Bitter Pills:Medicines & The Third World Poor | Page 125

Health promotion is carried out by teams of paramedics who are given a year's
training, partly at the base health centre and partly out in the villages. There are
now over 60 paramedics who divide their work between the villages, four subcentres and the main centre. The paramedics are able to handle the majority of
common illness including diarrhoea and dysentery, scabies, upper respiratory tract
infections, night blindness, worms, anaemia and 'body pain', which is mostly
backache.
Difficult cases are referred to the four doctors at the main centre, who supervise
the paramedics' work and carry out surgery. But most of the out-patients who
come to the centre are seen by the paramedics who also carry out some
straightforward operations. For instance, 85% of tubectomies are performed by
the paramedics, with a lower complication rate than the doctors. In the villages,
the paramedics make house-to-house visits to encourage disease prevention and
keep an eye on the health of mothers and young children who are most at risk.
Children are vaccinated free of charge and women of child-bearing age are
immunised against tetanus. The paramedics carry vaccines in thermos flasks, in
addition to a small number of basic drugs.
Drugs are only used when they are essential. Prevention comes first. For example,
to help prevent diarrhoeal disease, women are encouraged to use tubewell water
for cooking and drinking. They are also shown that instead of buying expensive
antidiarrhoeals, they can make a homemade rehydration solution, lobon-gur, from
lobon (salt) and gur (molasses) - ingredients which are easy to get hold of locally.
Rather than routinely handing out vitamin A capsules, the paramedics try to
convince mothers to include plenty of green vegetables in the family diet. If
medicines are necessary, the paramedic will wait while parents give children their
medicine, to make sure they understand the correct dose.
As this basic health care is now helping to ensure a better survival rate for children,
the paramedics are in a better position to offer advice to mothers on birth control,
and monitor the use of contraceptives, particularly the pill. The injectable
contraceptive, Depo-Provera (medroxyprogesterone acetate) was used on the
project, but although it was popular, its use has been abandoned because of fears
over the unknown degree of risk. Close monitoring of the women who received
Depo-Provera revealed that over an eight-month period, eleven women suffered
such severe bleeding that they had to be admitted as in-patients. The health team
at Gonoshasthaya Kendra have contacts in the health field all over the world,
so they are at an unusual advantage in keeping themselves informed about the
controversy in Europe and the US, over the use of Depo-Provera. However, after
stopping use of the drug, the health team openly expressed their uncertainty, as
to whether "we have helped our women or not".(3)
The traditional village midwives, the dais, have also been incorporated into the
health team a s far as possible. They are trained to use more hygienic methods
for deliveries, and are also involved in family planning.
The project can claim to have made an impact on health. For example, there has
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