Health education alone can do little to change people's habits - Dr. U.N. Jajoo

DR. U.N. JAJOO from the Department of Medicine at the Mahatma Ghandi Institute of Medicine Sciences, in India writing in the World Health Forum on promoting health through health education, says,

"Even when healthier ways of living have been clearly demonstrated, people mostly the villagers who form the majority in most of the countries in the Asian region are loathe to adopt them. This is not because they do not understand the messages, but they are powerless to change them."

Since this article gives so much food for thought for policy makers and health authorities, our Medical Advisory Panel has sent it to us for publication.

A naive notion

Most of us engaged in providing primary health care to the needy nurture, either consciously or subconsciously, a naive notion that what ails community health is ignorance and that if there are sincere attempts to provide scientific know-how most community health problems will find a solution.

In our enthusiasm we often deliver sermons and preach preconceived solutions to illiterate and (presumably) ignorant masses.

Frustration sets in when we realize that all our good advice goes unheeded and our work shows no results at all. But ignorance is far from being the cause. The following examples from our field work in the Sevagram area of the Wardha District of India make this quite clear.

Two is enough, three is a burden

"India has recorded remarkable progress in food grain production but, alas, human over-production has devoured all the gains."

With this lament in mind, Government policies give top priority to restricting family size, and vast resources are mobilized for family planning campaigns.

All possible media are used to carry this message to the rural poor - after all, they account for 80 per cent of India's population.

We thought it is our duty to promote the idea of a small family, using all the means at our disposal.

A film show was arranged, posters were distributed, and the target group was visited: we guaranteed transport to and from the hospital, personal attention during hospitalization, and nothing to pay. Our expectations crumbled when we found no-one turned up in spite of our persuasion.

Villagers did not seek our advice.

A mother of six children - all girls - asked us bluntly "Will you support us when we get old?" An ideal candidate for surgery, a woman with one son and a daughter, put it this way: "Doctor, have you seen a bullock cart with only one bullock? You need at least a pair, then if one succumbs the other will drag the cart alone."

And a farmer said, "We must have more children, doctor. Labour is too costly these days, and I need dependable manpower to help me."

The exercise taught us

The entire exercise taught us that unless under-five mortality is reduced, unless security for old age is provided, and unless agriculture becomes profitable, no amount of propaganda or incentives will convince poor village people about the benefits of a small family.

The key to improvement

Poverty is the greatest sin. To live, and even to die, with dignity is a luxury permitted to few.

The root cause of two major killer diseases in children - diarrhoea and respiratory infections - is the underlying malnutrition, an illness that cannot be treated by drugs but only by adequate food.

Untiring and enthusiastic management of these killer diseases in hospitals without an attack on the social cause - poverty - is like attempting to mop up a flood with the water tap full on above.

HealthWatch Medical Crossword with Guy's Hospital Paediatric Surgery Mission marks International Children's Day

WE devoted our (Novartis Medical Nutrition sponsored) HealthWatch Medical Crossword Draw No. 15 held at the Trans Asia Hotel in Colombo on Sunday October 2 to mark the International Children's Day by getting three children to participate in the draw.

The Guy's Hospital (London) Paediatric Heart Surgery Medical Mission team were in Colombo, and were our special invitees for the event.

The team's coordinator Jai Lameer a Sri Lankan expatriate speaking at the occasion said that he and the Guy's Hospital medical team felt greatly honoured to have been invited to pick the winners in the HealthWatch Medical Crossword which so far appears to be the first of its kind in an english daily, a novel way of health, educating the people on the preventive side and better health.

Being a Sri Lankan now domiciled in UK he was feeling so much for his mother country and her people. This is why he has been organising medical mission to operate on poor and needy children with congenital heart defects where they have to wait in a long waiting list for operations here due to various unavoidable problems.

From 2001 the team has been coming here annually and operated on about 50 children upto now. Except for one, all the other children were doing well.

One of those children at the draw

Mr. Lameer said he was able to get down one of those children who was operated on by the team in their first visit to Sri Lanka in 2001. She was 11 months at the time of the operation and according to the team doctors who examined her in 2001, she would have died in a month or two due to her wrong arterial connections of the hart if not for the operation done by the Team.

Her parents had been too poor to afford an operation abroad.

He thanked all doctors in the Colombo National Hospital, and the Karapitiya Hospital, Galle this time for all the assistance given to the team to carry out the operations.

And all other organisations, banks, friends individuals and the media for helping the mission in numerous ways.

Special word of thanks

He had a special word of thanks to the Daily News medical page HealthWatch and its compiler and coordinator Edward Arambewela for the publicity being given for the Mission from the very start since 2001.

Dr. Conal Austin the team's and Guy's Hospital Consultant Cardiac surgeon said he too felt honoured to participate in this novel health education feature of a 'Medical crossword'.

He too came to hear about it for the first time at this draw and was highly impressed by the large number of correct entries received. He wished all success for the feature.

He was able to carry out 14 operations this time in Galle. There were one or two complicated cases, but he was glad all were doing well.

The team was hoping to stay longer in their visit next year and help more needy children out of their heart defects.

He too wished to thank the Director, (doctors) and staff in the Karapitiya Hospital for all the assistance given to carry out the operations.

Dr. Viraj Peramuna (MO OPD, Colombo National Hospital and member of HealthWatch Medical Advisory Panel) and HealthWatch Coordinator Edward Arambewela both thanked the Guy's Medical Mission Jai Lameer, Dr. Conal Austin and Dr. John Simpson, Consultant Surgeon and Consultant Cardiologist respectively for participating in the crossword draw.

Dr. Peramuna said Sri Lankan doctors would have gained much knowledge from the internationally reputed Guy's surgical and medial team, when they were carrying out the operations in Galle.

He said the country should be grateful to Mr. Lameer for setting up this Mercy Mission in U.K. collecting funds and regularly organising these visits and carrying out difficult heart operations on children, who are in the lower income group.

- A. G.