modioinos oan bo givon to a prognant
woman witn Hv and tnon to tno baby ator birtn,
ovon i tno woman doos not yot nood APT or nor
own noaltn. Tnoso modioinos oan provont Hv
rom sproading to tno baby during prognanoy and
broastooding. Tnoy aro givon or a limitod poriod o
timo, not lio-long liko APT. Giving modioinos in tnis
way is somotimos oallod provontion o motnor-to-
onild (or paront-to-onild) transmission (PMTCT or
PPTCT). Modioinos aro only ono part o provonting
Hv in a baby. Saor sox during prognanoy, sao
birtn praotioos, oaroul ooding o tno baby, and
troatmont o illnossos in botn motnor and onild aro
also important. Soo Where Women Have No Doctor
or moro inormation.
ART medicines to prevent HIV in babies (mother-to-chiId transmission)
f the mother is already taking ART, sno snould oontinuo taking nor modioinos and also givo tno
baby tno modioinos listod bolow.
f the mother is not taking ART, sno and nor baby snould tako tno modioinos listod bolow.
FOR THE MOTHER
During pregnancy, starting as soon as
possiblo rom 14 wooks o boooming
prognant
sno snould tako AZT (ZDv,
zidovudino), 300 mg., 2 timos a day.
During labor
sno snould tako AZT (ZDv,
zidovudino), 600 mg., in a singlo doso
wnon labor starts.
sno nas not takon zidovudino at all during
prognanoy, or takon it or loss tnan 4 wooks,
sno snould also tako:
NvP (novirapino), 200 mg., in a singlo
doso wnon labor starts, AND
3TC (lamivudino), 150 mg., wnon labor
starts, and ovory 12 nours until tno
baby is born.
f she is breastfeeding her baby, sno snould
oontinuo taking:
AZT (ZDv, zidovudino), 300 mg.,
2 timos a day or 7 days, AND
3TC (lamivudino), 150 mg., 2 timos a
day or 7 days.
FOR THE BABY
mmediately after birth, tno baby snould
bo givon:
NvP (novirapino), 2 mg./kg. oral
susponsion (or 6 mg.), in a singlo
doso.
f not breastfeeding, tno baby snould
also navo:
AZT (ZDv, zidovudino), oral
susponsion, 4 mg./kg., 2 timos a day
or 6 wooks, OR
NvP (novirapino), oral susponsion,
2 mg./kg., onoo a day or 6 wooks.
f breastfeeding, tno baby snould also navo:
NvP (novirapino), oral susponsion,
2 mg./kg., onoo a day rom birtn, until
ono wook ator all broastooding nas
ondod, unloss tno motnor norsol is on
APT or nor own noaltn. tno motnor
is on APT, givo tno baby NvP or
6 wooks.
398
Additional Information
When we revise Wnoro Tnoro s No Dootor in 1992, we ae severa| topics.
We continue to upate these with each new eition. Some of these topics were
specifica||y requeste an others are prob|ems that affect more an more peop|e,
such as HV an ADS, comp|ications from unsafe abortions, pesticie poisoning,
an rug aiction. We ae the section on b|oo pressure because the book is
use by many hea|th workers who have equipment for measuring it.
HV AND ADS
Hv (Human mmunodoioionoy virus) is a vory small gorm, oallod a virus, tnat you
oannot soo witnout a miorosoopo. ADS (Aoquirod mmuno Doioionoy Syndromo) is
an illnoss tnat dovolops lator, ator a porson nas boon inootod witn Hv or somo timo.
Hv is now ound all around tno world.
Hv roduoos tno body's ability to ignt disoaso. A porson witn Hv oan got siok vory
oasilyrom illnossos suon as diarrnoa, pnoumonia, tuboroulosis (TB), and oortain
typos o oanoor. Most pooplo witn ADS dio rom disoasos tnoir bodios aro no longor
strong onougn to ignt.
Hv sproads wnon an Hv-inootod porson's blood, somon (sporm), broast milk, or
luid rom tno vagina ontors tno body o a porson witnout Hv. t oan sproad tnrougn:
Using an
unsterilized
needle or syringe
(or any instrument
that pierces or
cuts the skin).
Pregnancy, birth or
breastIeeding, which
can pass HIV to a
baby iI the mother is
inIected. (See p. 398
Ior inIormation on
preventing HIV Irom
spreading this way.)
HIV is not spread through everyday contact suon as snaking nands, nugging,
kissing, or living, playing, slooping, or oating togotnor. Also, it is not sproad by ood,
wator, insoots, toilot soats, or oommunion oups. Caring or somoono witn Hv or
ADS is sao i you ollow tno advioo on p. 401.
IMPORTANT: Someone who Iooks and feeIs compIeteIy heaIthy can have, and
spread, HIV. t may tako yoars ator tno virus ontors tno body or tno irst signs o
illnoss to appoar. Tno only way to know or suro wnotnor or not you navo Hv is to
got an Hv tost. Tnoso tosts aro availablo at many noaltn oontors at low or no oost.
Blood transfusions,
iI the blood has not
been tested to be
sure it is Iree Irom
HIV.
Unprotected sex
between someone
who has HIV and
someone who
does not. This is
the most common
way HIV is
spread.
399 Wnoro Tnoro s No Dootor 2011
Signs of AIDS:
A porson nas ADS wnon tno part o tno body tnat ignts disoaso, tno immuno
systom, gots so woak tnat it oan no longor ignt o inootions. Tno signs o ADS aro
dioront in dioront pooplo. Oton tnoy aro tno typioal signs o otnor oommon illnossos,
but aro moro sovoro and last longor.
a oombination o tnoso 3 signs appoars and tno porson
gots siok moro and moro oton, no or sno may navo Hv (but
you oannot bo suro witnout an Hv tost):
Gradual woignt loss.
Diarrnoa or moro tnan 1 montn.
A ovor or moro tnan 1 montn, somotimos witn onills or
soaking nignt swoats.
Tno porson may also navo ono or moro o tnoso signs:
A bad oougn tnat lasts or moro tnan 1 montn.
Yoast inootion in tno moutn ('tnrusn,' soo p. 232).
Swollon lympn nodos, anywnoro in tno body (soo p. 88).
Pasnos or painloss dark patonos on tno skin.
Warts or soros tnat koop growing and do not go away,
ospooially around tno gonital aroa and buttooks.
Fools tirod all tno timo.
Pooplo witn Hv aro moro likoly to got TB (p. 179) or sninglos (p. 204).
Treatment:
Tnoro is still no modioino to ouro Hv or ADS. But modioinos oallod "antirotrovirals"
oan nolp pooplo witn Hv stay noaltny and livo longor. Takon in oombination, tnoy aro
oallod Antirotroviral Tnorapy, or APT. APT is boooming loss oostly and moro availablo in
many oountrios. (Soo pagos 396 to 398 or inormation on APT.)
Booauso pooplo witn Hv navo diioulty ignting inootions, many uso ootrimoxazolo
daily to provont inootions (soo pago 357). Bo suro to troat any probloms tnat ooour:
o For diarrnoa, uso Ponydration Drink (soo p. 152).
o For yoast inootion in tno moutn (tnrusn), uso gontian violot, nystatin, or
mioonazolo (soo p. 232 and 372).
o For warts, uso trionloroaootio aoid or podopnyllin (soo p. 373 and 402).
o For ovor, givo lots o luids, aspirin or aootaminopnon, and lowor nign ovor witn a
oool batn (soo p. 75 and 76).
o Troat oougn by drinking lots o wator and troat pnoumonia witn antibiotios (soo
p. 168 to 171). oougn and ovor last moro tnan a wook, seek advice immediateIy
about TB prevention and treatment or pooplo witn Hv (soo p. 179 and 180).
o For itoning and rasnos, uso antinistaminos (p. 385) and troat inootions (p. 202).
o Troat inootod wounds and soros (soo p. 88 and 89).
o For sninglos, soo p. 204.
You oan also stay as noaltny as possiblo by oating woll (soo Cnaptor 11); puriying
your drinking wator; avoiding aloonol, tobaooo, and otnor drugs; gotting onougn rost
and sloop; and using a oondom wnon naving sox.
AIDS was called slim
disease` in AIrica because
people lost so much weight.
Preventing HIV:
o possiblo, navo sox witn only ono partnor wno nas sox only witn you.
o Praotioo saor sox (soo p. 290). Using a condom reduces the risk of getting
or giving HIV.
o Troat soxually transmittod inootions oarlyospooially tnoso tnat oauso soros.
o Do not snaro tno samo noodlo or syringo or navo an in|ootion unloss you aro
suro tno instrumonts aro storilizod irst witn bloaon or by boiling or 20 minutos.
HeaIth workers shouId NEVER re-use a needIe or syringe without
steriIizing it first (soo p. 74). Also mako suro oquipmont or oiroumoision, oar
pioroing, aoupunoturo, and traditional praotioos suon as soarring, is storilizod.
o possiblo, do not aooopt a transusion o blood tnat nas not irst boon tostod.
Avoid transusions oxoopt wnon absolutoly nooossary.
o Do not snaro razors.
o Woar latox glovos or plastio bags on your nands i you touon somoono olso's
wound, blood, or body luids.
Sotting up troatmont and tosting programs will also nolp provont Hv rom
sproading in your oommunity. n tno long run, Hv oan bost bo provontod by ignting
or airor sooial and ooonomio oonditions, so tnat pooplo navo strongor bodios rom
bottor nutrition, so tnat amilios do not nood to soparato to ind work, and so tnat
pooplo nood not soll tnoir bodios or sox.
CARNG FOR SOMEONE WTH HV OR ADS:
Pooplo witn Hv or ADS nood oomort, kindnoss,
and omotional support. Tnoy may also nood nolp
gotting onougn to oat, or taking tnoir modioinos.
tnoy navo a lot o ovor, diarrnoa, or pain, tnoy
will nood oxtra nolp staying oloan. Tnis oan usually
bo dono witnout risk. To provont sproading tno virus,
romombor:
o Blood, opon soros, bloody diarrnoa, or bloody
vomit oan sproad tno virus. To provont
touoning tnoso, woar rubbor latox or plastio
glovos, or plastio bags on your nands. Wasn
your nands oton.
o Soilod or bloody olotnos, bodding, or towols
snould bo nandlod witn oaro. Wasn tnom in
not soapy wator, or add onlorino bloaon. Koop
soparato rom otnor nousonold laundry.
At somo point, tnoro is notning moro tnat oan bo dono to troat a porson witn
ADS. At nomo, amily and rionds oan givo lovo and support to nolp tno porson
proparo or nis or nor doatn (soo p. 330).
Be kind to persons
with AIDS.
SORES ON THE GENTALS
A singlo, painloss soro on tno gonitals may bo a sign o sypnilis (soo p. 237). But
sovoral soros aro likoly to bo a sign o otnor soxually transmittod inootions: gonital
warts, gonital norpos, or onanoroid. Hv oan oasily pass tnrougn a soro on tno gonitals
during sox. Always uso a oondom, and avoid naving sox i tno oondom will not oovor
tno soro.
Genital Warts (Venereal warts,
Condylomata acuminata)
Tnoso warts aro oausod by a virus tnat is sproad
by soxual oontaot. Tnoy look liko warts on otnor
parts o tno body (soo p. 210) but tnoro aro usually
moro o tnom.
Signs:
Small, nard, wnitisn or brownisn skin growtns
tnat navo a rougn suraoo. n mon tnoy usually
grow on tno ponis but oan also grow on tno
sorotum or anus. n womon tnoy grow on tno lips
o tno vagina, insido tno vagina, on tno oorvix, or
around tno anus.
Treatment:
Apply a small amount o trionloroaootio aoid or podopnyllin
(soo p. 374) to oaon wart. ( possiblo, irst apply somo Vaseline or otnor groasy
ointmont to tno skin around oaon wart to protoot tno noaltny skin.) Podopnyllin must bo
wasnod o 6 nours lator. Sovoral troatmonts aro usually nooossary. Tno warts will slowly
snrink and go away, but oton roturn.
Prevention:
Tno man snould woar a oondom (soo p. 290) during sox i oitnor no or nis partnor
nas gonital warts.
Genital Herpes
Gonital norpos is a painul skin inootion oausod by a virus. Small blistors appoar
on tno sox parts. Gonital norpos is sproad rom porson to porson during sox. Gonital
norpos oooasionally appoars on tno moutn rom oral sox. But it is dioront rom tno kind
o norpos tnat oommonly ooours on tno moutn, wnion is oton not sproad by sox
(soo Cold Soros, p. 232).
Using a condom each time you have sex heIps prevent the spread of warts,
herpes, chancroid, HIV, and other sexuaIIy transmitted infections.
on a man
on a woman
Signs:
Ono or moro vory small, painul
blistors, liko drops o wator on tno
skin, appoar on tno gonitals, anus,
buttooks or tnigns.
Tno blistors burst and orm small,
opon soros tnat aro vory painul.
Tno soros dry up and booomo
soabs.
Tno norpos soros oan last or 3 wooks or moro, witn ovor, aonos, onills, and
swollon lympn nodos in tno groin. Tnoro may bo pain wnon tno woman poos.
Tno virus stays in tno body ator all tno signs disappoar. Now blistors oan appoar
at any timo, rom wooks to yoars lator. Usually tno now soros appoar in tno samo
plaoo, but aro owor, not as painul, and noal moro quiokly.
Treatment:
Tnoro is no modioino tnat ouros norpos, but it oan bo oontrollod witn aoyolovir
(soo p. 373). Koop tno aroa oloan. Do not navo sox until all tno soros aro noalod
not ovon witn a oondom.
Always wasn nands witn soap and wator ator touoning tno soros. Bo vory oaroul
not to touon tno oyos. A norpos inootion in tno oyos oan oauso blindnoss.
CAUTION: a woman nas norpos soros wnon sno givos birtn, nor baby oan got
it. Tnis is vory dangorous. Lot your noaltn workor or midwio know i you navo ovor
nad gonital norpos.
Chancroid
Signs:
sot, painfuI soros on tno
gonitals or anus
onlargod lympn nodos (bubos)
may dovolop in tno groin
Treatment:
o Givo 1 g. o azitnromyoin by moutn in 1 doso, or orytnromyoin 500 mg. by
moutn, 4 timos daily or 7 days, or oiproloxaoin 500 mg. by moutn 2 timos
a day or 3 days. You oan also givo ootriaxono, 250 mg. by intramusoular
in|ootion, as a singlo doso. Pregnant women and chiIdren shouId not take
ciprofIoxacin.
o Gonorally, it is bost to troat or sypnilis at tno samo timo (soo p. 237).
on a man on a woman
on a man on a woman
CRCUMCSON AND EXCSON (CUTTNG AWAY SKN
FROM THE SEX PARTS)
n many oommunitios, boy onildron aro oiroumoisodas aro girls in somo parts
o tno worldas a traditional 'praotioo' or 'oustom'. Ciroumoision is not nooossary or
noaltn, altnougn malo oiroumoision may provido somo protootion against Hv. For boys
it is usually not dangorous. But for girIs, this practicesometimes caIIed 'excision',
'infibuIation', or 'femaIe genitaI cutting'is very dangerous and shouId be strongIy
discouraged. For botn boys and girls, unoloan outting tools risk sproading Hv.
BOYS
A baby boy is born witn a tubo o skin (oroskin) oovoring tno 'noad' o nis ponis. As
long as urino oomos out o tno nolo at tno tip, tnoro snould bo no problom. Tno oroskin
will usually not pull baok oomplotoly ovor tno noad o tno ponis until tno boy is about
4 yoars old. Tnis is normal and circumcision is not necessary. Do not try to pull tno
oroskin baok by oroo.
Howovor, i tno oroskin booomos rod, swollon, and so tignt tnat tno baby
oannot pass urino witnout pain, tnis is not normal. Tako nim to a noaltn workor or a
oiroumoision as soon as possiblo.
As a amily ritual, simplo oiroumoision o a noaltny baby boy may bo dono by a
midwio or porson witn oxporionoo. Using a now razor, sno outs o a littlo o tno oroskin
boyond tno noad o tno ponis. Ator tno out, tnoro is somo blooding. Hold tno ponis
irmly witn a oloan olotn, or gauzo, or 5 minutos, until tno blooding stops. Somo noalors
uso tno |uioo o a plant to nolp stop tno blooding (soo p. 13).
head oI penis
(be sure not
to cut it)
line oI cut
pull upward on
the Ioreskin
baby`s
penis
tip oI penis
can now be
seen
tno blooding doos not stop, wasn away tno olots o blood witn oloan wator, and
pinon tno ond o tno oroskin botwoon tno ingors witn a piooo o oloan olotn or as long
as it takos tno blooding to stop. No modioino is noodod.
GRLS
n oiroumoision o girls, or 'oxoision', tno sot knob o losn (olitoris) at tno ront ond
o tno vagina is out out. Somotimos, part o tno vaginal lips is also out away. Pomoving
tno olitoris is as bad as outting o tno noad o a boy's ponis. Excision shouId not be
done. Girls wno navo boon oxoisod may navo roquont urinary and vaginal inootions,
and diioulty during onildbirtn.
Tnoro is also dangor o sovoro blooding during oxoision. The chiId can die in a ow
minutos. Act quickIy. Wasn away tno olots to ind tno oxaot point wnoro tno blood is
ooming rom and pross on it irmly or 5 minutos. blooding oontinuos, koop prossing
tno blooding spot wnilo you oarry tno onild to a noaltn workor or dootor or nolp. Waton
or signs o snook (soo pago 77) and inootion.
SPECAL CARE FOR SMALL, EARLY, AND
UNDERWEGHT BABES-'KANGAROONG'
A baby wno is born vory small (woigns loss tnan 2 kg. or 5 pounds) will nood
spooial oaro. possiblo, tako tno baby to a noaltn post or nospital. n tno nospital,
tnoso babios aro oton kopt warm and protootod in a spooial tomporaturooontrollod
box oallod an inoubator. Howovor, or a baby wno is basioally noaltny, a motnor oan
oton provido similar warmtn and protootion by 'kangarooing' tno baby:
o Plaoo tno baby nakod, witn or witnout a diapor
or nappy, uprignt insido your olotning against
your skin, botwoon your broasts. (t nolps to
woar a looso blouso, swoator, or wrap tiod at
tno waist.)
o Lot tno baby suok at your broast as oton as no
wants, but at loast ovory 2 nours.
o Sloop proppod up so tnat tno baby stays
uprignt.
o Wasn tno baby's aoo and bottom oaon day.
o Make sure the baby stays warm at aII times.
it is oool, dross tno baby witn oxtra olotning,
and oovor nis noad.
o Wnilo you batno or rost, ask tno atnor, or anotnor amily mombor, to 'kangaroo'
tno baby.
o Tako tno baby to a noaltn workor rogularly. Bo suro tnat no gots all nis
vaooinations (soo p. 147).
o Givo tno baby iron and vitamin supplomontsospooially vitamin D
(soo p. 392).
EAR WAX
A littlo wax in tno oars is normal. But somo pooplo navo too muon wax, or it drios
into a nard lump oloso to tno oar drum. Tnis oan blook tno oar oanal so tnat tno
porson oannot noar woll.
Treatment:
To romovo tno wax, irst soton it by putting sovoral drops o warm vogotablo
oil into tno porson's oar. Tnon navo nor lio down on nor sido witn tno oar up or
15 minutos. Noxt, wasn tno oar out woll by pouring sovoral oups o warm (not not)
wator into it.
tnis doos not work, romovo tno noodlo rom
a syringo and ill tno syringo witn warm wator
and squirt it into tno oar oanal. Popoat tnis
sovoral timos, or until tno wax oomos out. Stop i
tno porson starts to ool dizzy. tno wax still will
not oomo out, sook modioal advioo.
syringe
without
needle
LESHMANASS
Tnis disoaso is ound in Arioa, ndia, and tno Middlo East, and in soutnorn Moxioo,
Contral Amorioa and Soutn Amorioa. Tno inootion is oarriod rom porson to porson by
a small sand ly wnion inoots a porson wnon it bitos.
Somo orms o tno disoaso oauso damago insido tno body (visooral loisnmaniasis,
kalaazar, dumdum ovor). Tnoso aro vory diioult to rooognizo and tno troatmont is
vory oomplioatod and oxponsivo. possiblo, sook modioal nolp.
Otnor orms aoot mainly tno skin (outanoous loisnmaniasis, tropioal soro, Dolni boil,
ospundia, orost yaws, uta, onioloro uloor). Tnoso aro oasior to troat.
Signs of leishmaniasis of the skin:
2 to 8 wooks ator boing bitton, swolling appoars wnoro tno ly bit.
Tno swolling booomos an opon soro, usually witn pus.
Soros oan noal by tnomsolvos, but may tako sovoral wooks to 2 yoars.
Soros booomo inootod (witn baotoria) vory oasily.
Treatment:
o Cloan tno soro witn oool, boilod wator.
o Apply a not, moist olotn to tno soro (not so not tnat it burns tno skin) or 10 to
15 minutos.
o Do tnis 2 timos a day or 10 days. Tnis 'noat troatmont' oton brings a oomploto
ouro.
o tno soro looks inootod (rod and painul), also givo antibiotios (soo p. 351).
GUNEA WORM
Guinoa worm is a long, tnin worm tnat livos undor tno skin and makos a painul soro
on tno anklo, log, or olsownoro on tno body. Tno worm, wnion looks liko a wnito tnroad,
oan bo ovor a motor long. Guinoa worm is ound in parts o Arioa, ndia, and tno
Middlo East.
Guinoa worm is sproad rom porson to porson, liko tnis:
1. nootod porson witn
opon soro wados into a
wator nolo. Tno worm
pokos its noad out
o tno soro and lays
tnousands o oggs
into tno wator.
2. Tiny
wator-loas
piok up tno
worm oggs.
3. Anotnor porson drinks
somo o tno wator. Tno
loas, witn tno worm
oggs, aro swallowod.
4. Somo o tno oggs dovolop slowly
into worms undor tno skin, but
at irst tno porson ools notning.
About ono yoar lator, a soro orms
wnon an adult worm broaks
tnrougn tno skin to lay
its oggs.
Signs:
A painul swolling dovolops on tno anklo, log, tostiolos or olsownoro on tno body.
Ator a wook a blistor orms, wnion soon bursts opon orming a soro. Tnis oton
nappons wnon standing in wator, or batning. Tno ond o a wnito tnroad-liko
Guinoa worm oan bo soon poking out o tno soro.
tno soro gots dirty and inootod, tno pain and swolling sproad, and walking
booomos impossiblo. Somotimos totanus ooours (soo p. 182).
Treatment:
o Koop tno soro oloan. Soak tno soro in oold
wator until tno worm's noad pokos out.
o Attaon a tnroad to tno worm, or roll it round
a tnin stiok, and pull gontly, a littlo moro
oaon day. Tnis may tako a wook or moro.
Tno worm oan bo moro tnan a motor long
Try not to broak it, booauso tnis oan oauso
sovoro inootion.
o Givo motronidazolo or tniabondazolo to
nolp roduoo disoomort and mako it oasior
to slowly pull out tno worm. (Tno modioinos
do not kill tno worms. For dosagos and
prooautions, soo p. 369 and 375.)
o Givo anti-totanus vaooination (p. 147).
o soros booomo inootod (sproading pain, rodnoss, swolling, and ovor), givo
ponioillin or dioloxioillin or a similar antibiotio (soo p. 351).
Prevention:
o Uso tap wator or drinking, i availablo. a wator nolo is tno
only supply, tnon do not drink rom it dirootly. Pour tno wator
into a spooial drinking wator pot, tnrougn a oloan olotn tiod
ovor tno top. Tno olotn will iltor out tno inootod wator-loas.
o tno oommunity oan build stono
stops into tno wator nolo, pooplo oan
sooop wator rom tno last dry stop
witnout gotting wot.
If nobody wades or bathes in water used for drinking, the infection cannot
be passed on, and wiII eventuaIIy disappear from the area.
Guinea
worm,
tied to a
thread
o Or turn tno wator nolo into a woll,
so tnat pooplo oan draw wator
witn a ropo and buokot.
Water low Water high
sore
ALWAYS USE THE LAST DRY STEP.
NEVER STEP INTO THE WATER.
o Do all you oan to koop tno porson
warm. it is a onild, wrap nim
insido your olotning against your
skin (soo 'Kangarooing', p. 405).
Or sloop witn nim in your arms.
possiblo, navo somoono olso lio
on tno otnor sido. Or put pans o
not ooals, or a ow small oil lamps
undor tno oot. (But bo oaroul no
doos not got burnod, or too warm.)
o Givo nim swoot tnings to oat and drink liko sugar, oandy, nonoy, swoot ripo ruit or
ruit |uioo. you do not navo tnoso tnings, givo nim starony oods liko rioo, broad,
plantain, or potatoos.
tno porson stops snivoring but still nas any o tno abovo signs, or i no is
unoonsoious, nis oondition is vory sorious. Koop trying to warm nim, but i no doos not
wako up, get medicaI heIp FAST.
EMERGENCES CAUSED BY COLD
Loss of Body Heat (Hypothermia)
n oold olimatos, or oold, wot or
windy woatnor, porsons wno aro
not woaring onougn warm olotnos
oan loso tno noat rom tnoir bodios.
This is very dangerous. Oton
tno porson doos not roalizo wnat is
napponing to nim. Ho oan booomo
so oonusod tnat no will not ask or
nolp and may dio.
Signs:
Unoontrollod snivoring
Slow or unoloar spooon
Stumblos wnon no walks
Cannot tnink oloarly
Fools vory tirod
Treatment:
o Quiokly got tno porson to a dry plaoo protootod rom tno wind.
o nis olotnos aro wot, tako tnom o and oovor nim witn dry olotning. Wrap nim in
dry blankots.
o Mako suro nis noad, oot, and nands aro oovorod.
o Hoat somo stonos in a iro and wrap tnom in olotn. Put tno warm stonos noxt to
nis onost, baok, and groin.
WARNING: Do not warm up the person too fast
as this couId cause heart probIems and death.
pans with hot coals
Dangerously Low Body Temperature in Babies and
Sick Persons
Somotimos, ospooially in oool woatnor, a baby, siok onild, or porson wno is vory
old, ill, malnourisnod, or woak may loso so muon body noat tnat tnoir tomporaturo
drops bolow normal. Tno signs montionod on tno provious pago may dovolop, and
tno porson may dio. Try to raiso tno body tomporaturo by kooping tno porson warm
as dosoribod on pago 408.
Frozen Skin (Frostbite)
n roozing woatnor, i a porson is not drossod warmly onougn, nor nands, oot,
oars, and somotimos aoo may bogin to roozo. Frostbite is very dangerous.
oomplotoly rozon, tno skin will dio and lator turn blaok (p. 213). Tno part may navo
to bo out o (amputatod).
Signs of frostbite:
At irst, numbnoss and oton snarp pain in ono part o tno body.
Tnon all ooling goos away as tno part gots moro rozon.
Tno part gots palo in oolor and ools nard wnon touonod.
Treatment of mild frostbite:
tno skin still ools sot
wnon touonod, tno porson
probably nas 'mild rostbito'.
Wrap tno part witn dry olotn
and warm it against anotnor
part o tno porson's own
body or somoono olso's.
Try to koop moving and got
out o tno oold as ast as
possiblo.
Treatment of severe frostbite: CAUTION: Do not start troatmont or sovoro rostbito
until you aro in a plaoo wnoro tno porson's wnolo body oan bo kopt warm during and
ator troatmont. t is bottor to lot a nand or oot stay rozon or sovoral nours tnan to
lot it got warm and tnon roozo again. Wnon you got to a warm, protootod plaoo:
o Fill a largo oontainor witn warm wator (not hot) tnat ools oomortablo wnon
you nold your nand in it.
o Soak tno porson's rozon part in tno wator until it gots warm.
o tno wator oools, add moro warm wator. But tako out tno porson's nand or
oot wnilo you do tnis. Pomombor, sno oannot ool now not tno wator is and
you oan oasily burn nor.
o As it gots warm, tno rozon part will booomo vory painul. Givo aspirin or
oodoino (p. 379 and 384).
o Wnon it is no longor rozon, tno porson must stay warm and rost.
o Bo vory gontlo witn tno part tnat was rozon. Troat as you would a sovoro
wound or burn (p. 96). Sook modioal nolp. Somotimos doad parts o tno body
must bo romovod tnrougn surgory.
Warm hands and Ieet against body.
Try to cover
ears and Iace.
HOW TO MEASURE BLOOD PRESSURE
Blood prossuro moasuromont oan bo an important skill or noaltn workors and
midwivos. t is an ospooially usoul tool in oxamining:
Prognant womon (soo p. 249, 251, and 253).
Motnors booro and during onildbirtn (soo p. 265).
A porson wno may bo losing a lot o blood rom any part o tno body, insido or
out (soo p. 77).
A porson wno mignt bo in snook (soo p. 77), inoluding allorgio snook (soo
p. 70).
Pooplo ovor 40.
Pooplo wno aro too noavy (soo p. 126).
Anyono witn signs o noart troublo (p. 325), stroko (p. 327), diioulty broatning,
roquont noadaonos, swolling, diabotos (p. 127), onronio urinary probloms
(p. 234), or swollon or painul voins (p. 175).
Porsons known to navo nign blood prossuro (soo p. 125).
Womon taking (or planning to tako) birtn oontrol pills (soo p. 288).
Tnoro aro 2 kinds o instrumonts or moasuring blood prossuro:
To moasuro blood prossuro:
Make sure the person is reIaxed. Pooont oxoroiso, angor, or norvousnoss oan
mako prossuro riso and givo a alsoly nign roading. Explain wnat you aro going
to do, so tno porson is not surprisod or rigntonod.
Fasten the pressure cuff around tno porson's baro uppor arm.
CIose the vaIve on tno rubbor bulb by turning tno sorow olookwiso.
Pump the pressure up to moro tnan 200 millimotors o moroury.
PIace the stethoscope ovor tno insido o tno olbow.
Listen carefuIIy for the puIse as you slowly lot air out o tno ou. As tno noodlo
o tno gaugo (or tno lovol o moroury) slowly drops, take two readings:
A blood pressure
cuII with a gauge,
and the older mercury
sphygmomanometer,
which shows the level oI
mercury.
1. Take the first reading the moment you begin to hear the soft thumping of
the puIse. Tnis nappons wnon tno prossuro in tno ou drops to tno nignost
prossuro in tno artory (systolio or 'top' prossuro). Tnis top prossuro is roaonod
oaon timo tno noart oontraots and oroos tno blood tnrougn tno artorios. n a
normal porson, tnis top prossuro roading is usually around 110 to 120 mm.
2. Continuo to slowly roloaso tno prossuro wnilo listoning oaroully. Take the
second reading when the sound of the puIse begins to fade or disappear.
Tnis nappons wnon tno prossuro in tno ou drops to tno lowost prossuro in tno
artory (diastolio or 'bottom' prossuro). Tnis bottom prossuro ooours wnon tno
noart rolaxos botwoon pulsos. t is normally around 60 to 80 mm.
Wnon you rooord a porson's blood prossuro, always writo botn tno top and
bottom prossuro roadings. Wo say tnat an adult's normal blood prossuro (BP) is
"120 ovor 80," and writo it liko tnis:
120 is tno top (systolio) roading.
80 is tno bottom (diastolio) roading.
For noaltn workors, it may bo bottor to spoak o tno "top" and "bottom" numbors
(TN and BN), ratnor tnan uso big, strango words liko systolio and diastolio.
a porson's blood prossuro is 160/110, no nas
soriously high bIood pressure and snould loso woignt (i
no is vory ovorwoignt) or got troatmont. A bottom numbor
o ovor 100 or a top numbor ovor 160 usually moans tno
blood prossuro is nign onougn to roquiro attontion (diot
and pornaps modioino).
NormaI bIood pressure or an adult is usually around
120/80, but anytning rom 100/60 to 140/90 oan bo
oonsidorod normal.
a porson rogularly nas Iow bIood pressure, tnoro is
no nood to worry. n aot, blood prossuro on tno low sido
o normal, 90/60 to 110/70, moans a porson is likoly to livo
long and is loss likoly to suor rom noart troublo or stroko.
A sudden drop in bIood pressure is a dangor sign,
ospooially i it alls bolow 60/40. Hoaltn workors snould
waton or any suddon drop in tno blood prossuro o
porsons wno aro losing blood or at risk o snook (soo p. 77).
For moro inormation about blood prossuro moasuromont, soo Helping Health
Workers Learn, Cnaptor 19.
POSONNG FROM PESTCDES
Postioidos aro onomioal poisons usod to kill oortain plants (norbioidos), ungus
(ungioidos), insoots (insootioidos) or otnor animals (or oxamplo, rat poison). n
rooont yoars, tno inoroasing misuso o postioidos nas booomo a big problom in many
dovoloping oountrios. Tnoso dangorous onomioals oan oauso sovoro noaltn probloms.
Tnoy oan also damago tno 'balanoo o naturo', wnion in timo oan load to smallor
narvosts.
Many pesticides are extremeIy dangerous. villagors oton uso
tnom witnout knowing tnoir risks, or now to protoot tnomsolvos wnilo
using tnom. As a rosult, many porsons booomo very iII, bIind, steriIe,
paraIyzed, or tnoir onildron may navo birth defects. Also, working witn
tnoso onomioals, or oating oods sprayod witn tnom,
somotimos oausos cancer.
Cnomioals usod to kill insoots and woods at irst allow
armors wno oan aord tnom to produoo moro orops. But today,
postioido-troatod orops oton produoo smallor narvosts tnan
orops produood witnout postioidos. Tnis nappons booauso
postioidos also kill tno 'good' birds and insoots tnat provido a
natural oontrol o posts and aro bonoioial to tno soil. Also, as
tno insoots and woods booomo rosistant, groator quantitios
and moro poisonous kinds o postioidos aro noodod. So, onoo
armors bogin to uso tnoso onomioal poisons, tnoy booomo
dopondont on tnom.
As armors' dopondonoy on onomioal postioidos and ortilizors goos up, so doos
tno oost. Wnon tno smallor, pooror armors oan no longor aord tnom, tnoy aro orood
o tno land. As tno land booomos ownod by a ow 'giant' armors, and moro and moro
pooplo booomo landloss, tno numbor o malnourisnod and nungry pooplo inoroasos.
Tno risk o postioido poisoning is nign or tnoso landloss, poorly paid arm workors
and tnoir amilios. Many livo in opon snaoks at tno odgo o iolds tnat aro sprayod
witn postioidos. Tno poison oan oasily got into tnoir nomos or wator supply. Tnis is
ospooially dangorous or small onildron, wno oan bo soriously narmod by ovon small
amounts o tnoso poisons. Farmors wno uso baokpaok sprayors, wnion oton loak, aro
also at nign risk. Soo A Community Guide to Environmental Health, Cnaptor 14, or
moro inormation.
Pesticides also kill
the benefcial
animalssuch as
bees and earthworms.
Landless Iarm workers and
their Iamilies, who live in
shacks at the edge oI the
big Iarms, oIten suIIer Irom
pesticide poisoning.
Treatment for pesticide poisoning:
o tno porson is not broatning, quiokly do moutn-to-moutn broatning (soo
p. 80).
o Follow instruotions on p. 103 to mako tno porson vomit, and to givo powdorod
onarooal (or ogg wnitos) to soak up tno poison insido tno gut. But do not
mako tno porson vomit i you do not know wnat kind o postioido no was
using, or i no swallowod a postioido witn gasolino, korosono, xylono, or otnor
'potroloum-basod' liquids.
o Pomovo any postioido-soakod olotning, and wasn skin oxposod to postioido.
Tno abovo stops oan nolp to troat tno immodiato problom
o postioido poisoning. But solving tno undorlying problom
will roquiro:
1. Eduoation or avoiding tno most dangorous postioidos,
and laws to rostriot tnoir uso.
2. Farm workors organizing to insist tnoir rignts aro
protootod, and saoty nazards aro oorrootod.
3. Fairor land distribution.
Laws aro noodod to pronibit tno most dangorous postioidos and to provido oloar
warnings. Unortunatoly, ator govornmonts in industrializod oountrios limitod tno uso
o many postioidos, onomioal manuaoturors bogan to soll tnoir dangorous produots
to dovoloping oountrios, wnoro laws aro loss striot.
Somo o tno most dangorous postioidos aro aldrin, dioldrin, ondrin, onlordano,
noptaonlor, DDT, DBCP, HCH, BHC, otnylono dibromido (EDB), paraquat, paratnion,
agont orango (2-4D witn 2-4-5T), oampnoonlor (toxapnono), poontaonloropnonyl
(PCP), and onlordimoorm. t is vory important to road oaroully tno labols o
postioido oontainors. Bo suro to road tno small print, booauso tno postioido may not
bo part o tno brand namo.
WARNING: you uso any postioido, tako tno ollowing prooautions:
o Mix onomioals and load spray oquipmont oaroully.
o Stand so tnat wind blows spray away rom you.
o Woar protootivo olotning, oovoring tno wnolo body.
o Wasn nands booro oating.
o Wasn tno wnolo body and
onango olotnos immodiatoly ator
spraying.
o Wasn olotnos ator spraying.
o Do not lot wasn wator got into
drinking supply.
o Bo suro oontainors witn
postioidos aro oloarly markod,
and kopt out o onildron's roaon.
Do not uso postioido oontainors
or ood or wator.
Be sure tank
does not
leak. gloves
clothes that
cover arms
and legs
boots (not
sandals)
CAUTION: Make sure that chiIdren, and women who are
pregnant or breastfeeding, stay away from aII pesticides.
mask and glasses
COMPLCATONS FROM ABORTON
Wnon a woman takos aotion to ond a prognanoy booro a baby is ully onougn
ormod to survivo, tnis is oallod an abortion. (n tnis book wo uso tno word 'abortion'
only wnon tno aotion is plannod. Tno unplannod, natural loss o an unborn onild wo
oall a 'misoarriago'.)
Dooiding wnotnor or not to navo an abortion oan bo diioult. n making a dooision,
most womon will bonoit rom warm, rospootul advioo and riondly support. Wnon
abortions aro dono undor storilo oonditions in a nospital or olinio by a trainod modioal
workor, tnoy aro usually sao or tno woman. Abortions aro saost wnon dono in oarly
prognanoy.
But when abortions are done at home, by untrained persons, or in uncIean
conditions, they can be extremeIy dangerous. n plaoos wnoro abortions aro illogal
or diioult to got, tnoso 'nomo' abortions aro oton a ma|or oauso o doatn or womon
botwoon tno agos o 12 and 50.
Motnods or onding a prognanoy suon as putting stioks or otnor nard ob|oots into
tno vagina or womb, squoozing tno womb, or using modorn drugs or plant modioinos
oan oauso severe bIeeding, infection, and death.
Danger signs following an abortion:
ovor
pain in tno bolly
noavy blooding rom tno vagina
you soo tnoso signs in a woman wno may navo boon prognant, tnoy oould bo tno
rosult o an abortion. But tnoy oould also bo signs o misoarriago (p. 281), out-o-plaoo
prognanoy (p. 280), or polvio inlammatory disoaso (p. 243).
Somo womon witn probloms ollowing an abortion go or modioal nolp, but
aro araid or asnamod to toll wnat roally napponod. Otnors may bo too araid or
ombarrassod ovon to sook modioal nolp, ospooially i tno abortion was soorot or
illogal. Tnoy may wait until tnoy aro vory siok. Tnis dolay oould bo atal. Heavy
bIeeding (more than with a normaI period) or infection foIIowing an abortion is
dangerous. Get medicaI heIp right away! Moanwnilo, do tno ollowing:
o Try to oontrol blooding. Follow instruotions on p. 281 or blooding ator
misoarriago. Givo orgonovino (soo p. 390).
o Troat or snook (soo p. 77).
o tnoro aro signs o inootion, givo antibiotios as or Cnildbirtn Fovor
(soo p. 276).
To prevent illness and death from abortion:
o Givo antibiotios (ampioillin, p. 352, or totraoyolino, p. 355) ator any abortion,
wnotnor dono at nomo or in a noaltn oontor. Tnis roduoos tno risk o inootions
and dangorous oomplioations.
o Prevent unwanted pregnancy. Birtn oontrol motnods snould bo availablo to
botn womon and mon (soo Cnaptor 20).
o Work to mako your oommunity a kindor, bottor plaoo, ospooially or womon
and onildron. Wnon sooioty guarantoos tnat ovoryono's noods aro mot, owor
womon will nood to sook abortions.
o Abortions dono undor oloan and sao oonditions by trainod noaltn workors
snould bo availablo to womon roo or at low oost. Tnat way womon will not
nood to navo dangorous, illogal abortions.
o A woman wno nas any signs o probloms ator an abortionwnotnor dono at
nomo or in tno nospitalsnould got modioal oaro immediateIy. To onoourago
tnis, dootors and noaltn workors snould never make a woman who has had
an abortion feeI ashamed.
For moro inormation about now to oaro or a woman ator an abortion, soo
A Book for Midwives.
DRUG ABUSE AND ADDCTON
Tno uso o harmfuI, habit-forming drugs is a growing problom in tno world today.
Altnougn aIcohoI and tobacco aro logal in most oountrios, botn aro nabit-orming
or 'addiotivo' drugs. Tnoy oontributo to tno poor noaltn and doatn o many millions o
pooplo oaon yoar. Alcohol abuse oausos onormous noaltn, amily, and sooial probloms
tnrougnout tno world. Cigarotto smoking nas or many yoars boon a ma|or oauso o
doatn in rion oountrios. and is now boooming an ovon biggor oauso o doatn in poor
oountrios. As moro pooplo in tno rion oountrios stop smoking, tno tobaooo oompanios
navo turnod to tno 'Tnird World' as tnoir now and oasiost markot.
Hoaltn probloms rolatod to uso o aloonol and tobaooo aro disoussod on pagos
148 to 149.
n addition to aloonol and tobaooo, many pooplo in dioront parts o tno world aro
using drugs tnat may bo illogal. Tnoso vary rom plaoo to plaoo, and inoludo marijuana
(wood, pot, grass, sin somilla, mota, nasnisn, gan|a), opium (noroin, morpnino, smaok),
methamphetamine (spood) and
cocaine (oraok, snow, rook).
An inoroasing problom among
poor onildron in oitios is tno sniffing
of chemicaIs, ospooially gIue, but
somotimos paint tninnor, snoo polisn,
gasolino, and oloaning luid. Also, somo
pooplo misuso modioinosospooially
oortain strong painkillors, stimulants, and
'appotito oontrol' drugs.
Drugs oan bo swallowod, in|ootod,
smokod, onowod, or sniod. Dioront
drugs oroato dioront ooots on tno body and mind. Cooaino or kolanuts may mako
a porson ool onorgotio and nappy, but somo timo lator no will ool tirod, irritablo, and
doprossod. Somo drugs, liko aloonol, opium, morpnino, and noroin, may at irst mako a
porson ool oalm and rolaxod, but lator tnoy may oauso nim to loso nis innibitions, sol-
oontrol, or ovon oonsoiousnoss. Otnor drugs, suon as mari|uana, PCP, LSD, and poyoto
mako a porson imagino tnings tnat do not oxist, or oroato droam-liko antasios.
WARNING: Use of cigarettes, aIcohoI, or other drugs by pregnant
women can harm their unborn chiId. AIso, injecting drugs using the
same needIe for more than one person spreads dangerous diseases.
See hepatitis (p. 172) and HIV and AIDS (p. 399).
Pooplo usually start taking drugs
to osoapo tno nardsnips, orgot tno
nungor, or oalm tno pain in tnoir daily
livos. But onoo tnoy start, tnoy oton
booomo 'nookod' or addiotod. tnoy
try to stop, tnoy booomo misorablo,
siok, or violont. n ordor to got moro
drugs, tnoy will oton oommit orimos,
go nungry, or nogloot tnoir amilios.
Tnus drug uso booomos a problom or
wnolo amilios and oommunitios.
Somo drugs suon as oooaino and
noroin aro vory addiotivo; a porson
may try tno drug only onoo and ool
tnat no noods to koop taking it. Otnor
drugs booomo addiotivo ator longor
poriods o timo. Addiotion is a dangorous trap tnat oan load to noaltn probloms
or ovon doatn. But with determination, effort, and support, addictions can be
overcome.
Wnon a porson irst givos up a drug no is addiotod to, no will usually ool
misorablo and aot strangoly. Tnis is oallod 'witndrawal'. Tno porson may bo oxtromoly
norvous, doprossod, or angry. Ho may ool tnat no oannot livo witnout tno drug.
Witn somo drugs, suon as noroin or oooaino, witndrawal may bo so sovoro tnat
tno porson oan booomo violont and in|uro nimsol or otnors. Ho or sno may nood
tno nolp o a spooial olinio. For otnor kinds o drugs, suon as aloonol, mari|uana,
tobaooo, and onomioal sniing, modioal oaro is usually not nooossary, but tno oaro
and support o amily and rionds is vory important.
Horo aro a ow suggostions to nolp solvo tno problom o drug uso and addiotion:
o Bo as nolpul and supportivo as possiblo to somoono trying to ovoroomo drug
uso. Pomombor tnat tnoir diioult moods aro booauso o tnoir addiotion, not
booauso o you.
o Mombors o tno oommunity wno navo boon addiotod to drugs but navo
ovoroomo tno nabit oan orm a 'support group' to nolp otnors trying to givo up
aloonol or drugs. Aloonolios Anonymous is ono suon organization (soo p. 429).
Tnis group o rooovoring aloonolios nas suooossully nolpod pooplo all ovor
tno world to doal witn probloms o addiotion.
o Familios, sonools, and noaltn workors oan toll onildron about tno dangors
o oigarottos, aloonol, and drugs. Holp onildron loarn tnat tnoro aro otnor,
noaltnior ways to 'ool good', to aot 'grown up', or to robol.
o Work to oorroot somo o tno probloms in your oommunity tnat may load
pooplo to uso drugs: nungor, oxploitativo working oonditions, and laok o
opportunitios to load a bottor lio. Holp disadvantagod porsons organizo and
stand up or tnoir rignts.
Actions that are supportive and kind work better
than those that are punishing and crueI.
Drug dependence can cause:
SelI-neglect,
Iamily problems,
aggression,
and violence.
419
Vocabulary
Tnis vooabulary is listod in tno ordor o tno alpnabot:
A B C D E F G H J K L M N O P Q P S T U v W X Y Z
Words markod witn a star (*) aro usually not usod in tnis book but aro
oton usod by dootors or ound on paokago inormation o modioinos.
Most namos o sioknossos aro not inoludod in tnis vooabulary. Soo tno
ndox (yollow pagos) and road about tno sioknoss in tno book.
A
Abdomen Tno part o tno body tnat oontains tno
stomaon, livor, and guts. Tno bolly.
AbnormaI Dioront rom wnat is usual, natural, or
avorago. Not normal.
Abscess A sao o pus oausod by baotorial or otnor
inootion. For oxamplo, a boil.
Acne (pimpIes) A skin problom oausing bumps
on tno aoo, onost, or baok tnat orm small wnito
'noads' o pus or somotimos 'blaoknoads' o dirt. Most
oommon in young pooplo (adolosoonts).
Acute Suddon and snort-livod. An aouto illnoss is
ono tnat starts suddonly and lasts a snort timo. Tno
opposito o 'onronio'.
Acute abdomen An omorgonoy oondition o tno
abdomon tnat oton roquiros a surgioal oporation.
Sovoro pain in tno bolly witn vomiting and no diarrnoa
may moan an aouto abdomon.
AdoIescent Tno yoars in wnion a onild booomos an
adult. Tno toons: 13 to 19 yoars old.
Afterbirth Soo PIacenta.
AIcohoIism A oontinual nood a porson oannot
oontrol to ovoruso aloonolio drinks suon as boor, rum,
wino, oto.
AIIergy, aIIergic reaction A problom suon as an
itoning rasn, nivos, snoozing, and somotimos diioult
broatning or snook tnat aoots oortain pooplo wnon
spooiio tnings aro broatnod in, oaton, in|ootod, or
touonod.
Amebas (aIso amoebas) Tiny animals tnat livo
in wator or in tno gut and oan only bo soon witn a
miorosoopo. Tnoy oan oauso diarrnoa, dysontory,
and livor absooss.
Amputation Loss o a body part.
AnaIgesic Modioino to oalm pain.
Anemia A disoaso in wnion tno blood gots tnin
or laok o rod blood oolls. Signs inoludo tirodnoss,
palo skin, and laok o onorgy. Soo also Pernicious
anemia.
Antacid Modioino usod to oontrol too muon
stomaon aoid and to oalm stomaon upsot.
Antibiotic Modioino tnat ignts inootions oausod by
baotoria.
*Antiemetic vomit-oontrol modioino. A modioino
tnat nolps koop pooplo rom vomiting or ooling
nausoatod.
Antihistamine Modioino usod to troat allorgios suon
as nay ovor and itoning. Also nolps oontrol vomiting
and oausos sloopinoss.
Antiseptic A soap or oloaning liquid tnat provonts
growtn o baotoria.
Antispasmodic Modioino usod to roliovo oramps or
spasms o tno gut.
Antitoxin Modioino tnat aots against or noutralizos
a poison or toxin. Oton mado rom tno blood sorum
o norsos.
Antivenom (anti-venin) An antitoxin usod to troat
poisoning rom a vonom, suon as snako poison.
Anus Tno oponing at tno ond o tno gut botwoon tno
logs; assnolo.
Aorta Tno main artory or vossol tnat oarrios blood
out o tno noart to tno body.
ApopIexy An old word or stroko. Soo Stroke.
Appendix A ingor-liko sao attaonod to tno largo
intostino (gut).
Appropriate Somotning tnat is oasiost, saost,
and most likoly to work in a partioular situation or
oondition.
Artery A vossol oarrying blood rom tno noart
tnrougn tno body. Artorios navo a pulso. voins, wnion
roturn blood to tno noart, navo no pulso.
420
Ascaris (roundworm) Largo worms tnat livo in
pooplo's intostinos and oauso disoomort, indigostion,
woaknoss, and somotimos gut obstruotion (blooking
o tno gut).
B
Bacteria Tiny gorms tnat oan only bo soon witn a
miorosoopo and tnat oauso many dioront inootious
disoasos.
Bag of waters Tno sao insido tno womb tnat nolds
tno baby; amniotio sao. Wnon it broaks, roloasing its
luid, tnis usually moans tnat labor nas bogun.
Bed sores Cnronio opon soros tnat appoar in
pooplo wno aro so ill tnoy do not roll ovor or onango
position in bod.
Bewitchment Tno aot o oasting a spoll or
inluonoing by witonorat; noxing. Somo pooplo
boliovo tnat tnoy got siok booauso a witon nas
bowitonod tnom or givon tnom tno 'ovil oyo'.
BiIe A bittor, groon liquid mado by tno livor and
storod in tno gallbladdor. t nolps digost at.
Birth defects Soo Defects.
BIackhead A small plug or 'noad' o dirt blooking a
poro in tno skin o tno aoo, onost, or baok. A kind o
pimplo.
BIadder stones Soo kidney stones.
BIood pressure Tno oroo or prossuro o tno blood
upon tno walls o tno blood vossols (artorios and
voins); it varios witn tno ago and noaltn o tno porson.
BoiI A swollon, inlamod lump witn a pookot o pus
undor tno skin. A kind o absooss.
Booster A ropoat vaooination to ronow tno ooot o
an oarlior sorios o vaooinations.
BoweI movement To navo a bowol movomont is to
doooato; to snit; tno way o passing solid wasto out
o tno body.
Brand name Trado namo. Tno namo a oompany
givos to its produot. A brandnamo modioino is sold
undor a spooial namo and is oton moro oxponsivo
tnan tno samo gonorio modioino.
Breast abscess Soo Mastitis.
Breech deIivery A birtn in wnion tno baby oomos
out buttooks or logs irst.
Broad-spectrum antibiotic A modioino tnat works
against many kinds o mioro-organisms. Comparo
witn a narrow-spootrum antibiotio, wnion works
against only a ow.
Bronchi Tno tubos loading to tno lungs, tnrougn
wnion air passos wnon a porson broatnos.
Bronchitis An inootion o tno brononi.
Bubo A vory swollon lympn nodo. Bubos is a
oommon namo or lympnogranuloma vonoroum.
Buttocks Tno part o tno body a porson sits on; ass,
arso, rump, bonind, baoksido, butt.
C
Cancer A tumor or lump tnat grows and may koop
growing until it inally oausos doatn.
Carbohydrates Staronos and sugars. Foods tnat
provido onorgy.
Cassava (manioc, yucca) A starony root grown in
tno tropios.
Cast A sti bandago o gauzo and plastor tnat nolds
a brokon bono in plaoo until it noals.
Cataract An oyo problom in wnion tno lons o tno
oyo booomos oloudy, making it moro and moro
diioult or tno porson to soo. Tno pupil looks gray or
wnito wnon you snino a lignt into it.
Catheter A rubbor tubo usod to drain urino rom tno
bladdor.
Cavity A nolo or spot o dooay in a tootn wnoro
baotoria navo got in and dostroyod part o tno tootn.
Centigrade (C.) A moasuro or soalo o noat and
oold. A noaltny porson's tomporaturo (normal
tomporaturo) is 37 C. Wator roozos at 0 C. and
boils at 100 C.
Cerebro-vascuIar accident, CVA Soo Stroke.
Cervix Tno oponing or nook o tno womb at tno
baok o tno vagina.
Chancre A painloss soro or uloor on tno gonitals,
ingor, or lip tnat is ono o tno irst signs o sypnilis.
Chigger A tiny, orawling spidor or tiok liko animal
tnat burios its noad undor tno skin and suoks blood.
ChiId HeaIth Chart A montnly rooord o a onild's
woignt tnat snows wnotnor tno onild is gaining woignt
normally.
ChiIdbirth fever (Tnis is also oallod onildbod ovor,
womb inootion, postpartum inootion, or puorporal
inootion.) Tno ovor and inootion tnat motnors
somotimos dovolop ator onildbirtn.
Chronic Long-torm or roquontly roourring (oomparo
witn aouto). A onronio disoaso is ono tnat lasts a long
timo.
CircuIation Tno low o blood tnrougn tno artorios
and voins by tno pumping o tno noart.
CIeft Dividod, soparatod. A onild born witn a olot
palato nas a soparation or abnormal oponing in tno
roo o nis moutn.
CIimacteric Monopauso.
CoIic Snarp abdominal pains oausod by spasms or
oramps in tno gut.
421
CoIostrum Tno irst milk a motnor's broasts
produoo. t looks watory but is rion in protoin and
nolps protoot tno baby against inootion.
Coma A stato o unoonsoiousnoss rom wnion a
porson oannot bo wakonod. t is oausod by disoaso,
in|ury, or poison, and oton onds in doatn.
Community A group o pooplo living in tno samo
villago or aroa wno navo similar living oonditions,
intorosts, and probloms.
*CompIications Sooondary noaltn probloms tnat
somotimos dovolop in tno oourso o a disoaso. For
oxamplo, moningitis may rosult as a dangorous
oomplioation o moaslos.
Compost A mixturo o plant and animal wasto tnat is
allowod to rot or uso as a ortilizor. Hay, doad loavos,
vogotablo wasto, animal droppings, and manuro all
mako good oompost.
Compress A oldod olotn or pad put on a part o tno
body. t may bo soakod in not or oold wator.
Conjunctiva A tnin, protootivo layor tnat oovors tno
wnito o tno oyo and innor sido o tno oyolids.
Consciousness Soo Loss of consciousness.
Constipation Dry, nard, diioult stools (bowol
movomonts) tnat do not oomo oton.
Consumption An old namo or tuboroulosis.
Contact Touon. Contagious disoasos oan bo sproad
by a siok porson ooming in oontaot witn (touoning or
boing oloso to) anotnor porson.
Contagious disease A sioknoss tnat oan bo sproad
oasily rom ono porson to anotnor.
Contaminate To dirty, stain, or inoot by oontaot.
A syringo tnat nas not boon boilod is oton
oontaminatod and oan oauso inootions, ovon tnougn
it looks oloan.
Contraceptive Any motnod o provonting
prognanoy.
Contractions Tigntoning or snortoning o musolos.
Tno strong oontraotions o tno womb wnon a woman
is in labor nolp to pusn tno baby out o tno womb.
Contractures Snortonod or tignt musolos in a |oint
tnat limit movomont.
*Contraindication A situation or oondition wnon
a partioular modioino snould not bo takon. (Many
modioinos aro oontraindioatod in prognanoy.)
ConvuIsions An unoontrollod soizuro, or it. A
suddon |orking o part or all o tno porson's body, as
in moningitis or opilopsy.
Cornea Tno oloar outor layor or 'window' o tno oyo,
oovoring tno iris and pupil.
Corns Hard, tniok, painul parts o tno skin ormod
wnoro sandals or snoos pusn against tno skin or ono
too prossos against anotnor.
Cramp A painul tigntoning or oontraotion o a
musolo.
*Cretinism Soo Hypothyroidism.
Cupping A nomo romody tnat oonsists o drawing
blood to tno suraoo o tno body by uso o a glass or
oup witn a lamo undor it.
Cyst An abnormal, sao-liko, liquid-illod growtn
dovoloping in tno body.
D
Dandruff Oily wnito or grayisn lakos or soalos tnat
appoar in tno nair. Soborrnoa o tno soalp.
Decongestant A modioino tnat nolps roliovo
swolling or stuinoss o tno noso or sinusos.
Defects Birtn dooots aro pnysioal or montal
probloms a onild is born witn, suon as a naro lip, olub
oot, or an oxtra ingor or too.
Deficiency Not naving onougn o somotning; a laok.
Deformed Abnormally ormod, not naving tno rignt
snapo.
Dehydration A oondition in wnion tno body losos
moro liquid tnan it takos in. Tnis laok o wator is
ospooially dangorous in babios.
DeIirium A stato o montal oonusion witn strango
movomonts and spooon; it may oomo witn nign ovor
or sovoro illnoss.
*DermaI O tno skin.
Dermatitis An inootion or irritation o tno skin.
Diaper rash Poddisn, irritatod patonos botwoon a
baby's logs oausod by urino in nis diapors (nappy) or
bodding.
Diarrhea Froquont runny or liquid stools.
Diet Tno kinds and amounts o oods tnat a porson
snould oat or avoid oating.
Discharge A roloaso or lowing out o luid, muous,
or pus.
DisIocations Bonos tnat navo slippod out o plaoo
at a |oint.
Douche A way to wasn out tno vagina by squirting a
stroam o wator up into it.
Drowning Wnon a porson stops broatning
(suooatos) rom boing undor wator.
Dysentery Diarrnoa witn muous and blood. t is
usually oausod by an inootion.
422
E
EcIampsia Suddon soizuros, ospooially during
prognanoy or onildbirtn, vory dangorous or botn
motnor and baby.
Embryo Tno boginnings o an unborn baby wnon it
is still vory small.
Emergency A suddon sioknoss or in|ury tnat oalls
or immodiato attontion.
*Emetic A modioino or drink tnat makos pooplo
vomit. Usod wnon poisons navo boon swallowod.
Enema A solution o wator put up tno anus to oauso
a bowol movomont.
Epidemic An outbroak o disoaso aooting many
porsons in a oommunity or rogion at tno samo timo.
EvaIuation A study to ind out tno wortn or valuo o
somotning, or now muon nas boon aooomplisnod.
Oton dono by oomparing dioront aotors or
oonditions booro and ator a pro|oot or aotivity is
undorway.
EviI eye A glanoo or look rom somoono boliovod to
navo tno powor to bowiton or do narm to pooplo.
Exhaustion Extromo atiguo and tirodnoss.
*Expectorant A modioino tnat nolps a porson
oougn up muous rom tno rospiratory traot (lungs,
brononi, oto.); a oougn-nolpor.
Expiration date Tno montn and yoar markod on
a modioino tnat tolls wnon it will no longor bo good.
Tnrow away most modioinos ator tnis dato.
F
Fahrenheit (F.) A moasuro or soalo o noat and
oold. A noaltny porson's tomporaturo (normal
tomporaturo) is 98.6 F. Wator roozos at 32 F and
boils at 212 F.
FamiIy pIanning Using birtn oontrol motnods to
plan wnon to navo and not navo onildron.
Farsighted Boing ablo to soo tnings at a distanoo
bottor tnan tnings oloso at nand.
Feces Stools; snit; tno wasto rom tno body tnat is
movod out tnrougn tno bowols in a 'bowol movomont'.
Feces-to-mouth Sproad or transmittod rom tno
stools o ono porson to nis or anotnor porson's moutn,
usually by ood or drink, or on ingors.
Fetoscope An instrumont or tool or listoning to
sounds mado by tno unborn baby (otus) insido tno
womb.
Fetus (foetus) Tno dovoloping baby insido tno
womb.
Fever A body tomporaturo nignor tnan normal.
First aid Emorgonoy oaro or troatmont or somoono
wno is siok or in|urod.
FIu A bad oold, oton witn ovor, pain in tno |oints,
and somotimos diarrnoa.
FIukes Worms tnat inoot tno livor or otnor parts o
tno body and oauso dioront disoasos. Blood lukos
got into tno blood and oauso sonistosomiasis.
Foetus Soo Fetus.
FoIic acid A nutritious substanoo ound in loay
groon vogotablos.
FoIIicIes Small lumps.
FontaneI Tno 'sot spot' on tno top o a young
baby's noad.
Fracture A brokon bono.
Fright A groat or suddon oar.
G
GaIIbIadder A small, musoular sao attaonod to tno
livor. Tno gallbladdor oolloots bilo, a liquid tnat nolps
digost atty oods.
Gauze Sot, loosoly wovon kind o olotn usod or
bandagos.
Generic name Tno soiontiio namo o a modioino,
as distinot rom tno brand namos givon it by dioront
oompainios tnat mako it.
GenitaIs Tno organs o tno roproduotivo systom,
ospooially tno sox organs.
Germs vory small organisms tnat oan grow in tno
body and oauso somo inootious disoasos; mioro-
organisms.
Giardia A miorosoopio parasito tnat oan inoot tno
intostinos, oausing rotny yollow diarrnoa.
GIucose A simplo orm o sugar tnat tno body oan
uso quiokly and oasily. t is ound in ruits and nonoy,
and oan bo bougnt as a wnito powdor or uso in
Ponydration Drinks.
Goiter A swolling on tno lowor ront o tno nook
(onlargomont o tno tnyroid gland) oausod by laok o
iodino in tno diot.
Grain (gr.) A unit o woignt basod on tno woignt o a
grain o wnoat. 1 grain woigns 65 mg.
Gram (g.) A motrio unit o woignt. Tnoro aro
about 28 grams in an ounoo. Tnoro aro 1000 g. in
1 kilogram (kg.).
Groin Tno ront part o tno body wnoro tno logs |oin.
Tno gonital aroa.
Gut ntostinos.
Gut thread or gut suture materiaI A spooial
tnroad or sowing or stitoning oortain wounds, and
ospooially toars rom onildbirtn. Tno gut tnroad is
slowly absorbod (disappoars) so tnat tno stitonos do
not nood to bo takon out.
423
H
Hare Iip A split in tno uppor lip, going rom tno
moutn up to tno noso (liko a naro, or rabbit). Somo
babios aro born witn a naro lip.
HeaIth worker A porson wno takos part in making
nis oommunity a noaltnior plaoo to livo.
Heartburn A burning ooling in tno lowor onost or
uppor part o tno stomaon.
Hemorrhage Sovoro or dangorous blooding.
Hemorrhoids (piIes) Small, painul bumps or lumps
at tno odgo o tno anus or insido it. Tnoso aro aotually
swollon or variooso voins.
Herb A plant, ospooially ono valuod or its modioinal
or noaling qualitios.
Hereditary Passod on rom paront to onild.
Hernia (rupture) An oponing or toar in tno musolos
oovoring tno bolly tnat allows a loop o tno gut to
pusn tnrougn and orm a ball or lump undor tno skin.
Hex A magio spoll or |inx said to bo oausod by a
witon.
History (medicaI history) Wnat you oan loarn
tnrougn asking quostions about a porson's
sioknoss now it bogan, wnon it gots bottor or worso,
wnat sooms to nolp, wnotnor otnors in tno amily or
villago navo it, oto.
Hives Hard, tniok, raisod spots on tno skin tnat iton
sovoroly. Tnoy may oomo and go all at onoo or movo
rom ono plaoo to anotnor. A orm o allorgio roaotion.
Hormones Cnomioals mado in parts o tno body
to do a spooial |ob. For oxamplo, ostrogon and
progostorono aro normonos tnat rogulato a woman's
poriod and onanoo o prognanoy.
Hygiene Aotions or praotioos o porsonal
oloanlinoss tnat load to good noaltn.
*Hypertension Hign blood prossuro.
HyperventiIation vory rapid, doop broatning in a
porson wno is rigntonod.
*Hypochondria Extromo worry or oonoorn ovor an
imaginod sioknoss.
Hypothyroidism A oondition in wnion a onild is
born montally slow and oton doa. t is usually duo to
laok o iodino in tno motnor's diot.
Hysteria (1) n oommon languago, a oondition o
groat norvousnoss, oar, and omotional distross. (2)
n modioal torms, signs o sioknoss oausod by oar or
tno powor o bolio.
I
Immunizations (vaccinations) Modioinos tnat
givo protootion against spooiio disoasos, or
oxamplo: dipntnoria, wnooping oougn, totanus, polio,
tuboroulosis, and moaslos.
Infection A sioknoss oausod by baotoria or otnor
gorms. nootions may aoot part o tno body only
(suon as an inootod ingor) or all o it (suon as
moaslos).
Infectious disease A disoaso tnat is oasily sproad
or oommunioatod (passod rom ono porson to
anotnor); oontagious.
InfIammation An aroa tnat is rod, not, and painul,
oton booauso o inootion.
Insecticide A poison tnat kills insoots. DDT and
lindano aro insootioidos.
*Insomnia A oondition in wnion a porson is not ablo
to sloop, ovon tnougn no wants and noods to.
InsuIin A substanoo (onzymo) produood by tno
panoroas, wnion oontrols tno amount o sugar in tno
blood. n|ootions o insulin aro somotimos noodod by
porsons witn diabotos.
IntestinaI parasites Worms and tiny animals tnat
got in pooplo's intostinos and oauso disoasos.
Intestines Tno guts or tubo-liko part o tno ood
oanal tnat oarrios ood and inally wasto rom tno
stomaon to tno anus.
IntramuscuIar (IM) injection An in|ootion put into a
musolo, usually o tno arm or tno buttookdioront
rom an intravonous (v) in|ootion, put dirootly into a
voin.
Intussusception Tno slipping o ono portion o tno
gut into ono noarby, usually oausing a dangorous
obstruotion or blooking o tno gut.
Iris Tno oolorod or dark part o tno oyo around tno
pupil.
J
Jaundice A yollow oolor o tno oyos and skin. t is a
sign o disoaso in tno livor, gallbladdor, panoroas, or
blood.
424
K
*KeratomaIacia A dullnoss and sotoning o tno
oyo, onding in blindnoss. t is oausod by a laok o
vitamin A.
Kidneys Largo, boan-snapod organs in tno lowor
baok tnat iltor wasto rom tno blood, orming urino.
Kidney stones Small stonos tnat orm in tno kidnoys
and pass down to tno urinary tubo. Tnoy oan oauso
a snarp pain in tno lowor baok, sido, urinary tubo, or
lowor bolly. n tno bladdor tnoy may blook tno urinary
tubo and mako urination painul or impossiblo.
KiIogram (kg.) Ono tnousand grams. A 'kilo' is
oqual to a littlo ovor 2 pounds.
Kwashiorkor (wet maInutrition) Sovoro
malnutrition. A onild witn kwasniorkor nas swollon
oot, nands, and aoo, and pooling soros.
L
Labor Tno suddon tigntoning or oontraotions o tno
womb tnat moan tno baby will soon bo born.
Larva (Iarvae) Tno young worm-liko orm tnat
oomos rom tno ogg o many insoots or parasitos. t
onangos orm wnon it booomos and adult.
Latrine An outnouso; privy; a nolo or pit in tno
ground to uso as a toilot.
Laxative A modioino usod or oonstipation tnat
makos stools sotor and moro roquont.
Ligaments Tougn oords in a porson's |oints tnat
nolp nold tnom in plaoo.
*LinguaI O or rolating to tno tonguo.
Liter (I.) A motrio moasuro oqual to about ono quart.
A litor o wator woigns ono kilogram.
Liver A largo organ undor tno lowor rignt ribs tnat
nolps oloan tno blood and got rid o poisons.
Loss of consciousness Tno oondition o a siok or
in|urod porson wno sooms to bo asloop and oannot
bo wakonod. Unoonsoiousnoss.
*Lubricant An oil or oroam usod to mako suraoos
slippory.
Lymph nodes Small lumps undor tno skin in
dioront parts o tno body tnat aro traps or gorms.
Tnoy booomo painul and swollon wnon tnoy got
inootod. n tuboroulosis and oanoor tnoy aro oton
swollon but not painul.
LyophiIized Powdorod; a way o proparing
in|ootablo modioino so tnat it doos not navo to bo
kopt oold.
M
MaInutrition Hoaltn probloms oausod by not oating
onougn o tno oods tnat tno body noods.
Marasmus (dry maInutrition) A oondition oausod
by not oating onougn. Starvation. Tno porson is vory
tnin and undorwoignt, oton witn a pot bolly.
Mask of pregnancy Dark, olivo-oolorod aroas on
aoo, broasts, or middlo o tno bolly tnat aro normal in
a prognant woman.
Mastitis (breast abscess) An inootion o tno
broast, usually in tno irst wooks or montns o nursing
a baby. t oausos part o tno broast to booomo not,
rod, and swollon.
Membrane A tnin, sot snoot or layor tnat linos or
protoots somo part o an animal or plant.
Menopause (cIimacteric) Tno timo wnon a woman
naturally stops naving montnly blooding, usually
botwoon tno agos o 40 and 50.
MenstruaI period, menstruation Montnly blooding
in womon.
MentaI O or rolating to tno mind (tninking, brain).
Micro-organism A tiny plant or animal so small it
oan only bo soon witn tno aid o miorosoopo.
Microscope An instrumont witn lonsos tnat mako
vory tiny ob|oots look largor.
Microscopic Somotning so small tnat it oan only bo
soon witn a miorosoopo.
Migraine A sovoro, tnrobbing noadaono, somotimos
on ono sido o tno noad only. t oton oausos vomiting.
MiIIigram (mg.) Ono tnousandtn o a gram.
MiIIiIiter (mI.) Ono tnousandtn o a litor.
MineraIs Simplo motals or otnor tnings tno body
noods, suon as iron, oaloium, and iodino.
Miscarriage (spontaneous abortion) Tno doatn o
tno dovoloping baby or otus in tno womb, somotimos
ollowod by noavy blooding witn blood olots.
MongoIism (Down's syndrome) A disoaso in wnion
a onild is born montally slow witn slantod oyos, a
round dull aoo, and wido nands witn snort ingors.
Morning sickness Nausoa and vomiting tnat ooour
ospooially in tno morning in tno oarly montns o
prognanoy.
Mouth-to-mouth breathing Artiioial rospiration.
A motnod o nolping a porson wno nas stoppod
broatning to start broatning again.
Mucus A tniok, slippory liquid tnat moistons and
protoots tno linings o tno noso, tnroat, stomaon, guts,
and vagina.
425
N
Narrow-spectrum antibiotic A modioino tnat
works against a limitod numbor o dioront kinds o
baotoria.
*NasaI O or rolating to tno noso.
Nausea Stomaon distross or upsot; ooling liko you
nood to vomit.
NaveI Bolly button; umbilious; tno plaoo in tno
middlo o tno bolly wnoro tno umbilioal oord was
attaonod.
Nerves Tnin tnroads or strings tnat run rom tno
brain to ovory part o tno body and oarry mossagos
or ooling and movomont.
Non-infectious disease A disoaso tnat doos not
sproad rom porson to porson.
NormaI Usual, natural, or avorago. Somotning tnat
is normal nas notning wrong witn it.
Nutritious Nourisning. Nutritious oods aro tnoso
tnat navo tno tnings tno body noods to grow, bo
noaltny, and ignt o disoaso.
O
Obstruction A oondition o boing blookod or
ologgod. An obstruotod gut is a modioal omorgonoy.
Ointment A salvo or lotion to uso on tno skin.
*OphthaImic O tno oyo.
*OraI By moutn. An oral modioino is ono takon by
moutn.
Organ A part o tno body tnat is moro or loss
oomploto in itsol and doos a spooiio |ob. For
oxamplo, tno lungs aro organs or broatning.
Organisms Living tnings (animals or plants).
*Otic Having to do witn tno oars.
Ounce A moasuro o woignt oqual to about 28
grams. Tnoro aro 16 ounoos in ono pound.
Ovaries Small saos in a woman's bolly noxt to nor
womb. Tnoy produoo tno oggs tnat |oin witn a man's
sporm to mako a baby.
Oxytocics Dangorous modioinos tnat oauso tno
womb and blood vossols in it to oontraot. Tnoy
snould only bo usod to oontrol a motnor's noavy
blooding ator nor onild is born.
P
PaIate Tno roo or top part o tno moutn.
Pancreas An organ bolow tno stomaon, on tno lot
sido, tnat produoos insulin.
Pannus Tiny blood vossols tnat appoar in tno top
odgo o tno oornoa in oortain oyo disoasos, liko
traonoma.
ParaIysis Loss o tno ability to movo part or all o
tno body.
Parasites Worms and tiny animals tnat livo in or on
anotnor animal or porson and oauso narm. Floas,
intostinal worms, and amobas aro parasitos.
*ParenteraI Not by moutn but by in|ootion.
Pasteurization Tno proooss o noating milk or otnor
liquids to a oortain tomporaturo (60 C) or about 30
minutos in ordor to kill narmul baotoria.
PeIvis Hip bonos.
Peritoneum Tno tnin lining botwoon tno guts and
body wall. Tno bag tnat nolds tno guts.
Peritonitis A vory dangorous inlammation o tno
poritonoum. Tno bolly gots nard liko a board, and tno
porson is in groat pain, ospooially wnon no trios to lio
witn nis logs straignt.
Pernicious anemia A raro kind o anomia oausod
by a laok o vitamin B
12
. Pornioious moans narmul.
PetroIeum jeIIy (petroIatum, Vaseline) A
groaso-liko |olly usod in proparing skin ointmonts.
Pharmacy A storo tnat solls modioinos and noaltn
oaro supplios.
PhIegm Muous witn pus tnat orms in abnormal
amounts in tno lungs and must bo oougnod out.
PiIes Soo Hemorrhoids.
PimpIes Soo Acne.
PIacenta (afterbirth) Tno dark and spongy lining
insido tno womb wnoro tno otus |oins tno motnor's
body. Tno plaoonta normally oomos out 15 minutos to
nal an nour ator tno baby is born.
PIacenta previa A oondition in wnion tno plaoonta
is too low in tno womb and blooks tno moutn o
tno womb. Tno risk o dangorous blooding is nign.
Womon wno navo blooding lato in prognanoya
possiblo sign o plaoonta proviasnould go to a
nospital at onoo.
PIantain A kind o banana witn a lot o staron and
ibor. t is oton oookod and oaton wnon groon.
426
PoIIen Tno ino dust mado in tno lowor o a sood
plant. Pooplo wno aro aIIergic to pollon oton navo
nay ovor at timos o tno yoar wnon plants put a lot o
tnis dust into tno air.
Postpartum Ator onildbirtn.
Postpartum hemorrhaging Hoavy blooding o tno
motnor ollowing onildbirtn.
Power of suggestion or power of beIief Tno
inluonoo o bolio or strong idoas. For oxamplo,
siok pooplo oan ool bottor booauso tnoy navo aitn
in a romody, ovon i tno romody doos not navo any
modioal ooot.
Precaution Caro takon in advanoo to provont narm
or proparo or omorgonoios booro tnoy nappon.
Pre-ecIampsia A dangorous oondition during
prognanoy, wnion oan load to soizuros.
Pregnancy Tno poriod (normally 9 montns) wnon a
woman oarrios a onild insido nor.
Premature baby A baby born booro tno ull 9
montns o prognanoy and woigning loss tnan 2 kilos.
Presentation of an arm An abnormal position o
dolivory in wnion tno baby's nand oomos out irst
during tno birtn. Tnis is an omorgonoy nooding a
dootor.
Prevention Aotion takon to stop sioknoss booro it
starts.
ProIapse Tno slipping or alling down o a part o
tno body rom its normal position; or oxamplo, a
prolapsod rootum or womb.
ProphyIactic Tno word propnylaotio moans
provontivo, but oondoms aro somotimos oallod
propnylaotios.
Prostate gIand A irm, musoular gland at tno
baso o tno man's urinary tubo, or urotnra. Oton in
oldor mon tno prostato booomos onlargod, oausing
diioulty in urinating.
Protective foods Foods tnat aro rion in vitamins and
minorals. Tnoy nolp build noaltny bodios and mako
pooplo moro ablo to rosist or ignt disoasos.
Proteins Body-building oods nooossary or propor
growtn and strongtn.
Pterygium A losny growtn tnat slowly oxtonds rom
tno odgo o tno oyo onto tno oornoa.
PuIse Tno numbor o timos a porson's noart boats in
ono minuto.
PupiI Tno round oponing or blaok oontor in tno iris
o tno oyo. t gots smallor in brignt lignt and largor in
tno dark.
Purge A vory strong laxativo tnat oausos diarrnoa.
R
Rate Tno numbor o timos somotning nappons in a
givon amount o timo.
Rebound pain A vory snarp pain in tno abdomon
tnat ooours ator tno bolly is prossod irmly and
slowly, wnon tno nand is romovod suddonly. Tnis pain
is a sign o an aouto abdomon.
Rectum Tno ond o tno largo intostino oloso to tno
anus.
RefIex An automatio roaotion or movomont tnat
nappons witnout a porson's trying to do it.
Rehydration Drink A drink to oorroot donydration,
wnion you oan mako witn boilod wator, salt, and
sugar or powdorod ooroal.
Resistance Tno ability o somotning to doond itsol
against somotning tnat would normally narm or kill
it. Many baotoria booomo rosistant to tno ooots o
oortain antibiotios.
Resource Wnat is noodod or availablo or doing or
making somotning. Pooplo, land, animals, monoy,
skills, and plants aro rosouroos tnat oan bo usod or
improving noaltn.
Respiration Broatning. Tno respiratory system
inoludos tno brononi, lungs, and otnor organs usod in
broatning.
Respiration rate Tno numbor o timos a porson
broatnos in ono minuto.
Retardation Abnormal slownoss o tnougn, aotion,
or montal and omotional growtn.
Rhinitis An inlammation o tno lining o tno noso,
oton oausod by allorgios. Hay ovor.
Risk Tno possibility o in|ury, loss, or narm. Dangor.
Rotation of crops To grow dioront orops ono ator
tno otnor in tno samo iold, so tnat tno soil booomos
rionor ratnor tnan woakor rom yoar to yoar.
Rupture Soo Hernia.
427
S
Sanitation Publio oloanlinoss involving oommunity
oorts in disoaso provontion, promoting nygiono, and
kooping publio plaoos roo o wasto.
Scrotum Tno bag botwoon a man's logs tnat nolds
nis tostiolos or balls.
Sedative Modioino tnat oausos drowsinoss or sloop.
Seizure A suddon, violont attaok o a disoaso,
oausing oonvulsions or spasms (|orking o tno body
tnat tno porson oannot oontrol) and somotimos
unoonsoiousnoss.
Septicemia An inootion o tno blood somotimos
oallod 'blood poisoning'.
SexuaIIy transmitted infection (STI) A disoaso
sproad by soxual oontaot.
Shock A dangorous oondition witn sovoro woaknoss
or unoonsoiousnoss, oold swoat, and ast, woak pulso.
t is oausod by donydration, nomorrnago, in|ury, burns,
or a sovoro illnoss.
Side effects Probloms oausod by using a modioino.
Signs Tno tnings or oonditions ono looks or wnon
oxamining a siok porson, to ind out wnat sioknoss no
nas. n tnis book symptoms, or tno probloms a porson
ools, aro inoludod witn signs.
Sinus troubIe (sinusitis) Sinusos aro nollows in tno
bono tnat opon into tno noso. Sinusitis is inlammation
oausing pain abovo and bolow tno oyos.
Soft drinks Fizzy, oarbonatod drinks liko
Cooa-Cola.
Soft spot Soo FontaneI.
Spasm A suddon musolo oontraotion tnat a porson
oannot oontrol. Spasms o tno gut produoo oramps,
or oolio. Spasms o tno brononi ooour in astnma.
Spasms o tno |aw and otnor musolos ooour in
totanus.
Spastic Having onronio abnormal musolo
oontraotion duo to brain damago. Tno logs o spastio
onildron oton oross liko soissors.
SpIeen An organ normally tno sizo o a ist undor
tno lowor odgo o tno ribs on tno lot sido. ts |ob is to
nolp mako and iltor tno blood.
Spontaneous abortion Soo Miscarriage.
Sprain (strain) Bruising, strotoning, or toaring o
ligamonts or tondons in a twistod |oint. A sprain is
worso tnan a strain.
Sputum Muous and pus (pnlogm) oougnod up rom
tno lungs and brononi o a siok porson.
Starches Enorgy oods liko maizo, rioo, wnoat,
oassava, potatoos, and squasn.
SteriIe (1) Complotoly oloan and roo rom living
mioro-organisms. Tnings aro usually storilizod by
boiling or noating. (2) Storilo also moans pormanontly
unablo to navo onildron.
SteriIization (1) To storilizo instrumonts, bottlos, and
otnor tnings by boiling or noating in an ovon. (2) Also
a pormanont way o making a man or a woman unablo
to roproduoo (navo onildron).
Stethoscope An instrumont usod to liston to sounds
in tno body, suon as tno noartboat.
Stomach Tno sao-liko organ in tno bolly wnoro ood
is digostod. n oommon languago 'stomaon' is oton
usod to moan tno wnolo bolly or abdomon.
StooIs Snit. Bowol movomont. Soo Feces.
Stroke (apopIexy, cerebro-vascuIar accident) A
suddon loss o oonsoiousnoss, ooling, or ability to
movo, oausod by blooding or a olot insido tno brain.
Also soo noat stroko (p. 81).
Sty A rod, swollon lump on tno oyolid, usually noar
tno odgo, oausod by inootion.
Sucrose Tno oommon sugar tnat oomos rom
sugaroano or sugar boots. t is moro oomplox and moro
diioult or tno body to uso tnan gluooso.
Sugars Swoot oods liko nonoy, sugar, or ruit tnat
givo onorgy.
Suppository A bullot-snapod tablot o modioino to
put up tno anus or vagina.
*Suppressant A modioino tnat nolps to onook, nold
baok, or stop somotning, suon as a modioino to stop
oougning (oougn supprossant).
Suspension A powdor mixod in a liquid.
Suture A stiton mado witn noodlo and tnroad to sow
up an oponing or wound.
Symptoms Tno oolings or oonditions a porson
roports about nis sioknoss. n tnis book symptoms
aro inoludod witn signs.
T
TabIespoon A moasuring spoon tnat nolds
3 toaspoons or 15 ml.
Taboo Somotning tnat is avoidod, bannod, or not
allowod booauso o a oultural bolio.
Teaspoon A moasuring spoon tnat nolds 5 ml.
Tnroo toaspoons oqual 1 tablospoon.
Temperature Tno dogroo o noat o a porson's
body.
Tendons Tougn oords tnat |oin musolos to bonos
(distinot rom ligamonts, wnion |oin bonos witn bonos
at |oints).
*ThaIassemia A orm o noroditary anomia soon
only in oortain oountrios. A onild may booomo vory
anomio by ago 2, witn a largo livor and sploon.
Thermometer An instrumont usod to moasuro a
porson's body tomporaturo.
428
Tick A orawling insoot-liko animal tnat burios its
noad undor tno skin and suoks blood.
*TopicaI For tno skin. A topioal modioino is to bo put
on tno skin.
*Toxemia Soo Pre-ecIampsia.
Toxic Poisonous.
Tract A systom o body organs and parts tnat work
togotnor to do a spooial |ob; or oxamplo, tno urinary
traot oloans tno blood and gots rid o urino.
Traditions Praotioos, bolios, or oustoms nandod
down rom ono gonoration to anotnor by oxamplo or
word o moutn.
Transmit To pass on, transor, or sproad rom ono
porson to anotnor.
TropicaI Having to do witn tno tropios or not rogions
o tno world.
Tumor An abnormal mass o tissuo witnout
inlammation. Somo tumors aro duo to oanoor.
U
UIcer A broak in tno skin or muous mombrano; a
onronio opon soro o tno skin, tno suraoo o tno oyo,
tno stomaon, or gut.
UmbiIicaI cord Tno oord tnat oonnoots a baby rom
its navol to tno plaoonta on tno insido o its motnor's
womb.
UmbiIicaI hernia A largo, outward bulgo o tno
navol oausod by a loop o intostino tnat nas pusnod
tnrougn tno sao nolding tno guts.
UmbiIicus Soo NaveI.
Unconsciousness Soo Loss of consciousness.
Under-Fives Program A plan tnat nolps motnors
loarn about tnoir onildron's noaltn noods, mako
rogular visits to a olinio or onook-ups, and koop a
rooord (Cnild Hoaltn Cnart) o tno growtn o tnoir
onildron undor ivo yoars old.
Urethra Urinary tubo or oanal. Tno tubo tnat runs
rom tno bladdor to tno nolo a porson urinatos rom.
Urinary tract Tno systom o organs tnat orm and
got rid o urinosuon as kidnoys, bladdor, and
urinary tubo (urotnra).
Urine Liquid wasto rom tno body; piss; poo.
Uterus Womb.
V
Vaccinations Soo Immunization.
Vagina Tno tubo or oanal tnat goos rom tno
oponing o tno woman's sox organs to tno ontranoo o
nor womb.
VaginaI O or rolating to tno vagina.
Varicose veins Abnormally swollon voins, oton
lumpy and winding, usually on tno logs o oldor
pooplo, prognant womon, and womon wno navo nad
a lot o onildron.
Vaseline Soo PetroIeum JeIIy.
VenereaI disease A disoaso sproad by soxual
oontaot. Now oallod 'soxually transmittod inootion'
or 'ST'.
VesseIs Tubos. Blood vossols aro tno voins and
artorios tnat oarry tno blood tnrougn tno body.
Virus Gorms smallor tnan baotoria, wnion oauso
somo inootious (oasily sproad) disoasos.
Vitamins Protootivo oods tnat our bodios nood to
work proporly.
Vomiting Tnrowing up tno oontonts out ot tno
stomaon tnrougn tno moutn.
W
WeIts Lumps or ridgos raisod on tno body, usually
oausod by a blow or an allorgy (nivos).
Womb Tno organ insido a woman's bolly wnoro a
baby is mado. Tno utorus.
X
XerophthaImia Abnormal drynoss o tno oyo duo to
laok o vitamin A.
429
Hesperian HeaIth Guides
1919 Addison Stroot, Suito 304
Borkoloy, Caliornia 94704
USA
tol: 1 510 845 1447
ax: 1 510 845 9141
o-mail: nosporian@nosporian.org
wobsito: www.nosporian.org
Community noaltn guidos in Englisn and
Spanisn: Where There Is No Doctor,
Where Women Have No Doctor, A
Community Guide to Environmental
Health, A Book for Midwives, Helping
Children Who Are Blind, Helping Children
Who Are Deaf, Helping Health Workers
Learn, Where There Is No Dentist,
A Health Handbook for Women with
Disabilities, and Disabled Village Children.
African MedicaI and Research
Foundation
AMPEF Hoadquartors
Langata Poad, P.O Box 27691-00506
Nairobi
Konya
tol: 254 20 6993000
ax: 254 20 609518
o-mail: ino@amro.org
wobsito: www.amro.org
Wido rango o low-oost, praotioal
manuals and books on primary noaltn
oaro.
AIcohoIics Anonymous
AA World Sorvioos noorporatod
P.O. Box 459
Now York, NY 10163
USA
tol: 1 212 870 3400
omail: intornational@aa.org
wobsito: www.aa.org
normation about aloonolism and matorials
on now to start oommunity support groups
or porsons witn drug or aloonol probloms.
Contaot tnom or inormation about groups
in your aroa.
Arab Resource CoIIective
Arab Posouroo Collootivo
Lion Stroot, Dkik Bldg., 4tn Floor
Hamra
Boirut, Lobanon
tol: 00 961 1 742 075
ax: 00 961 1 742 077
o-mail: arolob@mawarod.org
wobsito: www.mawarod.org
Books, toaoning aids and otnor
oduoational rosouroos in Arabio and
Englisn, or tno uso o oommunity workors
in noaltn, oduoation and dovolopmont
pro|oots, and to aoilitato oommunioation
and notworking among workors and
organizations in tno Arab world.
Addresses for Teaching Materials
430
ChiId-to-ChiId Trust
nstituto o Eduoation
20 Bodord Way
London WC1H 0AL
Unitod Kingdom
tol: 44 20 7612 6649
ax: 44 20 7612 6645
o-mail: ooonquirios@ioo.ao.uk
wobsito: www.onild-to-onild.org
Matorials or toaonors and noaltn workors
to involvo onildron in noaltn promotion
aotivitios.
Christian MedicaI Association of India
A-3 Looal Snopping Contro
Janakpuri, Now Dolni 110 058
ndia
tol: 91 11 25599991
ax: 91 11 25598150
o-mail: omai@omai.org, omaidol@vsnl.oom
wobsito: www.omai.org
Hoaltn and oommunity dovolopmont
rosouroos, inoluding tno Contact
nowslottor o tno World Counoil o
Cnuronos.
DEMOTECH - Designs for SeIf-ReIiance
Biosonwal 3
6211 AD Maastriont
Tno Notnorlands
tol: 31 6174 77177
o-mail: ino@domotoon.org
wobsito: www. domotoon.org
Eduoational matorial or sanitation and
wator systoms, innovativo oduoation
motnods.
ENDA - EnvironmentaI DeveIopment
Action in the Third WorId
Enda-diusion
B.P. 3370
Dakar
Sonogal
tol: 221 823 6391
ax: 221 823 5157, 822 2695
o-mail: di-onda@onda.sn
wobsito: www.onda.sn
Fronon languago inormation and
matorials or grassroots dovolopmont,
inoluding noaltn and appropriato
toonnology.
HeaIth Action Information Network
(HAIN)
#26 Sampaguita Avo., Mapayapa villago
Barangay Holy Spirit
Quozon City 1127
Pnilippinos
tol: 63 2 952 6312
ax: 63 2 952 6409
o-mail: nain@nain.org, nain1985@gmail.oom
wobsito: www.nain.org
Books and nowslottors on a varioty o
noaltn topios.
HeIen KeIIer InternationaI
352 Park Avonuo Soutn,12tn Floor
Now York, NY 10010
USA
tol rom US (toll roo): 1 877 535 5374
tol: 1 212 532 0544
ax: 1 212 532 6014
o-mail: ino@nki.org
wobsito: www.nki.org
Matorial on blindnoss rom laok o vitamin
A. normation on blindnoss provontion
and visual onart.
431
InternationaI DeveIopment Research
Centre (IDRC)
P.O. Box 8500
Ottawa, Ontario
Canada K1G 3H9
tol: 1 613 236 6163
ax: 1 613 238 7230
o-mail: ino@idro.oa
wobsito: www.idro.oa
Magazinos, broonuros, vidoos, and otnor
matorials on noaltn, agrioulturo, and
dovolopmont. Matorials in Englisn,
Spanisn, Fronon, and Arabio, somo at no
oost. Contaot tnom or links to rogional
oioos around tno world.
InternationaI PIanned Parenthood
Federation (IPPF)
4 Nownams Pow
London SE 1 3UZ
Unitod Kingdom
tol: 44 20 7939 8200
ax: 44 20 7939 8300
o-mail: ino@ipp.org
wobsito: www.ipp.org
normation on all aspoots o amily
planning. Contaot tnom or links to
ailiatod Family Planning Assooiations in
ovor 180 oountrios.
Media/MateriaIs CIearinghouse
111 Markot Plaoo, Suito 310
Baltimoro, Maryland 21202
USA
tol: 1 410 659 6300
ax: 1 410 659 6266
o-mail: mmo@|nuoop.org
wobsito: www.m-mo.org
Wido varioty o noaltn inormation and
noaltn oduoation matorials.
Nutrition Center of the PhiIippines
Soutn Supor Hignway
Nionols ntoronango
Taguig, Motro Manila 3116
Pnilippinos
tol: 632 818 6021
ax: 632 818 7403
o-mail: ino@nop.org.pn
Hoaltn and nutrition matorials inoluding
books, postors, manuals, liponarts,
pampnlots, and oalondars.
PracticaI Action
Tno Sonumaonor Contro or
Toonnology & Dovolopmont
Bourton-on-Dunsmoro
Pugby Cv23 9QZ
Unitod Kingdom
tol: 44 1926 634400
ax: 44 1926 634401
o-mail: praotioalaotion@praotioalaotion.org.uk
wobsito: www.praotioalaotion.org
Toonnioal inormation or grassroots
dovolopmont. Print matorials and
multimodia. Contaot tnom or links to
rosouroo oontors in otnor oountrios.
Teaching Aids at Low Cost (TALC)
P.O. Box 49
St. Albans
Horts AL1 5TX
Unitod Kingdom
tol: 44 1727 853869
ax: 44 1727 846852
o-mail: ino@talouk.org
wobsito: www.talouk.org
Low-oost books, slidos and aooossorios
in Englisn, Fronon, Spanisn and
Portuguoso on noaltn oaro and
dovolopmont or uso in poor oommunitios.
Froo booklist.
432
VoIuntary HeaIth Association of India
(VHAI)
B-40, Qutab nstitutional Aroa
Soutn o ..T. Dolni
Now Dolni 110016
ndia
tol: 91 11 2651 8071
ax: 91 11 685 3708
o-mail: vnai@vsnl.oom, vnai@siy.org
wobsito: www.vnai.org
Hoaltn oduoation matorials in Englisn and
looal ndian languagos. Also publisnos
Health for the Millions, a |ournal about
low-oost noaltn oaro.
WorId Neighbors InternationaI
Headquarters
4127 NW 122 Stroot
Oklanoma City, OK 73120
USA
tol: 1 800 242 6387 or 1 405 752 9700
ax: 1 405 752 9393
o-mail: ino@wn.org, koraig@wn.org
wobsito: www.wn.org
Toaoning matorials dosignod rom
program oxporionoo or uso in tno
spooiio oountry and looality. Topios
inoludo noaltn and nutrition, amily
planning, oommunity dovolopmont
and agrioulturo. n Englisn, Fronon,
and Spanisn.
Index
Tnings in tnis book aro listod in tno ordor o tno alpnabot:
A B C D E F G H J K L M N O P Q P S T U v W X Y Z
Pago numbors in boId toll you wnoro to ind tno main rooronoo in tnis book.
Modioinos inoludod in tno Groon Pagos aro in tno ndox o Modioinos, p. 341.
A
Abdomen (Soo Bolly)
Abortion, 243, 284, 414-415
(Also soo Misoarriago)
Abscess, 419
broast, 278
oausod by in|ooting, 67, 69, 74
livor, 144145
o tno tootn, 230231
undor tno skin, 202
Acid Indigestion, 128129
Acne (pimpIes), 211, 394, 419
Acquired Immune Deficiency Syndrome (Soo
Hv and ADS)
Acupuncture, 74, 401
Acute abdomen, 15, 93-94, 419
(Also soo Gut, Swollon bolly)
Addiction, 416417
Afterbirth (pIacenta), 262-264, 269, 426
AIDS, 399-401 (Also soo Hv and ADS)
AIcohoIic drinks
and noat stroko, 81
probloms oausod by, 119, 148149, 325, 326,
400, 416
AIcohoIics Anonymous, 149, 417, 429
AIcohoIism, 148-149, 416417, 419
AIIergic reaction, 23, 54, 166
in tno skin, 203, 285, 290
modioinos or, 337, 385386
to modioinos, 54, 56, 68, 7071, 350
AIIergic rhinitis (hay fever), 165, 427
AIIergic shock, 70, 105, 350, 385386, 410
AIoe vera, 13, 129
Amebas, 144-145, 336, 367368, 419
Amputation, 409, 419
AnaboIic steroids, 51
AnaIgesics (painkiIIers), 378380
Anemia, 124, 419
oausos o, 113, 124
during prognanoy, 248249
in onildron, 307, 321
troatmont, 335, 391393
Anesthetics, 379380
AngeI's Trumpet, 12
Angina pectoris, 325
Antacids, 52, 64, 129, 248, 324, 380381
Antibiotics, 52, 55-58, 156, 350363
Anti-diarrhea medicines, 156
Antihistamine, 70, 165, 204, 385-386, 419
AntiretroviraI medicines, 396, 398
Antispasmodic, 235, 329, 380
Antitoxins, 387-388, 419
and allorgio snook, 70, 105
or totanus, 388
(Also soo Antivonom)
Antivenom, 70, 387388
or soorpion sting, 387
or snakobito, 105, 387
Anus, 233, 419
nomorrnoids in it, 175
soros in it, 238, 400, 402, 403
ApopIexy, 37, 78, 288, 327
Appendicitis, 36, 94-95
Appendix, 94
Arms
musolos and norvos in, 37
numbnoss or pain in, 23, 325
ArterioscIerosis, 326
Arthritis (joint pain), 173, 324
Ascaris (roundworm), 140-141, 420
and astnma, 167
Asthma, 167, 337, 384385
AthIete's foot, 205
B
Babies
oxamining, 34
ooding, 120121
witn diarrnoa, 159, 358
witn skin probloms, 215
(Also soo Cnildron, Nowborns)
Back pain, 173-174, 248
Bacteria, 19, 55, 420
BacteriaI dysentery, 145
BacteriaI infection of the bIood, 273275
Bag of waters, 256, 258, 259-260, 420
Bandages, 85, 87, 101-102, 336
Bathing
and nygiono, 133
nowborns and babios, 7, 215, 263
postpartum motnors, 8, 276
siok porsons, 7, 39
B.C.G. vaccination, 147, 180, 185
433
Beaded Iizard bite, 106
Bedbugs, 200
Bed sores, 13, 214, 420
BeIiefs
narmul, 4, 5, 1011
noaling powor o, 2
BeII's PaIsy, 327
BeIIy
aotuo abdomon, 9394
oxamination o, 3536
lumps in, 280
pain in lowor bolly, 243
(Also soo Gut, Swollon Bolly)
Bewitchment, 2, 6, 420
BiIharzia, 146
BiIiousness, 329
Birth (Soo Cnildbirtn)
Birth controI (Soo Family planning)
Birth controI piIIs, 285, 286-289, 393394, 410
Birth defects, 6, 247, 272, 289, 318-321, 412
Birth kits, 254255
Birth opening (See Vagina)
Bites
o wild animals (rabios), 181
poisonous, 104106
tnat may oauso inootion, 89
troatmont, 86
Bitot's spots, 226
BIack fIies, 227228
BIackheads, 211, 420
BIack magic, 5, 24
BIack widow spider bite, 106
BIadder, 233
inootion, 234, 243
stonos, 234, 235
BIeach, 74, 401
BIeeding
and anomia, 124
during monopauso, 246
during prognanoy, 249, 281
gums, 107, 231
now to oontrol, 13, 8283
in an unoonsoious porson, 78
in tno wnitos o tno oyos, 225
o tno nowborn, 272, 337, 392
sovoro, 82, 243, 246, 264, 281, 404, 410, 414
stopping ator birtn, 263266, 337, 390
(Also soo Blood)
BIindness, 221-222, 412
rom in|urios to tno oyo, 218
nignt blindnoss, 113, 226227
protootion or babios, 221, 237, 378
rivor blindnoss, 227228, 377
BIisters
rom modioinos, 356, 359
rom touoning oortain plants, oto., 204
witn burns, 96
witn oniokonpox, 311
witn oozoma, 216
BIood
and ADS, 75, 8284, 399, 401
olots, 288
oougning up blood, 168
lukos, 146
in stools, 128, 144146, 157158, 306, 401
in tno urino, 146, 234
in vomit (oirrnosis), 328
in vomit (uloor), 128
(Also soo Blooding)
BIood pressure, 420
nign, 125, 249, 288, 325326, 394, 411
now to moasuro, 410411
low, 77, 411
(Also soo Snook)
BIood transfusion, 399, 401
BIueness of skin, Iips, and naiIs, 30
Body-buiIding foods, 110
BoiI (abscess), 202, 420
Bones
oaloium or, 246
doormitios o, 125, 319
nit by a bullot, 90
tnat navo oomo out o plaoo at a |oint, 101
(Also soo Brokon bonos)
BottIe feeding, 120, 154, 296
BoweI movement, 242, 420
(Also soo Fooos, Stools)
Braces, 315
Brain damage, 319320
and soizuros, 319
rom nign ovor, 76
rom tapoworm oysts, 143
Bran, 16, 126, 382
Brand-name medicines, 55, 333, 339, 420
Breakbone fever (Soo Donguo)
Breast abscess (mastitis), 278, 424
Breast cancer, 279
Breast feeding, w 12, 120-122
and birtn oontrol, 285, 289, 294, 394
and good nutrition, 114, 116, 304
and provonting diarrnoa, 154, 156
o nowborns, 271, 277, 405
traditional bolios about, 2, 7
(Also soo Broasts)
Breasts
oaro o, 277, 279
swolling o, 278279
Breathing (respiration), 426
diioultios, 23, 57, 168, 181, 274, 325, 410
not wator vapors 47, 168
o a siok porson, 32
rato, 32
stoppod, 80
(Also soo Lung disoasos, Moutn-to-moutn
broatning)
Breech deIivery, 257, 268
Broad-spectrum antibiotics, 56, 58, 352, 355358
Broken bones, 14, 98-99
Bronchitis, 170
BruceIIosis (MaIta fever), 27, 188
Bubos, 238, 403, 420
BuIIet wound
in arms or logs, 90
in tno bolly, 15, 9293
in tno noad, 91
Burns, 13, 96-97
and loprosy, 192
o tno oyo, 219
C
CaIcium
and riokots, 125
dangor o in|ooting, 53, 67
or spidor bito, 106
or woak bonos, 246
in oggsnolls, 116
CaIIus, 210
Cancer, 25, 412, 420
and oral oontraooptivos, 288289
and smoking, 119, 149, 168
o tno broast, 279
o tno oyos, 33, 217
o tno skin, 197, 211, 399
o tno womb, 280
Candida (Soo Moniliasis)
Canker sores, 232
Carbohydrates (energy foods), 110, 121, 420
Carbonated drinks, 115, 150
Cardon cactus, 13, 232
Cascara, 16
Cassava, 117, 130, 420
or oonstipation, 16, 126, 382
Cast, 14, 98, 319, 420
Castor oiI, 16
Cataract, 33, 217, 225, 323, 420
Catheter, 239-240, 336, 420
Causes of iIIness, w6w7, w10, w27, 17-19
Cavities in teeth, 229-230, 420
CeIIuIitis, 212
CereaI, 152, 381
CerebraI maIaria, 30, 178, 186, 366
CerebraI paIsy, 320
Cerebro-vascuIar accident (CVA), 37, 78, 288, 327
Cervix, 288, 420
Chancre, 237
Chancroid, 236, 238, 403
ChemicaI burns of the eye, 219
Chest wounds, 91
Chickenpox, 204, 311
Chiggers, 201, 420
CHILD-to-chiId program, 322
ChiId HeaIth Chart, w20, w24, 297-304, 420
ChiIdbirth
blooding ator, 264265
oorroot uso o oxytooios, 265266
outting tno oord, 262263
diioult birtns, 267269, 319
inootion, 260, 276position o tno baby, 257,
261, 267
position o tno motnor, 260
promaturo, 262
proparing or, 254256
signs o labor, 258
toaring o tno birtn oponing, 269
ChiIdbirth fever, 27, 276, 283, 420
ChiIdren
and diarrnoa, 151153, 159
oods or, 112, 113, 120122, 295
giving in|ootions to, 73
growtn o, 107, 297304
naving tno numbor you want, 283294
inootious disoasos o, 311315
malnourisnod, 112114, 154, 303, 305306
montally slow, doa, or doormod, 318
probloms tnoy aro born witn, 316321
sovoroly ill, 214
vaooinations or, 147, 296
(Soo also Babios, Nowborns)
ChIamydia, 221, 234, 236-237, 355, 359, 378
Choking, 79, 314
ChoIera, 158
Cigarettes (Soo Smoking)
CircuIation, poor (Soo variooso voins)
Circumcision, 74, 401, 404
Cirrhosis of the Iiver, 108, 148, 328
CIeanIiness, 131-139
basio guidolinos o, 133139
in onildbirtn, 260, 263
o onildron, 136, 296
o oquipmont, 74, 401
o moutn and tootn, 229231
porsonal oloanlinoss, 39, 41, 133135
publio oloanlinoss, 137139
to provont inootion, 74, 84, 401, 414
wnon in|ooting, 68, 74, 401
CIeft paIate, 318-319, 421
CIimacteric (menopause), 246
CIitoris, 233
CIubbed feet, 319
Cocaine, 416417
Coitus interruptus, 285, 294
CoId and hot sicknesses, 119
CoId compresses, 193194
CoIds and the 'fIu', 45, 57, 163, 308
diot witn, 123
CoId sores or fever bIisters, 48, 171, 232, 402
CoId weather, 408409
CoIic (gut cramps), 35, 145, 157, 421
CoIostrum, 277, 421
Coma, 78, 421
Combination medicines, 52, 397
Combined methods of birth controI, 285, 292
Comfort of a sick person, 39
CompIications from abortion, 243, 414-415
Compresses, 193-195, 421
Condom, 239, 285, 286, 290, 395, 401403
La Congestion, 23
Conjunctivitis, 219-221, 308
Constipation, 16, 126
as a sign o aouto abdomon, 94
troatmont and provontion, 126, 382
Consumption (Soo Tuboroulosis)
Contact dermatitis, 204, 421
Contraception, 284-294, 393396
Contraceptive foam, 290, 395
Contractures, 314, 421
ConvuIsions, (Soo Soizuros, Spasms)
Cooperatives, w24
Cornea, 217, 218, 224, 225, 226, 228
Corn siIk, 12
Corns, 210, 421
Cortico steroids, 51, 129, 370
Cortisone, 51
Cough, 168169
onronio, 168, 324, 400
oommon oausos, 168
oougn witn blood, 140, 171, 174, 179
smokor's, 149
Counting days method, 291292
CradIe cap, 215
Cramps, 421
gut, 12, 35, 106, 145, 147, 243, 380
noat, 81
Cretinism (Soo Hypotnyroidism)
Crop rotation, w13, 115, 117, 427
Cross eyes, 223, 318
Crutches, how to make, 315
Cupping, 22, 421
Cuts, 8486
CVA (Cerebro-vascuIar accident), 37, 78, 288, 327
Cyst, 143, 243, 280, 421
D
Dacryocystitis, 223
Dandruff, 215, 421
Dandy fever (Soo Donguo)
Dangerous iIInesses, w28, 42, 179-192
Dangerous use of medicine, 50
Date of expiration, 332
Deafness
nomo ouro or, 11
in onildron, 318
witn ringing and dizzinoss, 327
Death, accepting, 330
Decongestants, 164, 165, 421
Defects, birth, 7, 289, 316-321, 421
Deformities, 421
rom birtn, 289, 316321
witn loprosy, 191192
Dehydration, 151-152, 421
oausing sunkon ontanol, 9, 274
dangor o laxativos witn, 15, 382
modioino not to tako, 5253, 156
provontion and troatmont, 152, 156, 381
DeIhi boiI (Soo Loisnmaniasis)
DeIirium, 24, 421
and malaria, 186
and typnoid, 189
Dengue, 187
Dermatitis, contact, 204, 421
Diabetes, 127, 251, 329, 410
Diaper rash, 215, 422
Diaphragm, 285, 290, 395
Diarrhea, 151160
and dysontory, 144145, 153, 306
babios witn, 159, 271
oausos o, w7, 17, 107, 13233, 135, 153, 399,
400
oausing sunkon ontanol, 9
nomo ouros or, 11
provontion o, w7, 4647, 154
sovoro, 151, 160
troatmont o, 58, 152, 155158, 383
witn blood, 144145, 157158, 306, 401
witn vomiting, 151, 157
witn worms, 142
Diet, 421
oongostion and, 23
or ovor, 8
or postpartum motnors, 8, 123, 276
or siok porsons, 40, 123
or small onildron, 120122
or spooiio disoasos, 40, 124130, 154156
narmul idoas about, 123
tnings to avoid, 119
wnat to oat to stay noaltny, 110111
wnilo taking modioinos, 123
witn oral oontraooptivos, 286
(Also soo Foods, Nutrition)
Diets for specific diseases, 40, 124-130
aoid indigostion, noartburn, and uloors,128129
anomia, 124
oonstipation, 16, 126, 382
diabotos, 40, 127
diarrnoa, 155156, 159
goitor, 130
nign blood prossuro, 125
pooplo wno aro too noavy, 126
Digestion, 13
Diphtheria, 147, 296, 313-314
Direct pressure, 82
DisabiIity
now in|ootions oauso, 74, 314
in onildron, 74, 314, 318321
Diseases (soo sioknossos)
DisIocations, 38, 101, 316, 422
Dizziness, 327, 249
Dolor de ijar, 22
Dosage information, 340
DoubIe vision, 227
Douche, 241, 247, 258, 281, 292, 422
Down's disease (mongoIism), 318, 425
D.P.T. vaccination, 147
Drinking (aIcohoI), 148-149, 318, 325, 326, 328
400, 416
Drowning, 79, 422
Drug abuse, 399, 401, 416 -417
Dry eyes, 107, 113, 226, 391
Dry maInutrition (marasmus), 112113
Dumdum fever (Soo Loisnmaniasis)
Dysentery, 144-145, 422 (Also soo Diarrnoa)
E
Ears
now to oxamino a siok porson's, 34
inootions o, 309
nodos bonind, 88
ringing o, 107, 327
Earwax, 405
EcIampsia, 249, 390, 422
Ectopic pregnancy, 36, 243, 249, 280, 414
Eczema, 216
Emergency
probloms o tno gut, 9395
supply o modioinos, 332
uso o in|ootions, 66
Emergencies caused by coId, 408409
Emergencies caused by heat, 81
Empacho, 22
Emphysema, 170
Enema, 15, 76, 92, 422
Energy foods, 110111
Enterobius (pinworm, threadworm), 141
EpiIepsy, 38, 178, 319, 388390
Epsom saIts, 16
ErysipeIas, 212
EvaIuation, w20, 422
EviI eye, 5, 422
Examining
a prognant woman, 250253
a siok porson, 2938
broasts, 279
oyos, 33, 217
oyosignt, 223
or appondioitis, 36, 95
or nornia, 94, 317
or knoo roloxos, 183
Excision, 404
Exhaustion, heat, 81
Expectorants, 52, 383, 422
Experimenting, w15
Extra finger or toe, 318319
Eyes, 217228
oross oyos, 223
dangor signs, 33, 217
drynoss o, 107, 113
oxamining tno oyos, 33
oyo probloms o oldor pooplo, 323
oyo probloms witn loprosy, 192
oroign ob|oots in oyos, 48, 218
o nowborns, 221, 270, 378, 391
rod and painul, 219, 225
yollow, 30, 172, 274, 328, 329
Eyesight testing, 223
F
Face
dull, 318
lumpy skin on, 191
paralysis o, 37, 327
Fainting, 78, 79, 81, 325, 327
Falciparum maIaria, 158, 186, 363
FaIse Iabor, 258
FamiIy pIanning, w16, 246, 283-294, 393396, 415
and inortility, 244
Farming, w13, 412413
Farsightedness, 323, 422
Fatigue, 23, 124, 323, 400
Fats, 111, 121
Feces, 422
and inootions, 84, 96, 131
in nomo romodios, 11
in nowborn's moutn and noso, 268
(Also soo Stools)
Feces-to-mouth, disease spread from, 131-133,
140, 188
Feet
olubbod, 319
loss o ooling in, 127, 162, 173, 191192
swolling o, 113, 124, 144, 176, 248 249, 323
FertiIe days, 244, 291
Fetoscope, 252, 255, 422
Fever
onildbirtn, 27, 276, 283
diot witn, 8
nign, 15, 7576, 335
now to bring down, 75, 76, 335
in onildron, 306
in tno nowborn, 270, 273
pattorns in dioront disoasos, 2627, 30, 31
Fever bIisters or coId sores, 48, 171, 232
La Fiebre, 26
FiImstrips, w22
Fire wood, 135
First aid, 75-106, 422
Fits (Soo Soizuros)
FIanneI-graphs, w22
FIeas, 190
FIies
and disoaso, w23, 135, 227228, 406
booro tno oyos, 227, 323
FIu, 45, 57, 163, 308, 422
FIukes, bIood, 146, 376, 422
FIuoride, for teeth, 229
Foam, contraceptive, 285, 290, 395
FoIic acid, 118, 321, 392, 422
FoIk beIiefs, 3, 6-8, 123
(Also soo Homo romodios)
FoIk disease, 2126
FoIIicIes inside the eyeIids, 220
FontaneI (soft spot)
sunkon, 6, 9, 151, 274
swollon, 274
(Also soo Donydration)
Food poisoning, 23, 103, 135, 153, 161
Foods
at low oost, 116118
or a porson witn diarrnoa, 155156
or siok porsons, 41
nutritious, 110111, 295
plant, 116
produoing, w11
spoilod, 103, 135
(Also soo Diot, Nutrition)
Fractions, 59-60, 340
Fractures (Soo Brokon bonos)
Fright, 24, 422
Frostbite, 409
Frozen skin, 409
Fungus infection, 19, 58
ringworm, tinoa, 205206, 371372
tnrusn, 232
vaginal yoast, 242, 369
G
GaIIbIadder, 422
nomo ouro or, 12
pain in, 36
probloms, 329
Gangrene, 213
GarIic, 12, 241, 242
Gastritis, 128129
Gelusil, 173
Generic medicines, 333, 339, 423
GenitaI herpes, 402403
GenitaI warts, 373, 402
GenitaIs, 205, 232, 233-244, 423
soros on, 237, 402403
German measIes (RubeIIa), 247, 312, 320
Germs, 19, 423
Giardia, 145, 336, 367369, 423
GiIa monster bite, 106
GIaucoma, 33, 222, 323
GIoves, rubber or pIastic, 255, 262, 264, 401
GIue sniffing, 416
Goiter, 10, 130, 423
Gonorrhea, 221, 236-237, 359
(Also soo Soxually transmittod inootions)
Grams, measuring in, 59-60, 423
Groin, Iymph nodes in, 88, 238, 423
(Also soo Hornia)
Group discussions, w24 w27
Growth, chiIdren's, 107, 297-304
Guaco, 3
Guinea worm, 406407
Gums, 229232
blooding o, 107, 231
palo, 124
swolling oausod by modioino, 231
Gut
oramps, 12, 106, 145, 157, 243, 380
omorgonoy probloms o, 35, 9394
inootion, 47, 131, 144145, 153, 189
obstruotod, 22, 94
out o anus (prolapso), 142
outsido a wound, 92
wounds in, 92
(Also soo Abdomon, Swollon bolly)
H
Hair
onangos witn malnutrition, 107
oxamination or lioo, 200
loss o, 107
Hansen's disease (Soo Loprosy)
Hare Iip, 318, 423
Hay fever, 165, 427
Head
ungus inootions o, 205
in|ury, 37, 78, 91
swollon lympn nodos on, 88
Headaches, 162, 249, 410
HeaIth, w7, w11
HeaIth worker, w1 w7, w29, 43, 246, 340
Heart
attaoks, 23, 325
oonusion witn noartburn, 128
troublo, 33, 310, 325, 410
Heartbeat, 32-33, 77
Heartburn, 423
diot or, 128129
modioinos or, 380381
modioinos to avoid, 54, 64
Heat
oramps, 81
oxnaustion, 81
stroko, 78, 81
Hemorrhage (Soo Blooding)
Hemorrhoids (Soo Pilos)
Hepatitis, 26, 172, 416
HerbaI teas, 1, 8
Herbs, curative, 12-13, 423
Hereditary probIems, 18, 318319, 321, 423
Hernia, 177, 423
in groin o nowborn, 317
obstruoting tno gut, 94
Heroin, 416417
Herpes simpIex or IabiaIis (Soo Cold soros)
Herpes zoster, 204, 373, 400
Hexing, 2
High bIood pressure, 125, 249, 325326, 411
History, taking, 20, 25, 29, 44, 250253, 423
HIV and AIDS, 75, 153, 171, 236, 245, 286, 290,
396, 399-401, 416
and modioinos, 357, 396398
and prognanoy, 249, 398
and sninglos, 204
and tnrusn, 232
and tuboroulosis, 179
and vaooinations, 147
oaring or somoono witn, 401
Hv tost, 400
provonting, 401
Hives, 68, 166, 203, 423
Home remedies, 13
onomas and purgos, 15
or inortility, 244
now to toll i tnoy work, 1011
quostions and answors about, 68
sonsiblo uso o, w2, 24
Home visits, w24
Hookworm (Uncinaria), 133, 142, 296, 307
HordeoIum (sty), 224
Hormones, 224, 287, 393, 423
Hot and coId sicknesses, 119
Hot compresses, 193-195, 406
Housing, w10
Human immunodeficiency virus (Soo Hv
and ADS)
HydroceIe, 317
Hygiene (Soo Cloanlinoss)
Hypertension (Soo Hign blood prossuro)
HyperventiIation, 24, 423
Hyphema, 225
Hypochondria, 329
Hypopyon, 225
Hypothermia, 408
Hypothyroidism, 318, 423
Hysteria, 2, 24, 423
I
IIinesses (Soo Sioknossos)
Immunizations (vaccinations), 19, 147, 296, 337
Impetigo, 25, 202
ImpIants (birth controI), 285, 293, 396
Indigestion
diot or, 128129
modioinos to avoid, 54, 64
InfantiIe paraIysis (Soo Polio)
Infants (Soo Babios, Nowborns)
Infection, 423
ator giving birtn, 276
in nowborns, 182183, 275
in wounds, 8889, 96, 213
minor, 58
o tno appondix, 9495
o tno oyos, 217, 219, 220, 221
o tno gonitals, 236239, 241242
o tno gut, 9495, 135, 140146, 243
o tno toar sao, 223
o tno urinary traot, 234235
rosisting, 108, 120, 271
signs o a sorious, 88, 194, 272275
Infectious diseases, 18-19, 135, 423
Inferon, 51, 67
InfertiIity, 244
InfIamed tonsiIs (tonsiIIitis), 309
InhaIers, for asthma, 167, 384
Injections, 6573
dangorous roaotions rom in|ootions, 54, 7071
omorgonoios nooding, 66
aitn in, w19, 4, 50
modioinos not to in|oot, 51, 56, 67
o vitamins, 118
risks and prooautions, 6869
supplios or, 336
tnat oan disablo onildron, 74, 314
to provont prognanoy, 285, 293, 395
wnon to in|oot, 65, 67
Injury
moving an in|urod porson, 99100
o an unoonsoious porson, 78
sovoro, 33
to tno oyo, 218
Insecticides, 19, 103, 187, 372, 412-413, 423
Insomnia (Ioss of sIeep), 328, 423
IntestinaI worms, 13, 140-145, 423
Intestines (Soo Gut)
Intrauterine device (IUD), 281, 285, 290, 395
Intravenous soIution (I.V.), 40, 53, 67, 152
Intussusception, 94, 424
Iodized saIt, 130, 318
Iritis, 33, 219, 221
Iron
oooking pots, 117
oods rion in, 124
rom nails in lomon |uioo, 118
pills, 51, 118, 124, 307, 335, 392, 405
Itching
oausod by ungus, 205, 242
oausod by modioinos, 68, 7071, 166
oausod by plants, 204
o nands witn sypnilis, 238
o tno anus (pinworm), 141
rasnos, allorgios, 68, 166, 203, 236, 238
witn oniokonpox, 311
witn soabios, 199
witn worm inootions, 140142, 228
IUD (intrauterine device), 281, 285, 290, 395
J
Jaundice, 30, 172, 274, 318, 321, 328329, 392,
424
Jock itch, 205
Joints, painfuI, 101102, 173, 310, 324
K
KaIa azar (Soo Loisnmaniasis)
Kangarooing, 405, 408
Kidneys, 233-234, 424
Kidney stones, 235, 424
KiIograms, measuring in, 62, 424
Kwashiorkor (wet maInutrition), 30, 113, 424
L
Labor, 258-262, 264, 424
also labor, 258
probloms witn labor, 267
signs tnat snow labor is noar, 258
stagos o, 259262
(Also soo Cnildbirtn)
Land
distribution o, w7, w11, 413
uso o, w11, w13w16, 115
Latido, 23
Latrines, 137139, 153
Laxatives, 15-16, 382
misuso o, 126
Lazy eye, 223
Leadership, w5
Learning, w4, w21w28, 322
Legs
orossod liko soissors, 320
oxamination o logs, 37
pain in, 288, 321
Leishmaniasis, 406
Lepra reaction, 191, 362
Leprosy, 10, 38, 191-192, 206, 337, 362363
or lepra, 25
Lice, 134, 190, 200, 372
Limits, knowing, w4
Liquids, 39-40, 151
Liters, measuring in, 61, 424
Liver, 36, 424
absoossos, 144145
disoasos, 172, 288, 328
inootion o, 172
Liver extract, 65, 67
Lockjaw (Soo Totanus)
Loss of bIood (Soo Blood, Blooding)
Loss of consciousness (Soo Unoonsoious
porson)
Loss of feeIing, 38, 127, 162, 173, 191, 192, 279
Loss of sight, 225, 412
Loss of sIeep (insomnia), 328
Loss of weight (Soo Woignt loss)
Low body temperature, 409
Low back pain, 173, 248
Low bIood pressure, 411
Lumps
in tno abdomon, 35, 243, 280
in tno broast, 279
on aoo and body, 191, 228
tnat koop growing, 196, 280
(Also soo Lympn nodos)
Lung diseases
and smoking, 149
astnma, 167
brononitis, 170
pnoumonia. 171
tuboroulosis, 179
Lymph nodes, swoIIen, 88, 317, 424
oausod by an absooss, 202
in tno groin, 238, 403
signs o inootion, 194
TB o, 212
witn ADS, 400
witn broast oanoor, 279
witn bruoollosis, 188 or typnus, 190
witn Gorman moaslos, 312
witn soabios or lioo, 199, 200
LymphogranuIoma venereum, 238, 420
M
Maalox, 173
MaIaria, 186-187
aloiparum, 158, 363
ovor pattorn, 26
witn soizuros, 307
witn sioklo ooll disoaso, 321
MaInutrition
and diarrnoa, 153155
oausos o, 115, 283, 412
onooking or, 109, 112113, 297304
in onildron, 107, 114, 305306
kinds o, 112114
provontion and troatmont o, 108, 109,
112113, 155156, 391393
probloms oausod by, 107, 306
signs o, 30, 37, 108, 112, 113, 208209, 305
MaIta fever (bruceIIosis), 27, 188
Marasmus (dry maInutrition), 112
Marijuana, 416
Mask of pregnancy, 207
Massaging
sprains or raoturos, 99, 102
tno birtn oponing, 269
tno womb, 264265
Mastitis (breast abscess), 278, 424
MeasIes (RubeoIa), 30, 108, 226, 311, 391
vaooination, 147, 312, 321
Measuring
blood prossuro, 410411
in pounds and kilos, 62
modioino, 5961, 340
MedicaI attention
illnossos tnat always nood, 179192
wnon to sook, 43, 159
MedicinaI pIants, 1213
Medicine kit, 331337
Medicines
brand namo, 55, 333, 339
oaro in giving to tno nowborn, 54, 272
dangorous misuso o modioino, 5053
during or ator birtn, 266
during prognanoy, 54, 247, 398
gonorio, 333, 339
guidolinos or uso, w18w19, 4973, 339396
noaling witnout modioinos, 4548
now to moasuro and givo, 5964, 340
now to writo instruotions or, 6364
limitod uso o modioinos, w18w19, 49
modioinos not to in|oot, 56
roaotions to, 68, 7071, 350
usos, dosago, and prooautions, 339398
wnon not to tako tnom, 5464
Mnire's disease, 327
Meningitis, 185, 274, 307
Menopause, 246, 424
MenstruaI period, 245-246, 281, 285, 294,
393396
MentaI probIems, 18, 318
Microscope, 19, 144
Midwives
dangor signs in prognanoy, 249
inormation or, 245282
pronatal oaro, 250
spooial risk at birtn, 256
tnings not to do, 260
tnings to navo roady booro birtn, 254255
Migraine, 162, 424
MiIk
and bruoollosis, 188
and diarrnoa, 156
and uloors, 129
powdorod, 391
(Also soo Broastooding)
MiIk of magnesia, 16, 382
MineraI oiI, 16, 382
MineraIs, 111, 116-118, 425
Mini piII, 289, 294, 394
Miscarriage (spontaneous abortion), 246, 249,
266, 281, 414
ModeIs for teaching, w22
MongoIism, 318, 425
MoniIiasis (thrush), 232, 242, 400
Morning sickness, 248, 287
Mosquitos, 186187
Mothers
noaltn ator onildbirtn, 276, 280
noaltn and sioknossos o onildron, 295321
inormation or, 245282
pronatal oaro, 250253
(Also soo Family planning)
Mouches voIantes, 227
Mouth, 107, 229-232
Mouth-to-mouth breathing, 78-80, 413
witn nowborns, 262
Moving an injured person, 99100
Mucus, how to drain, 169, 425
Mucus method, 285, 292
Mumps, 312
MuscIes
oxamining, 3738
laok o oontrol o, 320
N
Narrow-spectrum antibiotics, 56, 425
NaturaI baIance, 58
Nausea (Soo vomiting)
NaveI (umbiIicus), 425
outting tno oord, 262263
nornia o navol, 317, 318
inootion o navol, 182, 272
Neck
brokon, 99
sti, 38, 182185, 274
Needs, feIt and Iong-term, w8w12
NeedIes, 74, 399, 401
NeonataI conjunctivitis, 221
(Also soo Nowborns)
Nerves, 425
musolos and, 3738
Nevirapine, 249, 400
Newborns
and totanus, 182183
baotorial inootion o tno blood, 275
batning, 7, 263, 270
oyos, 221, 237, 270
ooding, 120, 263, 271
nornia, 317
illnossos o, 272275
modioinos or, 54, 272, 337
probloms witn dolivory, 268
small, oarly, and undorwoignt, 405
tno oord, 262263, 270
twins, 269
(Also soo Donydration)
Night bIindness, 113, 226-227, 337
Nodes (Soo Lympn nodos)
Non-infectious diseases, 18
Nose, stuffy or runny, 164-165, 383
NosebIeed, 11, 83
Numbness (Soo Loss o ooling)
Nutrition, w11, w13w16, 107-130, 295
(Also soo Malnutrition)
O
Obstructed gut, 22, 94
(Also soo Gut)
OIder persons, 83, 214, 235, 323330
Onchocerciasis, 227-228, 377
Opium, 416
OraI contraceptives, 285-289, 393394
Outhouses, 137139
Ovarian cyst, 280
Ovaries, 36, 280, 425
Oxytocics, 50, 265-266, 319, 390
Oxyuris (pinworm, threadworm), 141
P
Pain
asking about, 29
baok, 173174, 248
onost, 179, 325
in tno bolly, 12, 3536, 9495, 128, 146, 243
in tno oyo, 217, 219, 221, 222
in tno |oints, 101102, 173, 310, 324
in tno log, 288
in tno tootn, 165, 231
in urination, 146, 235236, 239, 242243
modioinos or, 19, 52, 7576, 162, 335,
378380
(Also soo Cramps, Hoadaonos)
Pannus, 220
Pap smear, 280
Papaya, 13
ParaIysis
oxamining or, 37
rom postioidos, 412
rom tioks, 201
in a spastio onild, 320
in loprosy, 191
in polio, 314315
in stroko, 37, 327
in TB o baokbono, 180
o aoo, 37, 327
Parasites, 19, 425
intostinal, 19, 140145, 308
on skin, 19, 199201
Patient report, 44
PeIIagra, 114, 208-209
PeIvic infIammatory disease, 237, 243, 244, 395
Penis, 199, 232, 233, 235240, 402403
Peritonitis, 94-95, 129, 189, 425
Pertussis (Soo Wnooping oougn)
Pesticides
burns in oyos, 219
oausing birtn dooots, 247
misuso o, 412413
Pharmacist, words to, 338
PhIebitis, 288
PID (Soo Polvio inlammatory disoaso)
PiIes (hemorrhoids), 16, 175, 423
modioino or, 391
the PiII (for birth controI), 285-289, 393394
PimpIes, 211, 419
(Also soo Cniokonpox)
Pink eye, 219-221, 308
Pinta, 207
Pinworm (threadworm, Enterobius), 12, 141
PIacenta (afterbirth), 262-264, 269, 426
PIacenta previa, 249, 426
PIantar warts, 210
PIants
modioinal, 1213
tnat oauso itoning, 204
PIay acting, w23
Pneumonia, 27, 41, 171, 399, 400
Poisoning, 103
ood, 23, 135, 153, 161
o prognanoy, 249, 422
urino, 239240
Poisonous
bitos, 104106
plants, 204
PoIiomyeIitis (infantiIe paraIysis), 314
signs o, 37
PopuIation, w10, 115
Posters, w22
Postpartum, 426
diot, 123
nomorrnago, 266, 390
PosturaI drainage, 169
Power of beIief or suggestion, 2-5, 24, 426
Pre-ecIampsia, 176, 249, 251, 422
Pregnancy, 247255
anomia during, 124, 248249, 391392
blooding during, 249, 264, 281
onook ups during, w24, 250253, 410
dangor signs in, 249251
diioulty boooming prognant, 244
ootopio, 36, 243, 249, 280, 414
Gorman moaslos during, 247, 312
growtn and position o baby, 251252, 257
now to provont, 283295
now to stay noaltny during, 247
now to toll tno baby's birtn dato, 252
modioinos during, 6, 54, 247, 398
minor probloms o, 174, 248, 251
nutrition during, 118, 250
rooord o pronatal oaro, 253
signs o, 247
supplios to navo roady booro birtn, 254255
(Also soo Family planning)
Pregnancy mask, 207
PrenataI care, 250253
Presentation of an arm, 268, 426
Pressure points, 82
Pressure sores (Soo Bod soros)
Preventive medicine, w17, 17, 131-150
oloanlinoss, 131136
now to avoid many sioknossos, 108, 148150,
242, 326
sanitation, 137139
soxually transmittod inootion, 239, 401403
vaooinations (immunizations), 147
worms and otnor intostinal parasitos, 140146
ProIapse of the rectum, 142, 426
ProphyIactic (condom), 239, 285, 290, 395,
401403
Prostate gIand, 233, 235236, 426
Protective foods, 110, 426
Proteins, 110, 111, 112, 113, 116118, 121
Psoriasis, 216
Pterygium, 224, 426
PuIIing out (to prevent pregnancy), 285, 294
PuIse, 32-33, 41, 410411, 426, insido baok oovor
PuIsing or throbbing of stomach, 23
PupiIs, examining, 217
Purges, 1516
misuso o, 92, 126
Pyorrhea, 231
Q
Questions to ask a sick person, 29, 44
R
Rabies, 181
Rash on the skin, 216, 236, 400
diapor rasn, 215, 421
liko tiny bruisos (typnus), 190
o allorgio roaotion, 68, 166, 203204, 356
o oniokonpox, 311
o Gorman moaslos, 312
o moaslos, 30, 311
o sypnilis, 238
o typnoid, 189
provonting, 133
witn itoning, 199200, 203
Reactions (Soo Allorgio roaotions)
Rebound pain, 35, 95, 426
Rectum
prolapso o, 142, 426
RefIexes, testing, 183, 426
Rehydration Drink, 152, 311, 381, 400, 426
and vomiting, 161
as an onoma, 15
or aouto abdomon, 95
or donydration, 9, 46, 158, 306
or nowborns, 273
or vory siok porsons, 40, 53
Remedies (Soo Homo romodios)
Resistance, 426
to antibiotios, w19, 5758, 237, 350
to inootion, 108, 120, 271
Resources, w8, w12, 115, 283, 426
Respiration (Soo Broatning)
Retardation, mentaI, 114, 306, 318, 320321, 426
Rheumatic fever, 27, 310
Rheumatoid arthritis, 324
Rhinitis, aIIergic (hay fever), 165, 426
Rhythm method, (Soo Counting days motnod)
Ribs, broken, 99
Rickets, 125
Ringing of the ears, deafness, and dizziness,
107, 327, 358, 361, 378
Ringworm, 11, 205-206, 371
River bIindness, 227-228, 377
Road to heaIth chart (Soo Cnild Hoaltn Cnart)
Rotating crops, w13, 115, 117, 427
Roundworm (ascaris), 140141
Rubber (condom), 239, 285, 290, 395, 401403
RubeIIa (Soo Gorman moaslos)
RubeoIa (Soo Moaslos)
Rupture (Soo Hornia)
S
SaIt
iodizod, 130, 247, 318
purgos, 16
using littlo, 120, 125, 176, 249, 325, 326
Sanitation, w10, 137-139, 153, 427
Scabies, 34, 199-200, 335, 372
ScaIes (to weigh babies), 297
Scars
on tno oornoa, 224, 226, 228
on tno oyolids, 220
provonting burn soars, 97
Schistosomiasis, 146, 337, 376
Scorpion sting, 11, 106, 337, 387
ScrofuIa, 212
Scrotum, 233, 427
small soros on, 199
swollon, 317
Seborrhea, 215
Seizures, 23, 178, 422
oausod by nign ovor, 76
rom birtn dooots, 273, 319
in oorobral malaria, 186, 366
in moningitis, 185
in prognant womon, 249, 390
(Also soo Spasms)
Senna Ieaf, 16
Septicemia, 275, 427
Serious iIInesses, w28, 42, 179-192
Seven year itch, 199200, 335, 372
SexuaIIy transmitted infections (STI), 236239,
285286, 290, 399-403, 427, 428
Sheath (condom), 239, 285, 290, 395, 401403
ShigeIIa, 145, 158, 353, 358
ShingIes, 204, 373, 400
Shock, 30, 77, 325, 427
allorgio, 70, 105, 166, 350
rom sorious burns, 97
noartboat during, 33, 410411
in postpartum motnor, 265
ShouIder, disIocated, 101
SickIe ceII disease, 30, 321, 392
Sicknesses
oausos o, 1720, 107
oommon, 151178
dangorous, w28, 42, 179192
"nomo," 21
"not" and "oold," 119
inootious, 1819
non inootious, 18
o onildron, 215, 272275, 311314
o oldor pooplo, 323330
o womon, 241
provontion o, 131150
sproad o, 131137, 140, 188189, 237239,
399
tolling apart, 2021, 2627
Side pains, 22
Signs, 20, 29, 427
Sinus troubIe (sinusitis), 165, 427
Skin
oanoor o, 211, 399
onart o dioront disoasos, 196198
disoasos, 193216, 406, 421
drynoss o, 107, 208
now to oxamino, 34
modioinos or, 334335, 370373
painloss soros, 191, 237, 279
TB o, 179, 212
uloors, 212213
SIipped disc, 173
SIowness (Soo Dooots, Montal probloms)
SmaIIpox, 147
SmaII sores with pus, 201, 211
Smoking
probloms oausod by, 119, 129, 149150, 289,
325, 326, 400, 416
SnaiIs, 146
Snakebite, 104105
antitoxin, 105, 337, 387
nomo ouro or, 3
Soaks, 102
SociaI conditions, 283, 401, 415, 417
Soft drinks, 155, 161, 229
Soft spot (Soo Fontanol)
Solda con solda, 14
Sores
bod soros, 41, 214
onronio, 20, 127, 212, 213, 236, 324, 406
largo, opon, 127, 213214
moutn, 232
o tno oot, 324
on ponis or gonitals, 199, 205, 232, 237, 238,
242, 400, 402403
sugar or nonoy troatmont or, 213, 214
tnat koop growing, 127, 191, 211, 213, 214
witnout ooling, 191, 237, 279
witn pus, 199, 201, 406
(Also soo Skin)
Sore throat, 163, 309-310
Spasms, 183, 427
in spidor bito, 106
in totanus, 182184
(Also soo Soizuros)
Spastic, 38, 319-320
Sperm, 233, 244
Spermicide, 285, 395
Sphygmomanometer, 410
Spider bite, 106
SpIeen, Iarge, 158, 186, 392, 427
Sponge method, 294
Spontaneous abortion (Soo Misoarriago)
Spots before the eyes, 227
Sprains, 102, 427
Spread of disease, 131-137, 140, 190, 237239,
399403
Squint, 223
Starches, 110, 203, 408, 427
Starvation (Soo Malnutrition)
SteriIe, 427
bandagos, 87
mon and womon, 236, 244, 412
SteriIization, 427
o oquipmont, 74, 401
o syringos, 69, 72, 74
to provont prognanoy, 285, 293
Steroids, 51
Stethoscope, 410
Sting
boo, 70
soorpion, 106
Stitches (sutures), 86, 255, 269, 423
anostnotios or, 379
Stomach ache, 12, 93, 427
(Also soo Bolly, Cramps)
Stomach uIcers, 128-129, 149, 380381
StooIs
in aouto abdomon (obstruotion), 94
in diarrnoa (dysontory), 144145
liko rioo wator, 158
wnito or palo, 172
witn blood, 128, 146, 189
witn sonistosomiasis, 146, 376
witn typnoid, 189190
witn uloor (blaok, tarry stools), 128
(Also soo Constipation, Fooos)
Story teIIing, w23
Strabismus, 223
Strains, 102
Strep throat, 310
Stretcher, 100
Stroke, 37, 78, 288, 327, 410
(Also soo Hoat stroko)
Sty (hordeoIum), 224, 427
Suction buIb, 84, 255, 262, 268
Sugars, 110, 111, 427
SuIfonamides, 55, 356
Sunken fontaneI (Soo Fontanol)
SunIight
and aono, 211
and riokots, 125
and skin probloms, 195
SuppIies
or onildbirtn, 254255
or tno modioino kit, 334, 336
Suppressants, 427
oougn, 52, 383
Surgery
immodiato nood or, 9195, 177, 222, 267
possiblo nood or, 102, 175, 177, 211, 222,
225, 235, 243, 279, 280, 293, 317, 319, 329
Susto, 24
Suture (Soo Stitonos)
Sweets, 115, 119, 122, 229, 408
SweIIing
broast swolling and lumps, 278279
oausod by modioino, 68, 7071, 231
nomo ouro or, 12
in old ago, 323
o brokon arms or logs, 14
o nands and aoo, 108, 239, 249
o strains and sprains, 102
o tno oyos, 144, 221, 313
o tno oot, 113, 124, 144, 176, 248249, 321
o tno sorotum or tostiolos, 312, 317
witn inootion, 194
(Also soo Lympn nodos, Swollon bolly,
variooso voins)
SwoIIen beIIy
dioront oausos o, 20
in onildron, 107, 112, 114, 321
in giardia inootion, 145
in gut obstruotion, 94
in malnutrition, 112, 114
in prognanoy, 248, 249
(Also soo Gut)
Symptoms, 29
SyphiIis, 10, 237-238, 403
Syringe, 72, 74, 336, 339, 401, 405
T
Taboo, 23, 428
T.A.L.C., 297, 429
Tapeworm, 143, 375
TB (Soo Tuboroulosis)
Teaching, w2, w4w5, w21-w28, 321
matorials, addrossos or, 429432
Tear sac, infection of, 217, 223
Teaspoons, for measuring, 61
Teeth, 133, 229-232
Temperature, 30-31, 272, 409, insido baok oovor
(Also soo Fovor)
Tepeguaje, 14
TesticIes, 233
swollings o tostiolos, 312, 317
Tetanus (Iockjaw), 182184
rom a wound, 84, 89, 105-106, 388, 407
in tno nowborn, 182183, 273
modioino or, 336337, 388390
ThaIassemia, 392, 428
Thermometer, 31, 334
Threadworm (pinworm, Enterobius), 141
Throat
lump on tno tnroat, 10, 130, 423
ob|oot stuok in, 79
soro tnroat, 163, 309310
Throwing up (Soo vomiting)
Thrush (moniIiasis), 232, 242, 400
Ticks, 190, 201, 428
Tinea, 205206
Tinea versicoIor, 206
Tobacco, 129, 416417
Tongue, 232
TonsiIIitIs (InfIamed tonsiIs), 309
Toothache, 231
Toothbrush, homemade, 230
Toothpaste, 230
Toxemia of pregnancy (Soo Pro-oolampsia)
Trachoma, 220
Traditions, w3, w11, 1, 2, 21
Trichinosis, 144
TrichocephaIus (whipworm, Trichuris), 142
Trichomonas, 241
Trichuris (whipworm, TrichocephaIus), 142
TropicaI sore (Soo Loisnmaniasis)
TubaI Iigation, 293
TubercuIosis, 108, 179-180, 337
and ADS, 396, 400
and onildron, 136
and moaslos, 311
o tno lympn nodos, 212
o tno skin, 212
o tno spino, 173
signs o, 30, 37
vaooination, 147
Tumors (Soo Canoor)
Twins, 251, 256, 269, 289
Twisted joint (sprain), 102
Typhoid fever, 188-190
ovor pattorn, 26
modioinos or, 356
pulso witn, 33
rosistanoo to modioinos, 58
Typhus, 26, 190
U
UIcer, 428
on tno oornoa (oyo), 224225
skin, 20, 212, 213, 324
stomaon, 13, 36, 53, 128129, 149, 381
UmbiIicaI cord, 428
and totanus, 182
now to out, 262263
inootion o, 270, 272
wrappod around tno baby's nook, 268
UmbiIicaI hernia, 317, 318, 428
UmbiIicus (Soo Navol)
UncInaria (hookworm), 133, 142
Unconscious person, 78, 424
broatning o, 32
dioronoo in pupil sizo, 33
in snook, 77
Under-Fives Program, w20, w24, 297, 428
UnduIant fever (bruceIIosis), 27, 188
Units, measuring in, 60
Uremia, 239240
Ureters, 233
Urethra, 233, 235, 428
Urination, difficuIties with, 234236, 239240,
324, 403, 410
Urinary tract, 36, 233-234, 428
Urine
blood in, 146, 234, 376
brown, 172
dark yollow, 151
loss tnan normal, 151, 236
too muon or oton, 127, 234
pus in, 236
Using this book, inside front cover, w28
Uta (Soo Loisnmaniasis)
V
Vaccinations, 19, 147, 180, 250, 296, 321, 337,
405
Vagina, 233, 428
inootions o, 241242, 369
plaoonta blooking, 249
toaring during birtn, 269
VaginaI discharge, 241-242, 369
Vapors, breathing hot water vapors, 47, 168
Varicose veins, 175, 213, 288, 410, 428
and onronio soros, 20, 212, 213, 324
Vasectomy, 293
VenereaI diseases (VD) (Soo Soxually transmittod
inootion)
VenereaI IymphogranuIoma, 238, 420
VentiIated improved pit Iatrine, 139
Verrucase (warts), 210
ViIIage heaIth committee, w24
ViIIage heaIth worker, w1w7, w29, 43, 340
ViIIage medicine kit, 336337
VIP Iatrine, 139
Virus, 19, 399401
Vision (Soo Eyos)
VitaI signs, 41, insido baok oovor
Vitamins, 110, 111, 116118, 391393, 405
in|ootions o, 65, 67, 118
tno bost way to got, 52, 118
vitamin A, 226, 391
vitamin B, 208
vitamin C, 248, 335,
vitamin B6, 360, 393
vitamin B12, 51, 65, 392
vitamin K, 265, 272, 337, 392
(Also soo ron, Zino)
VitiIigo, 207
Vomiting, 161
onomas and laxativos witn, 15
now to oauso vomiting, 103, 388
in tno nowborn, 273
modioinos or, 161, 335, 385386
violont vomiting, 151
witn blood, 128, 328
witn diarrnoa, 151, 157
witn urino poisoning (uromia), 239
W
Wandering eyes, 223
Warm compresses, 193195
Warts, 210, 212, 400, 402
Water, heaIing with, 4548
and oloanlinoss, 46, 131, 135, 137139, 144,
146
and sproad o disoaso, 146, 188
or ovor, 75
to oaso pain o burns, 96
vapors, 47, 168, 383
Weakness, fatigue, 23, 124, 323, 400
Weight
and diot, 110111, 127
dooiding dosago by, 340
nomomado soalos, 250
importanoo o losing, 125127, 325326
in pounds and kilos, 62
moasuring modioinos, 5961
woignt gain, in onildron, 297304
woignt gain in prognanoy, 247, 250
Weight Ioss
onronio, 179, 180, 400
dioront oausos, 20
now to loso woignt, 126
in tno nowborn, 273
suddon (donydration), 151
(Also soo Malnutrition)
WeIts (hives), 68, 203, 238
Wet maInutrition (kwashiorkor), 113
Whipworm (Trichuris, TrichocephaIus), 142
White spots and patches on the skin, 206-207,
232
Whooping cough (pertussis), 168, 313
modioinos or, 336
vaooination, 147, 296
Witchcraft, 5, 24
WithdrawaI
rom drug addiotion, 417
to provont prognanoy, 285, 294
Womb, 428
oanoor o, 280
oontraotions o, 258, 266
inootion (Soo Cnildbirtn ovor)
massaging, 264265
position o tno baby in, 251, 257
Women's heaIth care, 241
Working together, w5, w24
Worms, 140-146, 227228, 406407
oausing obstruotod gut, 94
in onildron, 308
modioinos or 335, 373375
provontion o, 47, 131134
Wounds
abdomon, 92
bullot, 9093
onost, 91
oontrolling blooding o, 82
doop, 8992
rom a brokon bono, 99
now to oloso tnom, 8586
inootod, 8889, 213, 401
knio and bullot, 8993
small, 84
tnat may oauso totanus, 89, 182
to tno oyo, 217218
X
XerophthaImia, 113, 226, 306, 337, 391, 428
Xerosis (Soo Xoropntnalmia)
X ray, 102
Y
Yaws, 198, 202, 238
Yeast infection, 58, 232, 242, 369370, 372
Yesca, 11
Yogurt, 57, 155, 232, 242
Z
Zinc, 155, 159, 393
Namo:
Modioino:
For:
Dosago:
DOSAGE BLANKSor giving modioinos to tnoso wno oannot road (soo p. 64)
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
Namo:
Modioino:
For:
Dosago:
PATIENT REPORT
TO USE WHEN SENDNG FOR MEDCAL HELP
Namo o tno siok porson: __________________________________________Ago: _____
Malo ______ Fomalo _______ Wnoro is no (sno)? ________________________________
Wnat is tno main sioknoss or problom rignt now? ________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Wnon did it bogin? __________________________________________________________
How did it bogin? ___________________________________________________________
Has tno porson nad tno samo problom booro? ___________Wnon? _______________
s tnoro ovor? ________ How nign? ________ Wnon and or now long? ___________
Pain? __________Wnoro? _______________________Wnat kind?____________________
Skin: ____________________________ Ears: ______________________________
Eyes: __________________________ Mouth and throat: ______________________
GenitaIs: __________________________________________________________________
Urine: Muon or littlo? _______________Color? ______________Troublo urinating?_____
Dosoribo: ________________________Timos in 24 nours: _______ Timos at nignt: ____
StooIs: Color? ________________ Blood or muous? ______________ Diarrnoa? ______
Numbor o timos a day: _________Cramps? ________ Donydration? _________Mild or
sovoro? _______________ Worms? __________ Wnat kind? ________________________
Breathing: Broatns por minuto: ___________ Doop, snallow, or normal? ____________
Diioulty broatning (dosoribo): ________________________ Cougn (dosoribo):_______
____________________Wnoozing? __________ Muous? ___________ Witn blood?_____
pago 42? __________Wnion? (givo dotails) _____________________________________
___________________________________________________________________________
Other signs: _______________________________________________________________
s tno porson taking modioino? __________Wnat? _______________________________
Has tno porson ovor usod modioino tnat nas oausod a rasn, nivos (or bumps)
witn itoning, or otnor allorgio roaotions? ___________ Wnat?_______________________
Tno stato o tno siok porson is: Not vory sorious: ________________Sorious: ________
vory sorious: _________________
On the back of this form write any other information you think may be important.
PATIENT REPORT
Namo o tno siok porson: __________________________________________ Ago: ____
Malo _______Fomalo _______ Wnoro is no (sno)? ________________________________
Wnat is tno main sioknoss or problom rignt now? ________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Wnon did it bogin? __________________________________________________________
How did it bogin? ___________________________________________________________
Has tno porson nad tno samo problom booro? ___________ Wnon?_______________
s tnoro ovor? _________How nign? ________ Wnon and or now long? ___________
Pain? __________Wnoro? _______________________ Wnat kind? ___________________
Skin: ____________________________ Ears: ______________________________
Eyes: __________________________ Mouth and throat: ______________________
GenitaIs: __________________________________________________________________
Urine: Muon or littlo? _______________ Color? _____________ Troublo urinating? ____
Dosoribo: _________________________Timos in 24 nours: _______Timos at nignt: ___
StooIs: Color? _________________Blood or muous? ______________Diarrnoa? ______
Numbor o timos a day: _________ Cramps? _________ Donydration? ________ Mild or
sovoro? _______________ Worms? __________ Wnat kind? ________________________
Breathing: Broatns por minuto: ___________ Doop, snallow, or normal?____________
Diioulty broatning (dosoribo): _________________________Cougn (dosoribo): ______
_____________________Wnoozing? __________Muous? ___________Witn blood? ____
pago 42? __________ Wnion? (givo dotails) _____________________________________
___________________________________________________________________________
Other signs: _______________________________________________________________
s tno porson taking modioino? __________ Wnat? ______________________________
witn itoning, or otnor allorgio roaotions? ____________Wnat? ______________________
Tno stato o tno siok porson is: Not vory sorious: ________________ Sorious: ________
vory sorious: __________________
rm write te te te te te any other er er er er er iiiiiinformati
PATIENT REPORT
Namo o tno siok porson: ________________________________________Ago: ______
Malo ____ Fomalo _______ Wnoro is no (sno)? _________________________________
Wnat is tno main sioknoss or problom rignt now? _______________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Wnon did it bogin? _________________________________________________________
How did it bogin? __________________________________________________________
Has tno porson nad tno samo problom booro? ________ Wnon?_________________
s tnoro ovor? ______ How nign? _______ Wnon and or now long?_____________
Pain? _______ Wnoro? _______________________ Wnat kind? ____________________
Skin: __________________________ Ears:_______________________________
Eyes: ________________________ Mouth and throat: _____________________
GenitaIs: __________________________________________________________
Urine: Muon or littlo? ____________ Color? ______________ Troublo urinating? _____
Dosoribo: ______________________ Timos in 24 nours:________Timos at nignt: ____
Stools: Color? ______________ Blood or muous? _______________ Diarrnoa?_______
Numbor o timos a day: _______Cramps? _________Donydration?_________Mild or
sovoro? ____________ Worms? __________Wnat kind? __________________________
Breathing: Broatns por minuto: _________Doop, snallow, or normal? _____________
Diioulty broatning (dosoribo): ______________________Cougn (dosoribo): ________
__________________ Wnoozing? _________ Muous? ____________Witn blood? _____
pago 42? _______ Wnion? (givo dotails) ______________________________________
__________________________________________________________________________
Other signs: ______________________________________________________________
s tno porson taking modioino? ________Wnat? ________________________________
witn itoning, or otnor allorgio roaotions? _________ Wnat? ________________________
Tno stato o tno siok porson is: Not vory sorious: _____________ Sorious: __________
vory sorious: ______________________________________________________________
PATIENT REPORT
Namo o tno siok porson: ________________________________________Ago: ______
Malo ____ Fomalo ______ Wnoro is no (sno)? _________________________________
Wnat is tno main sioknoss or problom rignt now? _______________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Wnon did it bogin? _________________________________________________________
How did it bogin? __________________________________________________________
Has tno porson nad tno samo problom booro? _________Wnon? ________________
s tnoro ovor? _______How nign? _______ Wnon and or now long?_____________
Pain? ________ Wnoro? ______________________ Wnat kind? ____________________
Skin: __________________________ Ears: _______________________________
Eyes: _________________________Mouth and throat: ____________________
GenitaIs: __________________________________________________________
Urine: Muon or littlo? _____________ Color? _____________ Troublo urinating? _____
Dosoribo: _______________________Timos in 24 nours: ______ Timos at nignt: _____
StooIs: Color? ______________ Blood or muous? _______________ Diarrnoa?_______
Numbor o timos a day: _______ Cramps? _________Donydration?_________Mild or
sovoro? _____________ Worms? __________ Wnat kind? _________________________
Breathing: Broatns por minuto: _________ Doop, snallow, or normal?_____________
Diioulty broatning (dosoribo): _______________________Cougn (dosoribo): _______
__________________ Wnoozing? __________Muous? ____________Witn blood? _____
pago 42? _______ Wnion? (givo dotails) ______________________________________
__________________________________________________________________________
Other signs: ______________________________________________________________
s tno porson taking modioino? ________ Wnat? _______________________________
witn itoning, or otnor allorgio roaotions? __________Wnat? _______________________
Tno stato o tno siok porson is: Not vory sorious: ______________ Sorious:_________
vory sorious: ______________________________________________________________
Where Women Have No Doctor, by A. August Burns, Ponnio
Lovion, Jano Maxwoll, and Katnarino Snapiro, oombinos sol-nolp
modioal inormation witn an undorstanding o tno ways povorty,
disorimination, and oultural bolios limit womon's noaltn and aoooss
to oaro. Cloarly writton and witn ovor 1,000 drawings, tnis book is
an ossontial rosouroo or any woman wno wants to improvo nor
noaltn, and or noaltn workors wno want moro inormation about tno
probloms tnat aoot only womon, or tnat aoot womon diorontly
rom mon. 584 pagos.
A Book for Midwives, by Susan Kloin, Suollon Millor, and Fiona
Tnomson, oomplotoly rovisod in 2005, is or midwivos, oommunity
noaltn workors, and anyono oonoornod about tno noaltn o womon
and babios in prognanoy, birtn and boyond. An invaluablo tool or
training as woll as a praotioal rooronoo, it oovors nolping prognant
womon stay noaltny, oaro during and ator birtn, nandling obstotrio
oomplioations, broastooding, and inoludos oxpandod inormation
or womon's roproduotivo noaltn oaro. 544 pagos.
Other Books from Hesperian
HeIping HeaIth Workers Learn, by David Wornor and Bill Bowor, is an
indisponsablo rosouroo or anyono involvod in toaoning about noaltn.
Tnis noavily illustratod book snows now to mako noaltn oduoation un
and oootivo. noludos aotivitios or motnors and onildron; pointors or
using tnoator, lannol-boards, and otnor toonniquos; and many idoas
or produoing low-oost toaoning aids. Empnasizing a pooplo-oontorod
approaon to noaltn oaro, it prosonts stratogios or oootivo oommunity
involvomont tnrougn partioipatory oduoation. 640 pagos.
A HeaIth Handbook for Women with DisabiIities, by Jano Maxwoll,
Julia Watts Bolsor, and Darlona David. Tno sooial stigma o disability
and inadoquato oaro aro oton groator barriors to noaltn tnan
disabilitios tnomsolvos. Tnis groundbroaking nandbook, ull o usoul
advioo and suggostions rom womon witn disabilitios worldwido,
will nolp womon witn disabilitios improvo tnoir gonoral noaltn, sol-
ostoom, and abilitios to oaro or tnomsolvos and partioipato in tnoir
oommunitios. 406 pagos.
Where There Is No Dentist, by Murray Diokson, snows now to oaro
or tno tootn and gums, and provont tootn and gum probloms tnrougn
nygiono, nutrition, and oduoation. noludos dotailod, woll-illustratod
inormation on using dontal oquipmont, plaoing illings, taking out
tootn, and moro. A now onaptor inoludos matorial on Hv and oral
noaltn. 237 pagos.
HeIping ChiIdren Who Are BIind, by Sandy Niomann and
Namita Jaoob, aids paronts and otnor oarogivors in nolping blind
onildron rom birtn tnrougn ago 5 dovolop all tnoir oapabilitios.
Topios inoludo: assossing now muon a onild oan soo, provonting
blindnoss, moving around saoly, toaoning oommon aotivitios, and
many otnors. 192 pagos.
HeIping ChiIdren Who Are Deaf, by Sandy Noimann, Dovoran
Groonstoin and Darlona David, nolps paronts and otnor oarogivors
build tno oommunioation skills o young onildron witn diioulty
noaring. Covors languago dovolopmont and now to ostor
oommunioation tnrougn botn sign and oral approaonos, as woll as
assossing noaring loss, oxploring oausos o doanoss, and moro.
250 pagos.
DisabIed ViIIage ChiIdren, by David Wornor, oontains a woaltn o
inormation about most oommon disabilitios o onildron, inoluding
polio, oorobral palsy, |uvonilo artnritis, blindnoss, and doanoss.
Tno autnor givos suggostions or simpliiod ronabilitation at tno villago
lovol and oxplains now to mako a varioty o appropriato low-oost aids.
Empnasis is plaood on now to nolp disablod onildron ind a rolo and
bo aoooptod in tno oommunity. 672 pagos.
A Community Guide to EnvironmentaI HeaIth by Jo Conant and
Pam Fadom. Tnis boautiully illustratod book oontains a woaltn
o inormation, motivational storios, simplo now-to pro|oots, and
group aotivitios to nolp pooplo tako onargo o tnoir oommunity's
uturo and transorm tno orisis in onvironmontal noaltn. Topios
oovorod inoludo: solid wasto, noaltn oaro wasto, and toxios; sao
wator and watorsnod protootion; orostry, rostoring land, and
planting troos; ood soourity and sustainablo arming; mining, oil,
and sao onorgy; and many otnors. 600 pagos.
1919 Addison St. #304, Berkeley, CA 94704 USA
www.hesperian.org bookorders@hesperian.org
tel: (1-510) 845-4507 fax: (1-510) 845-0539
health guides
NFORMATON ON VTAL SGNS
TEMPERATURE
Tnoro aro two kinds o tnormomotor soalos: Contigrado (C.) and Fanronnoit (F.).
Eitnor oan bo usod to moasuro a porson's tomporaturo.
Horo is now tnoy oomparo:
PULSE OR HEARTBEAT
For a ADULTS. . . . . . . 60 to 80 boats por minuto is normal.
porson CHLDPEN. . . . . 80 to 100 boats por minuto is normal.
at rost BABES. . . . . . . 100 to 140 boats por minuto is normal.
For oaon dogroo Contigrado (C.) o ovor, tno noartboat usually inoroasos
about 20 boats por minuto.
RESPIRATION
ADULTS AND
For a OLDEP CHLDPEN. .12 to 20 broatns por minuto is normal.
porson CHLDPEN. . . . . . . up to 30 broatns por minuto is normal.
at rost BABES. . . . . . . . . . up to 40 broatns por minuto is normal.
Moro tnan 40 snallow broatns a minuto usually moans pnoumonia (soo p. 171) or a
onild or an adult. For babios, 50-60 broatns por minuto probably moans pnoumonia.
BLOOD PRESSURE (Tnis is inoludod or noaltn workors wno navo tno
oquipmont to moasuro blood prossuro.)
For a porson at rost, 120/80 is normal, but tnis varios a lot.
tno irst roading (wnon tno sound bogins), is ovor 160, or i tno sooond roading
(wnon tno sound disappoars), is ovor 100, tnis is a dangor sign o nign blood
prossuro (soo p. 125).
CENTGPADE
Tnis tnormomotor roads 40C.
(Forty dogroos Contigrado)
FAHPENHET
Tnis tnormomotor roads 104 F.
(104 dogroos Fanronnoit)
NEWBOPNS . . . . . . .30 to 60 broatns por minuto is normal.

NEWBOPNS. . . . 120 to 160 boats por minuto is normal.
below
35 C
TOO
LOW
N
O
R
M
A
L
below
95 F
SOME
FEVER
HIGH
FEVER
above
39 C
above
102 F 98.6 F
37 C

Where There Is No Doctor

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Where There Is No Doctor

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Wnoro Tnoro s No Dootor 2011

Wnoro Tnoro s No Dootor 2011

Wnoro Tnoro s No Dootor 2011

Wnoro Tnoro s No Dootor 2011

Paroly, ALLEPGC SHOCK may

Wnoro Tnoro s No Dootor 2011

dosiro to oat dirt (anomia)

soros in oornors o moutn

roquont oolds and otnor

NEWBOPNS . . . . . . .30 to 60 broatns por minuto is normal.

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