• HOME CURES THAT HELP
  • The Limitations of Home Remedies
  • Old Ways and New
• BELIEFS THAT CAN MAKE PEOPLE WELL
  • The healing power of belief can be very strong!
  • What it often comes down to is showing you care!
  • May do some good if a person believes in it!
• BELIEFS THAT CAN MAKE PEOPLE SICK
  • witchcraft, black magic, and the evil eye
  • questions and answers on some folk beliefs and home remedies
  • sunken fontanel or soft spot
• WAYS TO TELL WHETHER A HOME REMEDY WORKS OR NOT
  • the more remedies there are for any one illness, the less likely it is that any of them works.
  • foul or disgusting remedies are not likely to help, and are often harmful.
  • remedies that use animal or human waste do no good and can cause dangerous infections. never use them.
  • the more a remedy resembles the sickness it is said to cure, the more likely its benefits come only from the power of belief.
• MEDICINAL PLANTS
  • Angel’s Trumpet, Brugmansia Arborea, Datura
  • CORN SILK: the tassels or silk from an ear of maize
  • GARLIC
  • CARDON CACTUS Pachycereus pecten-aboriginum
  • ALOE VERA Sabila
  • PAPAYA
• HOMEMADE CASTS for keeping broken bones in place.
• ENEMAS, LAXATIVES, AND PURGES
  • when to use them and when not to!
  • cases in which it is dangerous to use enemas or laxatives!
  • the correct uses of enemas
  • purges and laxatives often used
    • castor oil, senna leaf, cascara (cascara sagrada)
    • magnesium hydroxide, milk of magnesia, epsom salts, magnesium sulfate (see page 382)
    • mineral oil (see page 382)
  • correct uses of laxatives
    • Laxatives
    • Suppositories
  • A better way!
    • Foods with fiber.
    • Plenty of fruits and vegetables.

Everywhere on earth people use home remedies. In some places, the older or traditional ways of healing have been passed down from parents to children for hundreds of years.

Many home remedies have great value. Others have less. And some may be risky or harmful. Home remedies, like modern medicines, must be used with caution.

Try to do no harm. Only use remedies if you are sure they are safe and know exactly how to use them.

HOME CURES THAT HELP

For many sicknesses, time-tested home remedies work as well as modern medicines, or even better. They are often cheaper. And in some cases they are safer.

For example, many of the herbal teas people use for home treatment of coughs and colds do more good and cause fewer problems than cough syrups and strong medicines some doctors prescribe.

Also, the ‘rice water’, teas, or sweetened drinks that many mothers give to babies with diarrhea are often safer and do more good than any modern medicine. What matters most is that a baby with diarrhea get plenty of liquids (see page 151)

The Limitations of Home Remedies

Some diseases are helped by home remedies. Others can be treated better with modern medicine. This is true for most serious infections.

Sicknesses like pneumonia, tetanus, typhoid, tuberculosis, appendicitis, diseases caused by sexual contact, and fever after childbirth should be treated with modern medicines as soon as possible. For these diseases, do not lose time trying to treat them first with home remedies only.

It is sometimes hard to be sure which home remedies work well and which do not. More careful studies are needed. For this reason:

It is often safer to treat very serious illnesses with modern medicine, following the advice of a health worker if possible

2

Old Ways and New

Some modern ways of meeting health needs work better than old ones. But at times the older, traditional ways are best. For example, traditional ways of caring for children or old people are often kinder and work better than some newer, less personal ways. Not many years ago everyone thought that mother’s milk was the best food for a young baby. They were right! Then the big companies that make canned and artificial milk began to tell mothers that bottle feeding was better. This is not true, but many mothers believed them and started to bottle feed their babies. As a result, thousands of babies have suffered and died needlessly from infection or hunger. For the reasons breast is best, see page 271.

Respect your people’s traditions and build on them.

For more ideas for building on local traditions, see Helping Health Workers Learn.

BELIEFS THAT CAN MAKE PEOPLE WELL

The healing power of belief can be very strong!

Some home remedies have a direct effect on the body. Others seem to work only because people believe in them. The healing power of belief can be very strong.

For example, I once saw a man who suffered from a very bad headache. To cure him, a woman gave him a small piece of yam, or sweet potato. She told him it was a strong painkiller. He believed her, and the pain went away quickly.

It was his faith in her treatment, and not the yam itself, that made him feel better. Many home remedies work in this way. They help largely because people have faith in them.

For this reason, they are especially useful to cure illnesses that are partly in people’s minds, or those caused in part by a person’s beliefs, worry, or fears.

Included in this group of sicknesses are: bewitchment or hexing, unreasonable or hysterical fear, uncertain ‘aches and pains’ (especially in persons going through stressful times, such as teenage girls or older women), and anxiety or nervous worry.

Also included are some cases of asthma, hiccups, indigestion, stomach ulcers, migraine headaches, and even warts.

3

What it often comes down to is showing you care!

For all of these problems, the manner or ‘touch’ of the healer can be very important. What it often comes down to is showing you care, helping the sick person believe he will get well, or simply helping him relax.

Sometimes a person’s belief in a remedy can help with problems that have completely physical causes.

For example, Mexican villagers have the following home cures for poisonous snakebite:

1. to use ‘guaco’ leaves
2. to bite the snake
3. to apply tobacco
4. to apply the skin of a poisonous lizard

In other lands people have their own snakebite remedies, often many different ones. As far as we know, none of these home remedies has any direct effect against snake poison. The person who says that a home remedy kept a snake’s poison from harming him at all was probably bitten by a non-poisonous snake!

May do some good if a person believes in it!

Yet any of these home remedies may do some good if a person believes in it.

If it makes him less afraid, his pulse will slow down, he will move and tremble less, and as a result, the poison will spread through his body more slowly. So there is less danger!

But the benefit of these home remedies for snakebite is limited. In spite of their common use, many people still become very ill or die. As far as we know:

No home cure for poisonous bites (whether from snakes, scorpions, spiders, or other poisonous animals) has much effect beyond that of the healing power of belief.

For snakebite it is usually better to use modern treatment. Be prepared: obtain ‘antivenoms’ or ‘serums’ for poisonous bites before you need them (see page 387).
Do not wait until it is too late.

4

BELIEFS THAT CAN MAKE PEOPLE SICK

The power of belief can help heal people. But it can also harm them. If a person believes strongly enough that something will hurt him, his own fear can make him sick. For example:

Once I was called to see a woman who had just had a miscarriage and was still bleeding a little. There was an orange tree near her house. So I suggested she drink a glass of orange juice. (Oranges have vitamin C which helps strengthen blood vessels.) She drank it, even though she was afraid it would harm her.

Her fear was so great that soon she became very ill. I examined her, but could find nothing physically wrong.

I tried to comfort her, telling her she was not in danger. But she said she was going to die. At last I gave her an injection of distilled (completely pure) water. Distilled water has no medical effect. But since she had great faith in injections, she quickly got better.

Actually, the juice did not harm her. What harmed her was her belief that it would make her sick. And what made her well was her faith in injections!

In this same way, many persons go on believing false ideas about witchcraft, injections, diet, and many other things. Much needless suffering is the result.

Perhaps, in a way, I had helped this woman. But the more I thought about it, the more I realized I had also wronged her; I had led her to believe things that were not true.

I wanted to set this right. So a few days later, when she was completely well, I went to her home and apologized for what I had done. I tried to help her understand that not the orange juice, but her fear had made her so sick. And that not the injection of water, but her freedom from fear had helped her get well.

By understanding the truth about the orange, the injection, and the tricks of her own mind, perhaps this woman and her family will become freer from fear and better able to care for their health in the future. For health is closely related to understanding and freedom from fear.

Many things do harm only because people believe they are

5

witchcraft, black magic, and the evil eye

If a person believes strongly enough that someone has the power to harm him, he may actually become ill. Anyone who believes he is bewitched or has been given the evil eye is really the victim of his own fears (see Susto, see page 24).

A ‘witch’ has no power over other people, except for her ability to make them believe that she has. For this reason

It is impossible to bewitch a person who does not believe in witchcraft

Some people think that they are ‘bewitched’ when they have strange or frightening illnesses (such as tumors of the genitals or cirrhosis of the liver, see page 328). Such sicknesses have nothing to do with witchcraft or black magic. Their causes are natural.

Do not waste your money at ‘magic centers’ that claim to cure witchcraft. And do not seek revenge against a witch, because it will not solve anything. If you are seriously ill, go for medical help.

If you have a strange sickness do not blame a witch, do not go to a magic center. Ask for medical advice.

6

questions and answers on some folk beliefs and home remedies

These examples are from the mountains of Mexico, the area that I know best. Perhaps some of the beliefs of your people are similar. Think about ways to learn which beliefs in your area lead to better health and which do not.

When people think someone is bewitched, is it true that he will get well if his relatives harm or kill the witch?

FALSE! No one is ever helped by harming someone else.

Is it true that when the ‘soft spot’ on top of a baby’s head sinks inward this means the baby will die of diarrhea unless he gets special treatment?

This is often true. The ‘soft spot’ sinks because the baby has lost too much liquid (see page 151). Unless he gets more liquid soon, he may die (see page 152).

Is it true that if the light of the eclipsing moon falls on a pregnant mother, her child will be born deformed or mentally slow?

This is not true! But children may be born mentally slow, deaf, or deformed if the mother does not use iodized salt, if she takes certain medicines, or for other reasons (see page 318).

Is it true that mothers should give birth in a darkened room?

It is true that soft light is easier on the eyes of both the mother and the newborn child. But there should be enough light for the midwife to see what she is doing.

7

Is it true that a newborn baby should not be bathed until the cord falls off?

True! The stump of the cord should be kept dry until it falls off. But the baby can be gently cleaned with a clean, soft, damp cloth.

How many days after giving birth should a mother wait before she bathes?

A mother should wash with warm water the day after giving birth. The custom of not bathing for weeks following childbirth can lead to infections.

Is it true that traditional breastfeeding is better than ‘modern’ bottle feeding?

TRUE! Breast milk is better food and also helps protect the baby against infection.

What foods should women avoid in the first few weeks after childbirth?

In the weeks following childbirth, women should not avoid any nutritious foods. Instead, they should eat plenty of fruit, vegetables, meat, milk, eggs, whole grains, and beans (see page 276).

8

Is it a good idea to bathe a sick person, or will it do him harm?

It is a good idea. Sick people should be bathed in warm water every day.

Is it true that oranges, guavas, and other fruits are harmful when one has a cold or a fever?

NO! All fruits and juices are helpful when one has a cold or fever. They do not cause congestion or harm of any kind.

Is it true that when a person has a high fever, he should be wrapped up so that the air will not harm him?

NO! When a person has a high fever, take off all covers and clothing. Let the air reach his body. This will help the fever go down see page 76.

Is it true that tea made from willow bark will help bring fever down and stop pain?

True. It helps. Willow bark has a natural medicine in it very much like aspirin.

9

sunken fontanel or soft spot

The fontanel is the soft spot on the top of a newborn baby’s head. It is where the bones of his skull have not formed completely. Normally it takes a year to a year and a half for the soft spot to close completely.

Mothers in different lands realize that when the soft spot sinks inward their babies are in danger. They have many beliefs to explain this. In Latin America mothers think the baby’s brains have slipped downward.

They try to correct this by sucking on the soft spot, by pushing up on the roof of the mouth, or by holding the baby upside down and slapping his feet. This does not help because… A sunken soft spot is really caused by dehydration (see page 151).

This means the child is losing more liquid than he is drinking. He is too dry, usually because he has diarrhea, or diarrhea with vomiting.

Treatment:

1. Give the child plenty of liquid: Rehydration Drink (see page 152), breast milk, or boiled water.

2. If necessary, treat the causes of the diarrhea and vomiting (see page 152 to page 161). For most diarrheas, medicine is not needed, and may do more harm than good.

Note: If the soft spot is swollen or bulges upward, this may be a sign of meningitis. Begin treatment at once (see page 185), and get medical help.

10

WAYS TO TELL WHETHER A HOME REMEDY WORKS OR NOT

Because a lot of people use a home cure does not necessarily mean it works well or is safe. It is often hard to know which remedies are helpful and which may be harmful. Careful study is needed to be sure. Here are four rules to help tell which remedies are least likely to work, or are dangerous. (Examples are from Mexican villages.)

the more remedies there are for any one illness, the less likely it is that any of them works.

For example: In rural Mexico there are many home remedies for goiter, none of which does any real good. Here are some of them:

1. to tie a crab on the goiter. DON’T
2. to rub the goiter with the hand of a dead child. DON’T
3. to smear the brains of a vulture on the goiter. DON’T
4. to smear human feces on the goiter. DON’T

Not one of these many remedies works. If it did, the others would not be needed. When a sickness has just one popular cure, it is more likely to be a good one. For prevention and treatment of goiter use iodized salt. see page 131

foul or disgusting remedies are not likely to help, and are often harmful.

For example:

1. the idea that leprosy can be cured by a drink made of rotting snakes. DON’T

2. the idea that syphilis can be cured by eating a vulture. DON’T

These two remedies do not help at all. The first one can cause dangerous infections. Belief in remedies like these sometimes causes delay in getting proper medical care.

11

remedies that use animal or human waste do no good and can cause dangerous infections. never use them.

Examples:

1. Putting human feces around the eye does not cure blurred vision and can cause infections. DON’T!

2. Smearing cow dung on the head to fight ringworm can cause tetanus and other dangerous infections.. DON’T!

Also, the droppings of rabbits or other animals do not help heal burns. To use them is very dangerous. Cow dung, held in the hand, cannot help control seizures. Teas made from human, pig, or any other animal feces do not cure anything. They can make people sicker. Never put feces on the navel of a newborn baby. This can cause tetanus.

the more a remedy resembles the sickness it is said to cure, the more likely its benefits come only from the power of belief.

The association between each of the following illnesses and its remedy is clear in these examples from Mexico:

1. for a nosebleed, using yesca (a bright red mushroom)
2. for deafness, putting powdered rattlesnake’s rattle in the ear
3. for dog bite, drink tea made from the dog’s tail
4. for scorpion sting, tying a scorpion against the stung nger
5. to prevent diarrhea when a child is teething, putting a necklace of snake’s fangs around the baby’s neck
6. to ‘bring out’ the rash of measles, making tea from kapok bark

These remedies, and many other similar ones, have no curative value in themselves. They may be of some benefit if people believe in them. But for serious problems, be sure their use does not delay more effective treatment.

12

MEDICINAL PLANTS

Many plants have curative powers. Some of the best modern medicines are made from wild herbs.

Nevertheless, not all ‘curative herbs’ people use have medical value… and those that have are sometimes used the wrong way. Try to learn about the herbs in your area and find out which ones are worthwhile.

CAUTION: Some medicinal herbs are very poisonous if taken in more than the recommended dose. For this reason it is often safer to use modern medicine, since the dosage is easier to control.

Here are a few examples of plants that can be useful if used correctly:

Angel’s Trumpet, Brugmansia Arborea, Datura

The leaves of this and certain other members of the nightshade family contain a drug that helps to calm intestinal cramps, stomach-aches, and even gallbladder pain. Grind up 1 or 2 leaves of Angel’s Trumpet and soak them for a day in 7 tablespoons (100 ml.) of water.

Dosage: Between 10 and 15 drops every 4 hours (adults only).

WARNING: Angel’s Trumpet is very poisonous if you take more than the recommended dose.

CORN SILK: the tassels or silk from an ear of maize

A tea made from corn silk makes a person pass more urine. This can help reduce swelling of the feet, especially in pregnant women (see page 176 and page 248)

Boil a large handful of corn silk in water and drink 1 or 2 glasses. It is not dangerous.

GARLIC

A drink made from garlic may help get rid of pinworms.

Chop finely, or crush, 4 cloves of garlic and mix with 1 glass of liquid (water, juice, or milk).

Dosage: Drink 1 glass daily for 3 weeks.

To treat vaginal infections with garlic, see see page 241 and see page 242.

13

CARDON CACTUS Pachycereus pecten-aboriginum

Cactus juice can be used to clean wounds when there is no boiled water and no way to get any. Cardon cactus also helps stop a wound from bleeding, because the juice makes the cut blood vessels squeeze shut.

Cut a piece of the cactus with a clean knife and press it firmly against the wound. When the bleeding is under control, tie a piece of the cactus to the wound with a strip of cloth.

After 2 or 3 hours, take off the cactus and clean the wound with boiled water and soap. There are more instructions on how to care for wounds and control bleeding on pages page 82 to page 87.

ALOE VERA Sabila

Aloe vera can be used to treat to heal burn wounds for first - to second - degree burns. The thick, slimy juice inside the plant calms pain and itching, aids healing, and helps prevent infection. It can also be effective for genital herpes and psoriasis.

Take a leaf of the plant, the closer to the ground, cut off the outer green layer, and apply the fleshy leaf or juice directly to the burn or wound.

Aloe can also help treat stomach ulcers and gastritis.

Chop the gelly leaves into small pieces, soak them in water overnight, and then drink one glass of the slimy, bitter liquid every 2 hours.

PAPAYA

Ripe papayas are rich in vitamins and also aid digestion. Eating them is especially helpful for weak or old people who complain of upset stomach when they eat meat, chicken, or eggs. Papaya makes these foods easier to digest.

Papaya can also help get rid of intestinal worms, although modern medicines work better.

Collect 3 or 4 teaspoons (15-20 ml.) of the ‘milk’ that comes out when the green fruit or trunk of the tree is cut.

Mix this with an equal amount of sugar or honey and stir it into a cup of hot water. If possible, drink along with a laxative.

Even better, dry and crush to a powder the papaya seeds. Take 3 teaspoons mixed with 1 glass water or some honey 3 times a day for 7 days.

Papayas can also be used for treating pressure sores. The fruit contains chemicals that help soften and make dead flesh easier to remove.

First clean and wash out a pressure sore that has dead flesh in it. Then soak a sterile cloth or gauze with ‘milk’ from the trunk or green fruit of a papaya plant and pack this into the sore, Repeat cleaning and repacking 3 times a day.

14

HOMEMADE CASTS for keeping broken bones in place.

In Mexico several different plants such as tepeguaje (a tree of the bean family) and solda con solda (a huge, tree-climbing arum lily) are used to make casts. However, any plant will do if a syrup can be made from it that will dry hard and firm and will not irritate the skin.

In India, traditional bone-setters make casts using a mixture of egg whites and herbs instead of a syrup made from plant juices. But the method is similar. Try out different plants in your area.

For a cast using tepeguaje: Put 1 kilogram of the bark into 5 liters of water and boil until only 2 liters are left. Strain and boil until a thick syrup is formed. Dip strips of flannel or clean sheet in the syrup and carefully use as follows.

Make sure the bones are in a good position (see page 98)

Do not put the cast directly against the skin. Wrap the arm or leg in a soft cloth.

Then follow with a layer of cotton or wild kapok. Finally, put on the wet cloth strips so that they form a cast that is firm but not too tight.

Most doctors recommend that the cast cover the joint above and the joint below the break, to keep the broken bones from moving.

This would mean that, for a broken wrist, the cast should cover almost the whole arm, like this:

Leave the finger tips uncovered so that you can see if they keep a good color.

However, traditional bone-setters in China and Latin America use a short cast on a simple break of the arm saying that a little movement of the bone-ends speeds healing. Recent scientific studies have proven this to be true.

A temporary leg or arm splint can be made of cardboard, folded paper, or the thick curved stem of dried banana leaf, or palm leaf.

CAUTION: Even if the cast is not very tight when you put it on, the broken limb may swell up later. If the person complains that the cast is too tight, or if his fingers or toes become cold, white, or blue, take the cast off and put on a new, looser one. Never put on a cast over a cut or a wound.

15

ENEMAS, LAXATIVES, AND PURGES

when to use them and when not to!

Many people give enemas and take laxatives far too often. The ‘urge to purge’ is worldwide.

Enemas and purges are very popular home cures. And they are often very harmful. Many people believe fever and diarrhea can be ‘washed out’ by giving an enema (running water into the gut through the anus) or by using a purge, or strong laxative. Unfortunately, such efforts to clean or purge the sick body often cause more injury to the already damaged gut.

Rarely do enemas or laxatives do any good at all. Often they are dangerous, especially strong laxative

cases in which it is dangerous to use enemas or laxatives!

Never use an enema or laxative if a person has a severe stomach-ache or any other sign of appendicitis or ‘acute abdomen’ (see page 93), even if he passes days without a bowel movement.

Never give an enema or laxative to a person with a bullet wound or other injury to the gut.

Never give a strong laxative to a weak or sick person. It will weaken him more. Never give an enema or purge to a baby less than 2 years old.

Never give a laxative or purge to a child with high fever, vomiting, diarrhea or signs of dehydration (see page 151). It can increase dehydration and kill the child. Do not make a habit of using laxatives often (see Constipation, see page 126).

the correct uses of enemas

1. Simple enemas can help relieve constipation (dry, hard, difficult stools). Use warm water only.

2. When a person with severe vomiting is dehydrated, you can try replacing water by giving an enema of Rehydration Drink very slowly (see page 152).

16

purges and laxatives often used

castor oil, senna leaf, cascara (cascara sagrada)

These are irritating purges that often do more harm than good. It is better not to use them.

magnesium hydroxide, milk of magnesia, epsom salts, magnesium sulfate (see page 382)

These are salt purges. Use them only in low doses, as laxative for constipation.

Do not use them often and never when there is pain in the belly.

mineral oil (see page 382)

This is sometimes used for constipation in persons with piles…but it is like passing greased rocks. Not recommended.

correct uses of laxatives

Laxatives are like purges but weaker. All the products listed above are laxatives when taken in small doses and purges when taken in large doses. Laxatives soften and hurry the bowel movement; purges cause diarrhea. Purges are always harmful, but laxatives can sometimes be used to relieve constipation.

Laxatives

One can use milk of magnesia or other magnesium salts in small doses, as laxatives, in some cases of constipation. People with hemorrhoids (piles, see page 175) who have constipation can take mineral oil but this only makes their stools slippery, not soft. The dose for mineral oil is 3 to 6 teaspoons at bedtime (never with a meal because the oil will rob the body of important vitamins in the food). This is not the best way.

Suppositories

Or bullet-shaped pills that can be pushed up the rectum, can also be used to relieve constipation or piles (see page 175, page 382,page 391).

A better way!

Foods with fiber.

The healthiest and most gentle way to have softer, more frequent stools is to drink a lot of water and to eat more foods with lots of natural fiber, or ‘roughage’ like cassava, yam, or bran (wheat husks) and other whole grain cereals (see page 126).

People who traditionally eat lots of food with natural fiber suffer much less from piles, constipation, and cancer of the gut than do people who eat a lot of refined ‘modern’ foods.

For better bowel habits, avoid refined foods and eat foods prepared from unpolished or unrefined grains.

Plenty of fruits and vegetables.

Eating plenty of fruits and vegetables also helps.

• WHAT CAUSES SICKNESS?
• DIFFERENT KINDS OF SICKNESSES AND THEIR CAUSES
• NON-INFECTIOUS DISEASES
  • examples of NON-INFECTIOUS DISEASES
• INFECTIOUS DISEASES
  • examples of INFECTIOUS DISEASES
    • bacteria (microbes or germs)
      • tuberculosis
      • tetanus
      • some diarrhea
      • pneumonia (some kinds)
      • gonorrhea, chlamydia, and syphillis
      • earache
      • infected wounds
      • sores with pus
    • virus (germs smaller than bacteria)
      • colds, flu, measles, mumps, chickenpox, infantile paralysis, virus diarrhea
      • rabies
      • warts
      • HIV
    • Fungus
      • ringworm fungus athlete’s foot, jock itch, yeast infection
    • internal parasites (harmful animals living in the body)
      • In the gut: worms, amebas (dysentery)
    • internal parasites (harmful animals living in the body)
      • In the blood: malaria
    • External parasites (harmful animals living on the body)
      • lice, fleas bedbugs scabies
• SICKNESSES THAT ARE HARD TO TELL APART
• SICKNESSES THAT ARE OFTEN CONFUSED or given the same name
  • examples of local names for sicknesses
• MISUNDERSTANDINGS DUE TO CONFUSION OF NAMES
  • confusion between different illnesses that cause fever

WHAT CAUSES SICKNESS?

Persons from different countries or backgrounds have different ways to explain what causes sickness.

A baby gets diarrhea. But why?

People in small villages may say it is because the parents did something wrong, or perhaps because they made a god or spirit angry.

A doctor may say it is because the child has an infection.

A public health officer may say it is because the villagers do not have a good water system or use latrines.

A social reformer may say the unhealthy conditions that lead to frequent childhood diarrhea are caused by an unfair distribution of land and wealth.

A teacher may place the blame on lack of education. People see the cause of sickness in terms of their own experience and point of view. Who then is right about the cause? Possibly everyone is right, or partly right. This is because…

Sickness usually results from a combination of causes

Each of the causes suggested above may be a part of the reason why a baby gets diarrhea.

To prevent and treat sickness successfully, it helps to have as full an understanding as possible about the common sicknesses in your area and the combination of things that causes them.

In this book, different sicknesses are discussed mostly according to the systems and terms of modern or scientific medicine.

To make good use of this book, and safe use of the medicines it recommends, you will need some understanding of sicknesses and their causes according to medical science. Reading this chapter may help.

18

DIFFERENT KINDS OF SICKNESSES AND THEIR CAUSES

When considering how to prevent or treat different sicknesses, it helps to think of them in two groups: infectious and non-infectious.

Infectious diseases are those that spread from one person to another. Healthy persons must be protected from people with these sicknesses.

Non-Infectious diseases do not spread from person to person. They have other causes. Therefore, it is important to know which sicknesses are infectious and which are not.

NON-INFECTIOUS DISEASES

Non-infectious diseases have many different causes. But they are never caused by germs, bacteria, or other living organisms that attack the body. They never spread from one person to another. It is important to realize that antibiotics, or medicines that fight germs (see page 55), do not help cure non-infectious diseases.

Remember: Antibiotics are of no use for non-infectious diseases.

examples of NON-INFECTIOUS DISEASES

Problems caused by:

something that wears out or goes wrong within the body

• rheumatism
• heart attack epileptic seizures stroke
• migraine headaches cataract
• cancer

something from outside that harms or troubles the body

• allergies
• asthma
• poisons
• snakebite
• cough from smoking
• stomach ulcer
• alcoholism

lack of something the body needs

• malnutrition
• anemia
• pellagra
• night blindness and xerophthalmia
• goiter and hypothyroidism
• cirrhosis of the liver (part of the cause)

Problems people are born with

• harelip
• crossed or wall-eyes (squint)
• other deformities
• epilepsy (some kinds)
• mental slowness
• birthmark

Problems that begin in the mind (mental illnesses)

• fear that something is harmful when it is not (paranoia)
• nervous worry (anxiety)
• belief in hexes (witchcraft)
• uncontrolled fear (hysteria)

INFECTIOUS DISEASES

Infectious diseases are caused by bacteria and other organisms (living things) that harm the body. They are spread in many ways. Here are some of the most important kinds of organisms that cause infections and examples of sicknesses they cause:

19

examples of INFECTIOUS DISEASES

Organism that causes the sickness:

bacteria (microbes or germs)

tuberculosis

How it is spread or enters the body: through the air (coughing)

Principal medicine: different antibiotics for different bacterial infections

tetanus

How it is spread or enters the body: dirty wounds

Principal medicine: different antibiotics for different bacterial infections

some diarrhea

How it is spread or enters the body: dirty fingers, water, flies

Principal medicine: different antibiotics for different bacterial infections

pneumonia (some kinds)

How it is spread or enters the body: through the air (coughing)

Principal medicine: different antibiotics for different bacterial infections

gonorrhea, chlamydia, and syphillis

How it is spread or enters the body: sexual contact

Principal medicine: different antibiotics for different bacterial infections

earache

How it is spread or enters the body: with a cold

Principal medicine: different antibiotics for different bacterial infections

infected wounds

How it is spread or enters the body: contact with dirty things

Principal medicine: different antibiotics for different bacterial infections

sores with pus

How it is spread or enters the body: direct contact (by touch)

Principal medicine: different antibiotics for different bacterial infections

virus (germs smaller than bacteria)

colds, flu, measles, mumps, chickenpox, infantile paralysis, virus diarrhea

How it is spread or enters the body: from someone who is sick, through the air, by coughing. flies, etc.

Principal medicine: acetaminophen and other painkillers

rabies

How it is spread or enters the body: animal bites

Principal medicine: vaccinations prevent some virus infections

warts

How it is spread or enters the body: touch

Principal medicine: vaccinations prevent some virus infections

HIV

How it is spread or enters the body: body fluids of someone infected get inside another person ́s body

Principal medicine: Antiretroviral medicines fight HIV.

Fungus

ringworm fungus athlete’s foot, jock itch, yeast infection

How it is spread or enters the body: by touch or from clothing

Principal medicine: nystatin, miconazole, gentian violet, ointments with undecylenic, benzoic, or salicylic acid

internal parasites (harmful animals living in the body)

In the gut: worms, amebas (dysentery)

How it is spread or enters the body: feces-to-mouth lack of cleanliness

Principal medicine: different specific medicines

internal parasites (harmful animals living in the body)

In the blood: malaria

How it is spread or enters the body: mosquito bite

Principal medicine: a combination of malaria medicines

External parasites (harmful animals living on the body)

lice, fleas bedbugs scabies

How it is spread or enters the body: by contact with infected persons or their clothes

Principal medicine: permethrin, keeping very clean

Bacteria, like many of the organisms that cause infections, are so small you cannot see them without a microscope, an instrument that makes tiny things look bigger. Viruses are even smaller than bacteria.

Antibiotics (penicillin, tetracycline, etc.) are medicines that help cure certain illnesses caused by bacteria.

Antibiotics have no effect on illnesses caused by viruses, such as colds, flu, mumps, chickenpox, etc.

Do not treat virus infections with antibiotics. They will not help and may be harmful (see antibiotics).

20

SICKNESSES THAT ARE HARD TO TELL APART

Sometimes diseases that have different causes and require different treatment result in problems that look very much alike. For example:

1. A child who slowly becomes thin and wasted, while his belly gets more and more swollen, could have any (or several) of the following problems:

   • malnutrition (see page 112)

   • a lot of roundworms, (see page 140), (usually together with malnutrition)

   • advanced tuberculosis (see page 179)

   • a long-term severe urinary infection (see page 234)

   • any of several problems of the liver or spleen

   • leukemia (cancer of the blood)

   • HIV (see page 339)

2. An older person with a big, open, slowly growing sore on the ankle could have:

   • bad circulation that results from varicose veins or other causes (see page 213)

   • diabetes(see page 127)

   • infection of the bone (osteomyelitis)

   • leprosy (see page 191)

   • tuberculosis of the skin (see page 212)

   • advanced syphilis (see page 237)

The medical treatment for each of these diseases is different, so to treat them correctly it is important to tell them apart.

Many illnesses at first seem very similar. But if you ask the right questions and know what to look for, you can often learn information and see certain signs that will help tell you what illness a person has.

This book describes the typical history and signs for many illnesses. But be careful! Diseases do not always show the signs described for them, or the signs may be confusing.

For difficult cases, the help of a skilled health worker or doctor is often needed. Sometimes special tests or analyses are necessary.

Work within your limits! In using this book, remember it is easy to make mistakes. Never pretend you know something you do not. If you are not fairly sure what an illness is and how to treat it, or if the illness is very serious, get medical help.

21

SICKNESSES THAT ARE OFTEN CONFUSED or given the same name

Many of the common names people use for their sicknesses were first used long before anyone knew about germs or bacteria or the medicines that fight them. Different diseases that caused more or less similar problems-such as ‘high fever’ or ‘pain in the side’, were often given a single name. In many parts of the world, these common names are still used.

City-trained doctors often neither know nor use these names. For this reason, people sometimes think they apply to ‘sicknesses doctors do not treat’. So they treat these home sicknesses with herbs or home remedies.

Actually, most of these home sicknesses or ‘folk diseases’ are the same ones known to medical science. Only the names are different.

For many sicknesses, home remedies work well. But for some sicknesses, treatment with modern medicine works much better and may be life-saving. This is especially true for dangerous infections like pneumonia, typhoid, tuberculosis, or infections after giving birth.

To know which sicknesses definitely require modern medicines and to decide what medicine to use, it is important that you try to find out what the disease is in the terms used by trained health workers and in this book.

If you cannot find the sickness you are looking for in this book, look for it under a different name or in the chapter that covers the same sort of problem. Use the list of CONTENTS and the Index

If you are unsure what the sickness is, especially if it seems serious, try to get medical help.

The rest of this chapter gives examples of common or traditional names people use for various sicknesses. Often a single name is given to diseases that are different according to medical science.

Examples cannot be given for each country or area where this book may be used. Therefore, I have kept those from the Spanish edition, with names used by villagers in western Mexico. They will not be the same names you use. However, people in many parts of the world see and speak of their illnesses in a similar way. So the examples may help you think about how people name diseases in your area.

examples of local names for sicknesses

STOPPED-UP GUT

Means that the gut is stopped up or obstructed (see page 94). But in Mexican villages any illness causing stomach-ache or diarrhea may be called empacho. It is said that a ball of hair or something else blocks a part of the gut. People put the blame on witches or evil spirits, and treat with magic cures and cupping (see picture). Sometimes folk healers pretend to take a ball of hair and thorns out of the gut by sucking on the belly.

Different illnesses that cause stomach pain or discomfort and are sometimes called empacho are:

• diarrhea or dysentery with cramps (see page 153)

• worms (see page 140)

• swollen stomach due to malnutrition (see page 112)

• indigestion or stomach ulcer (see page 128)

• and rarely, true gut obstruction or appendicitis (see page 94)

Most of these problems are not helped much by magic cures or cupping. To treat empacho, try to identify and treat the sickness that causes it.

SIDE PAINS

This name is used for any pain women get in one side of their belly. Often the pain goes around to the mid or lower back. Possible causes of this kind of pain include:

• an infection of the urinary system (the kidneys, the bladder, or the tubes that join them, (see page 234)

• cramps or gas pains (see diarrhea 153)

• menstrual pains (see page 245)

• appendicitis (see page 94)

• an infection, cyst, or tumor in the womb or ovaries (see page 243) or an ectopic pregnancy (see page 280)

22

CONGESTION

Any sudden upset or illness that causes great distress is called la congestión by Mexican villagers. People speak of congestión of:

the head, the chest, the stomach, or the whole body. It is said that la congestión strikes persons who break ‘the diet’ (see page 123), by eating foods that are forbidden or taboo after childbirth, while taking a medicine, or when they have a cold or cough.

Although these foods usually cause no harm and are sometimes just what their bodies need, many people will not touch them because they are so afraid of getting la congestión.

Different illnesses that are sometimes called la congestión are:

• Food poisoning, from eating spoiled food: causes sudden vomiting followed by diarrhea, cramps, and weakness (see page 135).

• A severe allergic reaction, in allergic persons after they eat certain foods (shellfish, chocolate, etc,), take certain medicines, or are injected with penicillin. May cause vomiting, diarrhea, cold sweat, breathing trouble, itchy rash, and severe distress (see page 166).

• Any sudden upset of the stomach or gut: see diarrhea (see page 153), vomiting (see page 161), and acute abdomen (see page 93).

• Sudden or severe difficulty breathing: caused by asthma (page 167), pneumonia (page 171), or something stuck in the throat (page 79).

• Illnesses that cause seizures (fits) or paralysis: see seizures (page 178), tetanus (page 182), meningitis (page 185), polio (page 314), and stroke (page 327).

• Heart attacks: mostly in older persons (page 325).

23

CONGESTION

Any sudden upset or illness that causes great distress is called la congestión by Mexican villagers. People speak of congestión of:

the head, the chest, the stomach, or the whole body. It is said that la congestión strikes persons who break ‘the diet’ (see page 123), by eating foods that are forbidden or taboo after childbirth, while taking a medicine, or when they have a cold or cough. Although these foods usually cause no harm and are sometimes just what their bodies need, many people will not touch them because they are so afraid of getting la congestión. Different illnesses that are sometimes called la congestión are:

• Food poisoning, from eating spoiled food: causes sudden vomiting followed by diarrhea, cramps, and weakness (see page 135).

• A severe allergic reaction, in allergic persons after they eat certain foods (shellfish, chocolate, etc,), take certain medicines, or are injected with penicillin. May cause vomiting, diarrhea, cold sweat, breathing trouble, itchy rash, and severe distress (see page 166).

• Any sudden upset of the stomach or gut: see diarrhea (page 153), vomiting (page 161), and acute abdomen (page 93).

• Sudden or severe difficulty breathing: caused by asthma (page 167), pneumonia (page 171), or something stuck in the throat (page 79).

• Illnesses that cause seizures (fits) or paralysis: see seizures (page 178), tetanus (page 182), meningitis (page 185), polio (page 314), and stroke (page 327).

• Heart attacks: mostly in older persons (page 325).

PULSING

Latido is a name used in Latin America for a pulsing or ‘jumping’ in the pit of the stomach. It is really the pulse of the aorta or big blood vessel coming from the heart. This pulse can be seen and felt on a person who is very thin and hungry. Latido is often a sign of malnutrition (page 112), or hunger! Eating enough good food is the only real treatment (see page 110 and page 111).

24

HYSTERIA, FRIGHT

According to Mexican villagers, hysteria (susto) is caused by a sudden fright a person has had, or by witchcraft, black magic, or evil spirits. A person with fright is very nervous and afraid. He may shake, behave strangely, not be able to sleep, lose weight, or even die.

Possible medical explanations for hysteria:

1. In many people, hysteria is a state of fear, perhaps caused by the ‘power of belief’ (see page 4). For example, a woman who is afraid someone will hex her becomes nervous and does not eat or sleep well. She begins to grow weak and lose weight. She takes this as a sign she has been hexed, so she becomes still more nervous and frightened. Her susto gets worse and worse.

2. In babies or small children, hysteria is usually very different. Bad dreams may cause a child to cry out in his sleep or wake up frightened. High fevers from any illness can cause very strange speech and behavior (delirium). A child that often looks and acts worried may be malnourished (page 112). Sometimes early signs of tetanus (page 182) or meningitis (page 185) are also called susto.

Treatment:

When the hysteria is caused by a specific illness, treat the illness. Help the person understand its cause. Ask for medical advice, if needed.

When the hysteria is caused by fright, try to comfort the person and help him understand that his fear itself is the cause of his problem. Magic cures and home remedies sometimes help.

If the frightened person is breathing very hard and fast, his body may be getting too much air, which may be part of the problem:

EXTREME FRIGHT OR HYSTERIA WITH FAST HEAVY BREATHING (HYPERVENTILATION)

Signs:

• person very frightened

• breathing fast and deep

• fast, pounding heartbeat

• numbness or tingling of face, hands, or feet

• muscle cramps

Treatment:

♦ Keep the person as quiet as possible.

♦ Have her put her face in a paper bag and breathe slowly. She should continue breathing the same air for 2 or 3 minutes. This will usually calm her down.

♦ Explain to her that the problem is not dangerous and she will soon be all right.

25

MISUNDERSTANDINGS DUE TO CONFUSION OF NAMES

This page shows 2 examples of misunderstandings that can result when certain names like ‘cancer’ and ‘leprosy’ mean one thing to medical workers and something else to villagers. In talking with health workers-and in using this book:

Avoid misunderstanding, go by the signs and history of a person’s sickness, not the name people give it!

Spanish Name: CÁNCER (CANCER)

Mexican villagers use the word cáncer for any severe infection of the skin, especially badly infected wounds (page 88) or gangrene (page 213).

In modern medical language, cancer is not an infection, but an abnormal growth or lump in any part of the body. Common types of cancer that you should watch out for are:

Any hard, painless, slowly growing lump in any part of your body may be cancer. Cancer is often dangerous and may need surgery.

At the first suspicion of cancer seek medical help.

Spanish Name: LEPRA (LEPROSY)

Mexican villagers call any open spreading sore lepra. This leads to confusion, because medical workers use this term only for true leprosy (Hansen’s disease, page 191). Sores commonly called lepra are:

• impetigo and other skin infections (page 202)

• sores that come from insect bites or scabies (page 199)

• chronic sores or skin ulcers such as those caused by poor circulation (page 213)

• skin cancer (page 211)

• less commonly, leprosy (page 191) or tuberculosis of the skin (page 212)

26

confusion between different illnesses that cause fever

Spanish Name: LA FIEBRE (THE FEVER)

Correctly speaking, a fever is a body temperature higher than normal. But in Latin America, a number of serious illnesses that cause high temperatures are all called la fiebre, or ‘the fever’.

To prevent or treat these diseases successfully, it is important to know how to tell one from another.

Here are some of the important acute illnesses in which fever is an outstanding sign. The drawings show the fever pattern (rise and fall of temperature) that is typical for each disease.

Malaria: (see page 186)

Begins with weakness, chills and fever. Fever may come and go for a few days, with shivering (chills) as the temperature rises, and sweating as it falls. Then, fever may come for a few hours every second or third day. On other days, the person may feel more or less well.

Typhoid: (see page 188)

Begins like a cold. Temperature goes up a little more each day. Pulse relatively slow. Sometimes diarrhea and dehydration. Trembling or delirium (mind wanders). Person very ill.

Typhus: (see page 190)

Similar to typhoid. Rash similar to that of measles, with tiny bruises.

Hepatitis: (see page 172)

Person loses appetite. Does not wish to eat or smoke. Wants to vomit (nausea). Eyes and skin turn yellow; urine orange or brown; stools whitish. Sometimes liver becomes large, tender. Mild fever. Person very weak.

27

Pneumonia: (see page 171)

Fast, shallow breathing. Temperature rises quickly. Cough with green, yellow, or bloody mucus. May be pain in chest. Person very ill.

Rheumatic fever: (see page 310)

Most common in children and teenagers. Pain in joints. High fever. Often comes after a sore throat. May be pain in the chest with shortness of breath. Or uncontrolled movements of arms and legs.

Brucellosis (undulant fever, Malta fever): (see page 188)

Begins slowly with tiredness, headache, and pains in the bones. Fever and sweating most common at night. Fever disappears for a few days only to come back again. This may go on for months or years.

Childbirth fever: (see page 276)

Begins a day or more after giving birth. Starts with a slight fever, which often rises later. Foul-smelling vaginal discharge. Pain and sometimes bleeding.

All of these illnesses can be dangerous. In addition to those shown here, there are many other diseases that may cause similar signs and fever. For example, fevers that last for more than 1 month, or night sweats, may be caused by HIV infection (see page 399). When possible, seek medical help.

• QUESTIONS
• GENERAL CONDITION OF HEALTH
• TEMPERATURE
• HOW TO USE A THERMOMETER
  • How to take the temperature
• BREATHING (RESPIRATION)
• PULSE (HEARTBEAT)
  • normal pulse for people at rest
  • EYES
• EARS, THROAT, AND NOSE
  • SKIN
• THE BELLY (ABDOMEN)
• MUSCLES AND NERVES
  • Check for stiffness or tightness of different muscles
  • To check for loss of feeling in the hands, feet, or other parts of the body

To find out the needs of a sick person, first you must ask important questions and then examine him carefully. You should look for signs and symptoms that help you tell how ill the person is and what kind of sickness he may have.

Always examine the person where there is good light, preferably in the sunlight, never in a dark room.

There are certain basic things to ask and to look for in anyone who is sick. These include things the sick person feels or reports (symptoms), as well as things you notice on examining him (signs). These signs can be especially important in babies and persons unable to talk. In this book the word ‘signs’ is used for both symptoms and signs.

When you examine a sick person, write down your findings and keep them for the health worker in case he is needed (see page 44).

QUESTIONS

Start by asking the person about her sickness. Be sure to ask the following: What bothers you most right now?

What makes you feel better or worse?

How and when did your sickness begin?

Have you had this same trouble before, or has anyone else in your family or neighborhood had it?

Continue with other questions in order to learn the details of the illness. For example, if the sick person has a pain, ask her:

Where does it hurt? (Ask her to point to the exact place with one finger.)

Does it hurt all the time, or off and on?

What is the pain like? (sharp? dull? burning?)

Can you sleep with the pain?

If the sick person is a baby who still does not talk, look for signs of pain. Notice his movements and how he cries. (For example, a child with an earache sometimes rubs the side of his head or pulls at his ear.)

30

GENERAL CONDITION OF HEALTH

Before touching the sick person, look at him carefully. Observe how ill or weak he looks, the way he moves, how he breathes, and how clear his mind seems. Look for signs of dehydration (see page 151) and of shock (page 77).

Notice whether the person looks well nourished or poorly nourished. Has he been losing weight? When a person has lost weight slowly over a long period of time, he may have a chronic illness (one that lasts a long time).

Also note the color of the skin and eyes. These sometimes change when a person is sick. (Dark skin can hide color changes. So look at parts of the body where the skin is pale, such as palms of the hands or soles of the feet, the fingernails, or the insides of the lips and eyelids.)

• Paleness, especially of the lips and inside the eyelids, is a sign of anemia (page 124). Skin may also go lighter as a result of tuberculosis (page 179), or kwashiorkor (page 113).

• Darkening of the skin may be a sign of starvation (see page 112).

• Bluish skin, especially blueness or darkness of the lips and fingernails, may mean serious problems with breathing (page 79, 167, and 313) or with the heart (page 325). Blue-gray color in an unconscious child may be a sign of cerebral malaria (page 186).

• A gray-white coloring, with cool moist skin, often means a person is in shock (page 77).

• Yellow color (jaundice) of the skin and eyes may result from disease in the liver (hepatitis, page 172, cirrhosis, page 328, or amebic abscess, page 145) or gallbladder (page 329). It may also occur in newborn babies (page 274), and in children born with sickle cell disease (page 321). Look also at the skin when a light is shining across it from one side. This can show the earliest sign of measles rash on the face of a feverish child (page 311).

TEMPERATURE

It is often wise to take a sick person’s temperature, even if he does not seem to have a fever. If the person is very sick, take the temperature at least 4 times each day and write it down.

If there is no thermometer, you can get an idea of the temperature by putting the back of one hand on the sick person’s forehead and the other on your own or that of another healthy person. If the sick person has a fever, you should feel the difference.

It is important to find out when and how the fever comes, how long it lasts, and how it goes away. This may help you identify the disease. Not every fever is malaria, though in some countries it is often treated as such. Remember other possible causes.

For example:

• Common cold, and other virus infections (page 163). The fever is usually mild.

• Typhoid causes a fever that goes on rising for 5 days. Malaria medicine does not help.

• Tuberculosis sometimes causes a mild fever in the afternoon. At night the person often sweats, and the fever goes down.

31

HOW TO USE A THERMOMETER

Every family should have a thermometer. Take the temperature of a sick person 4 times a day and always write it down.

How to read the thermometer (using one marked in degrees centigrade, °C):

• Turn the thermometer until you can see the silver line.

• The point where the silver line stops marks the temperature.

• Normal: 37

• Fever: 37 > 39

• High Fever: 39 > 42

How to take the temperature

1. Clean the thermometer well with soap and water or alcohol. Shake it hard, with a snap of the wrist, until it reads less than 36 degrees.

2. Put the thermometer:

   • under the tongue (keeping the or mouth shut)

   • in the armpit if there is danger of biting or the thermometer

   • carefully, in the anus of a small child (wet or grease it first)

3. Leave it there for 3 or 4 minutes.

4. Read it. (An armpit temperature will read a little lower than a mouth reading; in the anus it will read a little higher.)

5. Wash the thermometer well with soap and water.

Note: In newborn babies a temperature that is unusually high or unusually low (below 36° C) may mean a serious infection (see page 275).

♦ To learn about other fever patterns, see page 26 to page 27.

♦ To learn what to do for a fever, see page 75.

32

BREATHING (RESPIRATION)

Pay special attention to the way the sick person breathes, the depth (deep or shallow), rate (how often breaths are taken), and difficulty. Notice if both sides of the chest move equally when she breathes.

If you have a watch or simple timer, count the number of breaths per minute (when the person is quiet).

Between 12 and 20 breaths per minute is normal for adults and older children. Up to 30 breaths a minute is normal for younger children, and 40 for babies.

People with a high fever or serious respiratory illness breathe more quickly than normal. For example, more than 30 shallow breaths a minute in an adult usually means pneumonia, as does 60 breaths a minute for a newborn baby.

Listen carefully to the sound of the breaths. For example:

• A whistle or wheeze and difficulty breathing out can mean asthma (see page 167).

• A gurgling or snoring noise and difficult breathing in an unconscious person may mean the tongue, mucus (slime or pus), or something else is stuck in the throat and does not let enough air get through.

Look for ‘sucking in’ of the skin between ribs and at the angle of the neck (behind the collar bone) when the person breathes in. This means air has trouble getting through. Consider the possibility of something stuck in the throat (page 79), pneumonia (page 171), asthma (page 167), or bronchitis (mild sucking in, see page 170).

If the person has a cough, ask if it keeps her from sleeping. Find out if she coughs up mucus, how much, its color, and if there is blood in it.

Pay attention to the strength, the rate, and the regularity of the pulse. If you have a watch or timer, count the pulses per minute.

PULSE (HEARTBEAT)

To take the person’s pulse, put your ngers on the wrist as shown. (Do not use your thumb to feel for the pulse.)

If you cannot nd the pulse in the wrist, feel for it in the neck beside the voicebox.

Or put your ear directly or the chest and listen for the heartbeat (or use a stethoscope if you have one).

normal pulse for people at rest

adults - from 60 to 80 per minute

children - 80 to 100

babies - 100 to 140

The pulse gets much faster with exercise and when a person is nervous, frightened, or has a fever. As a general rule, the pulse increases 20 beats per minute for each degree (°C) rise in fever.

When a person is very ill, take the pulse often and write it down along with the temperature and rate of breathing.

It is important to notice changes in the pulse rate. For example:

• A weak, rapid pulse can mean a state of shock (see page 77).

• A very rapid, very slow, or irregular pulse could mean heart trouble (see page 325).

• A relatively slow pulse in a person with a high fever may be a sign of typhoid (see page 188).

33

EYES

Look at the color of the white part of the eyes. Is it normal, red (page 219), or yellow? Also note any changes in the sick person’s vision.

Have the person slowly move her eyes up and down and from side to side. Jerking or uneven movement may be a sign of brain damage.

Pay attention to the size and color of the pupils (the black ‘window’ in the center of the eye). If they are very large, it can mean a state of shock (see page 77). If they are very large, or very small, it can mean poison or the effect of certain drugs. If there is a white glow, it can mean cataracts (see page 225) or cancer.

Look at both eyes and note any difference between the two, especially in the size of the pupils:

A big difference in the size of the pupils is almost always a medical emergency.

• If the eye with the larger pupil hurts so badly it causes vomiting, the person probably has GLAUCOMA (see page 222).

• If the eye with the smaller pupil hurts a great deal, the person may have IRITIS, a very serious problem (see page 221).

• Difference in the size of the pupils of an unconscious person or a person who has had a recent head injury may mean brain damage. It may also mean STROKE (see page 327).

Always compare the pupils of a person who is unconscious or has had a head injury.

34

EARS, THROAT, AND NOSE

Ears: Always check for signs of pain and infection in the ears-especially in a child with fever or a cold. A baby who cries a lot or pulls at his ear may have an ear infection (page 309).

Pull the ear gently. If this increases pain, the infection is probably in the tube of the ear (ear canal). Also look for redness or pus inside the ear. A small flashlight or penlight will help. But never put a stick, wire, or other hard object inside the ear.

Find out if the person hears well, or if one side is more deaf than the other. Rub your thumb and fingers together near the person’s ear to see if he can hear it. For deafness and ringing of the ears see page 327.

Throat and Mouth: With a torch (flashlight) or sunlight examine the mouth and throat. To do this hold down tongue with a spoon handle or have the person say ‘ahhhhh…’ Notice if the throat is red and if the tonsils (2 lumps at the back of the throat) are swollen or have spots with pus (see page 309). Also examine the mouth for sores, inflamed gums, sore tongue, rotten or abscessed teeth and other problems. (Read Chapter 17.)

Nose: Is the nose runny or plugged? (Notice if and how a baby breathes through his nose.) Shine a light inside and look for mucus, pus, blood; also look for redness, swelling, or bad smell. Check for signs of sinus trouble or hay fever (page 165).

SKIN

It is important to examine the sick person’s whole body, no matter how mild the sickness may seem. Babies and children should be undressed completely. Look carefully for anything that is not normal, including:

• sores, wounds, or splinters

• rashes or welts

• spots, patches, or any unusual markings •

• inflammation (sign of infection with • redness, heat, pain and swelling)

• swelling or puffiness •

• swollen lymph nodes (little lumps in the neck, the armpits, or the groin, see page 88)

• abnormal lumps or masses

• unusual thinning or loss of hair, or loss of its color or shine (page 112)

• loss of eyebrows (leprosy? page 191)

Always examine little children between the buttocks, in the genital area, between the fingers and toes, behind the ears, and in the hair (for lice, scabies, ringworm, rashes, and sores).

For identification of different skin problems, see pages 196–198.

35

THE BELLY (ABDOMEN)

If a person has pain in the belly, try to find out exactly where it hurts.
Learn whether the pain is steady or whether it suddenly comes and goes, like cramps or colic.

When you examine the belly, first look at it for any unusual swelling or lumps. The location of the pain often gives a clue to the cause (see the following page).

First, ask the person to point with one finger where it hurts.

Then, beginning on the opposite side from the spot where he has pointed, press gently on different parts of the belly to see where it hurts most.

See if the belly is soft or hard and whether the person can relax his stomach muscles. A very hard belly could mean an acute abdomen, perhaps appendicitis or peritonitis (see page 94).

If you suspect peritonitis or appendicitis, do the test for rebound pain described on page 95.

Feel for any abnormal lumps and hardened areas in the belly.

If the person has a constant pain in the stomach, with nausea, and has not been able to move her bowels, put an ear (or stethoscope) on the belly, like this:

Listen for gurgles in the intestines. If you hear nothing after about 2 minutes, this is a danger sign. (See Emergency Problems of the Gut, page 93.)

A silent belly is like a silent dog. Beware!

36

These pictures show the areas of the belly that usually hurt when a person has the following problems:

Ulcer (see page 128) pain in the ‘pit of the stomach

Appendicitis (see page 94) First it hurts here later it hurts here

Gallbladder (see page 329) the pain often reaches to the back

Liver (see page 172, page 144, and page 328) pain here, at times it spreads to the chest

Urinary system (see page 234) mid or low back pain, often goes around the waist to the lower part of the belly

Ectopic pregnancy (see page 280) pain on one side or both, sometimes with pain in the shoulder or neck

Note: For different causes of back pain, see page 173

37

MUSCLES AND NERVES

If a person complains of numbness, weakness, or loss of control in part of his body, or you want to test it: notice the way he walks and moves. Have him stand, sit, or lie completely straight, and carefully compare both sides of his body.

Face: Have him smile, frown, open his eyes wide, and squeeze them shut. Notice any drooping or weakness on one side.

If the problem began more or less suddenly, think of a head injury (page 91), stroke (page 327), or Bell’s palsy (page 327).

If it came slowly, it may be a brain tumor. Get medical advice.

Also check for normal eye movement, size of pupils (page 217), and how well he can see.

Arms and legs: Look for loss of muscle. Notice, or measure, difference in thickness of arms or legs.

Watch how he moves and walks. If muscle loss or weakness affects the whole body, suspect malnutrition (page 112) or a chronic (long-term) illness like tuberculosis.

Have him squeeze your fingers to compare strength in his hands and push and pull with his feet against your hand.

Also have him hold his arms straight out and turn his hands up and down.

Any string or ribbon will do to check if the distance around the arms or legs is different.

Have him lie down and lift one leg and then the other.

Note any weakness or trembling.

If muscle loss and weakness is uneven or worse on one side, in children, think first of polio (page 314); in adults, think of a back problem, a back or head injury, or stroke.

For more information on muscle testing and physical examination of disabled persons, see Disabled Village Children, Chapter 4.

38

Check for stiffness or tightness of different muscles

• If the jaw is stiff or will not open, suspect tetanus (page 182) or a severe infection of the throat (page 309) or of a tooth (page 231). If the problem began after he yawned or was hit in the jaw, he may have a dislocated jaw.

• If the neck or back is stiff and bent backwards, in a very sick child, suspect meningitis. If the head will not bend forward or cannot be put between the knees, meningitis is likely (page 185). meningitis

• If a child always has some stiff muscles and makes strange or jerky movements, he may be spastic (page 320).

• If strange or jerky movements come suddenly, with loss of consciousness, he may have seizures (page 178). If seizures happen often, think of epilepsy.

If they happen when he is ill, the cause may be high fever (page 76) or dehydration (page 151) or tetanus (page 182) or meningitis (page 185).

To test a person’s reflexes when you suspect tetanus, see page 183.

To check for loss of feeling in the hands, feet, or other parts of the body

Have the person cover his eyes. Lightly touch or prick the skin in different places. Ask him to say ‘yes’ when he feels it.

• Loss of feeling in or near spots or patches on the body is probably leprosy (page 191). • Loss of feeling in both hands or feet may be due to diabetes (page 127) or leprosy.

• Loss of feeling on one side only could come from a back problem (page 174) or injury.

• 1. The Comfort of the Sick Person
• 2. Liquids
• 3. Personal Cleanliness
• 4. Good Food
• SPECIAL CARE FOR A PERSON WHO IS VERY ILL
• 1. Liquids
• 2. Food
• 3. Cleanliness
• 4. Changing Position in Bed
• 5. Watching for Changes
• SIGNS OF DANGEROUS ILLNESS
• WHEN AND HOW TO LOOK FOR MEDICAL HELP
• WHAT TO TELL THE HEALTH WORKER
  • patient report
  • What is wrong or different from normal in any of the following ?

Sickness weakens the body. To gain strength and get well quickly, special care is needed.

The care a sick person receives is frequently the most important part of his treatment.

Medicines are often not necessary. But good care is always important. The following are the basis of good care:

1. The Comfort of the Sick Person

A person who is sick should rest in a quiet, comfortable place with plenty of fresh air and light. He should keep from getting too hot or cold. If the air is cold or the person is chilled, cover him with a sheet or blanket. But if the weather is hot or the person has a fever, do not cover him at all (see page 75).

2. Liquids

In nearly every sickness, especially when there is fever or diarrhea, the sick person should drink plenty of liquids: water, tea, juices, broths, etc.

3. Personal Cleanliness

It is important to keep the sick person clean. He should be bathed every day. If he is too sick to get out of bed, wash him with a sponge or cloth and lukewarm water.

His clothes, sheets, and covers must also be kept clean. Take care to keep crumbs and bits of food out of the bed.

40

4. Good Food

If the sick person feels like eating, let him. Most sicknesses do not require special diets.

A sick person should drink plenty of liquids and eat a lot of nourishing food (see Chapter 11).

If the person is very weak, give him as much nourishing food as he can eat, many times a day. If necessary, mash the foods, or make them into soups or juices.

Energy foods are especially important, for example, porridges of rice, wheat, oatmeal, potato, or cassava. Adding a little sugar and vegetable oil will increase the energy. Also encourage the sick person to drink plenty of sweetened drinks, especially if he will not eat much.

A few problems do require special diets. These are explained on the following pages:

• anemia 124
• stomach ulcers and heartburn 128
• appendicitis, gut obstruction, acute abdomen (in these cases take no food at all) 93
• diabetes 127
• heart problems 325
• gallbladder problems 329
• high blood pressure 125

SPECIAL CARE FOR A PERSON WHO IS VERY ILL

1. Liquids

It is extremely important that a very sick person drink enough liquid. drink a little at a time, give him small amounts often. If he can barely swallow, give him sips every 5 or 10 minutes.

Measure the amount of liquids the person drinks each day. An adult needs to drink 2 liters or more every day and should urinate at least a cup (240 ml.) of urine 3 or 4 times daily.

If the person is not drinking or urinating enough, or if he begins to show signs of dehydration (page 151), encourage him to drink more. He should drink nutritious liquids, usually with a little salt added.

If he will not drink these, give him a Rehydration Drink (see page 152). If he cannot drink enough of this, and develops signs of dehydration, a health worker may be able to give him intravenous solution. But the need for this can usually be avoided if the person is urged to take small sips often.

41

2. Food

If the person is too sick to eat solid foods, give her soups, milk, juices, broths, and other nutritious liquids (see Chapter 11). A porridge of cornmeal, oatmeal, or rice is also good, but should be given together with body-building foods. Soups can be made with egg, beans, or well-chopped meat, fish, or chicken. If the person can eat only a little at a time, she should eat several small meals each day.

3. Cleanliness

Personal cleanliness is very important for a seriously ill person. She should be bathed every day with warm water. Change the bed clothes daily and each time they become dirty. Soiled or bloodstained clothes, bedding, and towels of a person with an infectious disease should be handled with care. To kill any viruses or germs, wash these in hot soapy water, or add some chlorine bleach.

4. Changing Position in Bed

A person who is very weak and cannot turn over alone should be helped to change position in bed many times each day. This helps prevent bed sores (see page 214). A child who is sick for a long time should be held often on her mother’s lap. Frequent changing of the person’s position also helps to prevent pneumonia, a constant danger for anyone who is very weak or ill and must stay in bed for a long time. If the person has a fever, begins to cough, and breathes with fast, shallow breaths, she probably has pneumonia (see page 171).

5. Watching for Changes

You should watch for any change in the sick person’s condition that may tell you whether he is getting better or worse. Keep a record of his ‘vital signs’. Write down the following facts 4 times a day: temperature pulse breathing (how many degrees) (beats per minute) (breaths per minute)

Also write down the amount of liquids the person drinks and how many times a day he urinates and has a bowel movement. Save this information for the health worker or doctor.

It is very important to look for signs that warn you that the person’s sickness is serious or dangerous. A list of Signs of Dangerous Illness is on the next page. If the person shows any of these signs, seek medical help immediately.

42

SIGNS OF DANGEROUS ILLNESS

A person who has one or more of the following signs is probably too sick to be treated at home without skilled medical help. His life may be in danger.

Seek medical help as soon as possible.

Until help comes, follow the instructions on the pages indicated:

1. Loss of large amounts of blood from anywhere in the body 82, 264, 281

2. Coughing up blood 179

3. Marked blueness of lips and nails (if it is new) 30

4. Great difficulty in breathing; does not improve with rest 167, 325

5. The person cannot be wakened (coma) 78

6. The person is so weak he faints when he stands up 325

7. Twelve hours or more without being able to urinate 234

8. A day or more without being able to drink any liquids 151

9. Heavy vomiting or severe diarrhea that lasts for more than one day or more than a few hours in babies. 151

10. Black stools like tar, or vomit with blood or feces 128

11. Strong, continuous stomach pains with vomiting in a person who does not have diarrhea or cannot have a bowel movement 93

12. Any strong continuous pain that lasts for more than 3 days 29 > 38

13. Stiff neck with arched back, with or without a stiff jaw 182 , 185

14. More than one seizure (fit) in someone with fever or serious illness 76, 185

15. High fever (above 39° C) that cannot be brought down or that lasts more than 4 or 5 days 75

16. Weight loss over an extended time 20, 400

17. Blood in the urine 146, 234

18. Sores that keep growing and do not go away with treatment 191, 196, 211, 212

19. A lump in any part of the body that keeps getting bigger 196, 280

20. Very high blood pressure (220/120 or greater) 327

21. Problems with pregnancy and childbirth:

• any bleeding during pregnancy 249, 281

• high blood pressure (140/90 or greater) 249

• long delay once the waters have broken and labor has begun 267

• severe bleeding 264

43

WHEN AND HOW TO LOOK FOR MEDICAL HELP

Seek medical help at the first sign of a dangerous illness. Do not wait until the person is so sick that it becomes difficult or impossible to take him to a health center or hospital.

If a sick or injured person’s condition could be made worse by the difficulties in moving him to a health center, try to bring a health worker to the person. But in an emergency when very special attention or an operation may be needed (for example, appendicitis), do not wait for the health worker. Take the person to the health center or the hospital at once.

When you need to carry a person on a stretcher, make sure he is as comfortable as possible and cannot fall out. If he has any broken bones, splint them before moving him (see page 99). If the sun is very strong, rig a sheet over the stretcher to give shade yet allow fresh air to pass underneath

WHAT TO TELL THE HEALTH WORKER

For a health worker or doctor to recommend treatment or prescribe medicine wisely, she should see the sick person. If the sick person cannot be moved, have the health worker come to him. If this is not possible, send a responsible person who knows the details of the illness. Never send a small child or a fool.

Before sending for medical help, examine the sick person carefully and completely. Then write down the details of his disease and general condition (see Chapter 3).

On the next page is a form on which you can make a PATIENT REPORT. Several copies of this form are at the end of this book. Tear out one of these forms and carefully complete the report, giving all the details you can.

When you send someone for medical help, always send a completed information form with him.

44

patient report

TO USE WHEN SENDING FOR MEDICAL HELP

Name of the sick person:

Age:

Male Female

Where is he (she) ?

What is the main sickness or problem right now ?

When did it begin ?

How did it begin ?

Has the person had the same problem before ?

When ?

Is there fever?

How high ? °

When and for how long ?

Pain ?

Where ?

What kind ?

What is wrong or different from normal in any of the following ?

**Skin:

Ears:

Eyes:

Mouth and throat:

Genitals:

Urine:**

Much or little ?

Color ?

Trouble urinating ?

Describe:

Times in 24 hours:

Times at night:

Stools:

• Color ?

• Blood or mucus ?

• Diarrhea ?

• Number of times a day:

• Cramps ?

• Dehydration ?

• Mild or severe ?

• Worms ?

• What kind ?

Breathing:

• Breaths per minute:

• Deep, shallow, or normal ?

• Difficulty breathing (describe):

• Cough (describe):

• Wheezing ?

• Mucus?

• With blood?

Does the person have any of the SIGNS OF DANGEROUS ILLNESS listed on page page 42 ?

• Which ? (give details):

Other signs:

• Is the person taking medicine ?

• What ?

• Has the person ever used medicine that has caused a rash, hives (or bumps) ?

• with itching, or other allergic reactions ?

• What ?

• The state of the sick person is:

  • Not very serious

  • Serious

  • Very serious

• HEALING WITH WATER
  • Prevention
  • Treatment
• TIMES WHEN THE RIGHT USE OF WATER MAY DO MORE GOOD THAN MEDICINES
  • prevention
  • treatment

For most sicknesses no medicines are needed. Our bodies have their own defenses, or ways to resist and fight disease. In most cases, these natural defenses are far more important to our health than are medicines.

People will get well from most sicknesses , including the common cold and ‘flu’, by themselves, without need for medicines.

To help the body fight off or overcome a sickness, often all that is needed is to:

• keep clean
• get plenty of rest
• eat well and drink a lot of liquid

Even in a case of more serious illness, when a medicine may be needed, it is the body that must overcome the disease; the medicine only helps. Cleanliness, rest, nutritious food, and lots of water are still very important.

Much of the art of health care does not, and should not, depend on use of medications. Even if you live in an area where there are no modern medicines, there is a great deal you can do to prevent and treat most common sicknesses, if you learn how.

Many sicknesses can be prevented or treated without medicine.

If people simply learned how to use water correctly, this alone might do more to prevent and cure illnesses than all the medicines they now use. . .and misuse.

46

HEALING WITH WATER

Most of us could live without medicines. But no one can live without water. In fact, over half (57%) of the human body is water.

If everyone living in farms and villages made the best use of water, the amount of sickness and death, especially of children, could be reduced.

For example, correct use of water is basic both in the prevention and treatment of diarrhea. In many areas diarrhea is the most common cause of sickness and death in small children. Contaminated (unclean) water is often part of the cause.

An important part of the prevention of diarrhea and many other illnesses is to make sure that drinking water is safe.

Protect wells and springs from dirt and animals by putting fences or walls around them.

Use cement or rock to provide good drainage around the well or spring, so that rain or spilled water runs away from it.

Prevention

Where water may be contaminated, an important part of the prevention of diarrhea is to boil or filter the water used for drinking or for preparing foods.

This is especially important for babies. Babies’ bottles and eating utensils should also be boiled.

If regular boiling of bottles is not possible, it is safer to use a cup and water spoon. Washing hands with soap and water after a bowel movement (shitting) and before eating or handling foods is also important.

Treatment

A common cause of death in children with diarrhea is severe dehydration, or loss of too much water from the body (see page 151).

By giving a child with diarrhea plenty of water (best with sugar or cereal and salt), dehydration can often be prevented or corrected (see Rehydration Drink, p. 152).

Giving lots of liquids to a child with diarrhea is more important than any medicine. In fact, if enough liquid is given, no medicine is usually needed in the treatment of diarrhea.

On the next 2 pages are a number of other situations in which it is often more important to use water correctly than to use medicines.

47

TIMES WHEN THE RIGHT USE OF WATER MAY DO MORE GOOD THAN MEDICINES

prevention

to help prevent / use water

1. diarrhea, worms, gut infections / boil or filter drinking water, wash hands, etc. 135

2. skin infections / bathe often 153

3. wounds becoming infected; tetanus / wash wounds well with soap and clean water 84, 89

48

treatment

In the following list:

to treat: / use water in this way:

1. diarrhea, dehydration / drink plenty of liquids 152

2. illnesses with fever / drink plenty of liquids 75, 76

3. high fever / remove clothing and soak body with water 76

4. minor urinary infections (common in women) / drink plenty of water 235

5. cough, asthma, bronchitis, pneumonia / drink a lot of water and breathe hot water vapors (to loosen mucus) 166

6. sores, impetigo, ringworm of skin or scalp, cradle cap, pimples / scrub with soap and clean water 201, 202, 205, 211, 215,

7. infected wounds, abscesses, boils / hot soaks or compresses 88, 202,

8. stiff, sore muscles and joints / hot compresses 102, 173, 174

9. strains and sprains / the first day: soak joint in cold water; then use hot soaks 102

10. itching, burning, or weeping irritations of the skin / cold compresses 193, 194

11. minor burns / hold in cold water at once 96

12. sore throat or tonsillitis / gargle with warm salt water 96

13. acid, lye, dirt, or irritating substance in eye / flood eye with cool water at once, and continue for 30 minutes 219

14. stuffed up nose / sniff salt water 164

15. constipation, hard stools / drink lots of water (also, enemas are safer than laxatives, but do not overuse) 15, 126

16. cold sores or fever blisters / hold ice on blister for several minutes at first sign 232

In each of the above cases (except pneumonia) when water is used correctly, often medicines are not needed. In this book you will find many suggestions for ways of healing without need for medicine. Use medicines only when absolutely necessary.

• Medicines must be used correctly!
• Guidelines for the use of medicine
• THE MOST DANGEROUS MISUSE OF MEDICINE
  • 1. Chloramphenicol (Chloromycetin)
  • 2. Oxytocin (Pitocin), Ergonovine (Ergotrate), and Misoprostol (Cytotec)
  • 3. Injections of any medicine
  • 4. Penicillin
  • 5. Gentamicin (Garamycin)
  • 6. Anti-diarrhea medicines with hydroxyquinolines
  • 7. Cortisone and cortico-steroids
  • 8. Anabolic steroids
  • 9. Arthritis medicines
  • 10. Vitamin B12, liver extract, and iron injections
  • 11. Other vitamins
  • 12. Combination medicines
  • 13. Calcium
  • 14. ‘Feeding’ through the veins
• WHEN SHOULD MEDICINE NOT BE TAKEN?
  • Pregnant women
  • Newborn children
  • A person who’s allergic
  • Persons who have stomach ulcers or heartburn
  • Persons who have specific illness
  • Persons who are dehydrated or have disease of the kidneys

Medicines must be used correctly!

Some medicines sold in pharmacies or village stores can be very useful. But many are of no value. Of the 60,000 medicines sold in most countries, the World Health Organization says that only about 200 are necessary.

Also, people sometimes use the best medicines in the wrong way, so that they do more harm than good. To be helpful, medicine must be used correctly.

Many people, including most doctors and health workers, prescribe far more medicines than are needed, and by so doing cause much needless sickness and death.

There is some danger in the use of any medicine.

Some medicines are much more dangerous than others. Unfortunately, people sometimes use very dangerous medicines for mild sicknesses. (I have seen a baby die because his parents gave him a dangerous medicine, chloramphenicol, for a cold.) Never use a dangerous medicine for a mild illness.

REMEMBER: MEDICINES CAN KILL.

Guidelines for the use of medicine

1. Use medicines only when necessary.
2. Know the correct use and precautions for any medicine you use (see the GREEN PAGES).
3. Be sure to use the right dose.
4. If the medicine does not help, or causes problems, stop using it.
5. When in doubt, seek the advice of a health worker.

Note: Some health workers and many doctors give medicines when none is needed, often because they think patients expect medicine and will not be satisfied until they get some. Tell your doctor or health worker you only want medicine if it is definitely needed. This will save you money and be safer for your health.

Only use a medicine when you are sure it is needed and when you are sure how to use it.

50

THE MOST DANGEROUS MISUSE OF MEDICINE

Here is a list of the most common and dangerous errors people make in using modern medicines. The improper use of the following medicines causes many deaths each year. BE CAREFUL!

1. Chloramphenicol (Chloromycetin)

The popular use of this medicine (page 356) for simple diarrhea and other mild sicknesses is extremely unfortunate, because it is so risky. Use chloramphenicol only for very severe illnesses, like typhoid (see page 188). Never give it to babies younger than 1 month old.

2. Oxytocin (Pitocin), Ergonovine (Ergotrate), and Misoprostol (Cytotec)

Unfortunately, some woman use these medicines (page 390) to speed up childbirth or ‘give strength’ to the mother in labor. This practice is very dangerous. It can kill the mother or the child. Use these medicines only to control bleeding after the child is born (see page 266).

3. Injections of any medicine

The common belief that injections are usually better than medicine taken by mouth is not true. Many times medicines taken by mouth work as well as or better than injections. Also, most medicine is more dangerous injected than when taken by mouth. Injections given to a child who has a mild polio infection (with only signs of a cold) can lead to paralysis (see page 74). Use of injections should be very limited (read Chapter 9 carefully).

4. Penicillin

Penicillin works only against certain types of infections. (page 350) Use of penicillin for sprains, bruises, or any pain or fever is a great mistake. As a general rule, injuries that do not break the skin, even if they make large bruises, have no danger of infection; they do not need to be treated with penicillin or any other antibiotic. Neither penicillin nor other antibiotics helps colds (see page 163).

Penicillin is dangerous for some people. Before using it, know its risks and the precautions you must take, see page 70 and page 350.

5. Gentamicin (Garamycin)

Too much use of this antibiotic (page 358) for babies has caused permanent hearing loss (deafness) in millions of babies. Give to babies only for life-threatening infections. For many infections of the newborn, ampicillin works as well and is much less dangerous.

51

6. Anti-diarrhea medicines with hydroxyquinolines

Anti-diarrhea medicines with hydroxyquinolines (Clioquinol, di-iodohydroxyquinoline, halquinol, broxyquinoline: Diodoquin, Enteroquinol, Amicline, Quogyl, and many other brand names) (page 369)

In the past clioquinols were widely used to treat diarrhea. These dangerous medicines are now prohibited in many countries, but in others are still sold. They can cause permanent paralysis, blindness, and even death. For treatment of diarrhea, see Chapter 13.

7. Cortisone and cortico-steroids

(Prednisolone, dexamethasone, and others)

These are powerful anti-inflammatory drugs that are needed for severe attacks of asthma, arthritis, or severe allergic reactions. But in many countries, steroids are prescribed for minor aches and pains because they often give quick results. This is a big mistake. Steroids cause serious or dangerous side effects, especially if used in high doses or for more than a few days. They lower a person’s defenses against infection. They can make tuberculosis much worse, cause bleeding of stomach ulcers, and make bones so weak that they break easily.

8. Anabolic steroids

(Nandrolone decanoate, Durabolin, Deca-Durabolin, Orabolin; stanozolol, Cetabon; oxymetholone, Anapolon; ethylestrenol, Organaboral. There are many other brand names.)

Anabolic steroids are made from male hormones and are mistakenly used in tonics to help children gain weight and grow. At first the child may grow faster, but he will stop growing sooner and end up shorter than he would have if he had not taken the medicine. Anabolic steroids cause very dangerous side effects. Girls grow hair on their faces like boys, which does not go away, even when the child stops taking the medicine. Do not give growth tonics to children. Instead, to help your child grow, use the money to buy food.

9. Arthritis medicines

(Butazones: oxyphenbutazone, Amidozone; and phenylbutazone, Butazolidin)

These medicines for joint pain (arthritis) can cause a dangerous, sometimes deadly, blood disease (agranulocytosis). They can also damage the stomach, liver, and kidneys. Do not use these dangerous medicines. For arthritis, aspirin (page 378) or ibuprofen (page 379) is much safer and cheaper. For pain and fever only, acetaminophen (page 379) can be used.

10. Vitamin B12, liver extract, and iron injections

Vitamin B12 and liver extract do not help anemia or ‘weakness’ except in rare cases. (page 392) Also, they have certain risks when injected.

They should only be used when a specialist has prescribed them after testing the blood. Also, avoid injectable iron, such as Imferon. To combat anemia, iron pills are safer and work as well (see page 124).

52

11. Other vitamins

As a general rule, DO NOT INJECT VITAMINS. Injections are more dangerous, more expensive, and usually no more effective than pills. (page 391)

Unfortunately, many people waste their money on syrups, tonics, and ‘elixirs’ that contain vitamins. Many lack the most important vitamins (see page 118).

But even when they contain them, it is wiser to buy more and better food. Body-building and protective foods like beans, eggs, meat, fruit, vegetables, and whole grains are rich in vitamins and other nutrients (see page 111).

Giving a thin, weak person good food more often will usually help him far more than giving him vitamin and mineral supplements.

THE BEST WAY TO GET VITAMINS:

For more information about vitamins, when they are necessary, and the foods that have them, read Chapter 11, especially page 111 and page 118.

12. Combination medicines

Sometimes, 2 or more medicines are combined in the same pill or tonic. Usually they are less effective, and more expensive, when prepared this way. Sometimes they do more harm than good. If someone wants to prescribe combination medicines, ask him or her to prescribe only the medicine that is really necessary.

Do not waste your money on unnecessary medicines. Some medicines for HIV come in combination pills (see page 397). This makes them easier to take. Some common combination medicines that should be avoided are:

• cough medicines which contain medicines both to suppress a cough and also to get rid of mucus. (Cough medicines are almost always useless and a waste of money, whether or not they combine medicines.)

• antibiotics combined with anti-diarrhea medicine

• antacids to treat stomach ulcers together with medicine to prevent stomach cramps

• 2 or more pain medicines (aspirin with acetaminophen, sometimes also with caffeine)

53

13. Calcium

Injecting calcium into a vein can be extremely dangerous. It can quickly kill someone if not injected very slowly. Injecting calcium into the buttocks sometimes causes very serious abscesses or infections.

Never inject calcium without first seeking medical advice!

Note: In Mexico and other countries where people eat a lot of corn tortillas or other foods prepared with lime (“cal”, not the fruit), it is foolish to use calcium injections or tonics (as is often done to ‘give strength’ or ‘help children grow’). The body gets all the calcium it needs from the lime.

14. ‘Feeding’ through the veins

(Intravenous or ‘I.V.’ solutions)

In some areas, persons who are anemic or very weak spend their last penny to have a liter of I.V. solution put into their veins. They believe that this will make them stronger or their blood richer. But they are wrong! Intravenous solution is nothing more than pure water with some salt or sugar in it. It gives less energy than a large candy bar and makes the blood thinner, not richer. It does not help anemia or make the weak person stronger.

Also when a person who is not well trained puts the I.V. solution into a vein, there is danger of an infection entering the blood. This can kill the sick person.

Intravenous solution should be used only when a person can take nothing by mouth, or when she is badly dehydrated (see page 151).

If the sick person can swallow, give her a liter of water with sugar (or cereal) and salt (see Rehydration Drink, page 152). It will do as much for her as injecting a liter of I.V. solution. For people who are able to eat, nutritious foods do more to strengthen them than any type of I.V. fluid.

If a sick person is able to swallow and keep down liquids . . .

54

WHEN SHOULD MEDICINE NOT BE TAKEN?

Many people have beliefs about things they should not do or eat when taking medicines. For this reason they may stop taking a medicine they need.

In truth, no medicine causes harm just because it is taken with certain foods, whether pork, chili pepper, guava, oranges, or any other food.

But foods with lots of grease or spices can make problems of the stomach or gut worse, whether or not any medicine is being taken (see page 128).

Certain medicines will cause bad reactions if a person drinks alcohol (see metronidazole, page 368).

There are situations when, without a doubt, it is best no to use certain medicines:

Pregnant women

1. Pregnant women or women who are breastfeeding should avoid all medicines that are not absolutely necessary. (However, they can take limited amounts of vitamins or iron pills without danger. Also, pregnant or breastfeeding women with HIV should take medicines to prevent spreading HIV to the baby, see page 398.)

Newborn children

1. With newborn children, be very careful when using medicines. Whenever possible look for medical help before giving them any type of medicine. Be sure not to give too much.

A person who’s allergic

1. A person who has ever had any sort of allergic reaction , hives, itching, etc. , after taking penicillin, ampicillin, a sulfonamide, or other medicines, should never use that medicine again for the rest of his life because it would be dangerous (see Dangerous reactions from injections of certain medicines, page 70).

Persons who have stomach ulcers or heartburn

1. Persons who have stomach ulcers or heartburn should avoid medicines that contain aspirin. Most painkillers, and all steroids (see page 51) make ulcers and acid indigestion worse. One painkiller that does not irritate the stomach is acetaminophen (paracetamol, see page 379).

Persons who have specific illness

1. There are some medicines that are harmful or dangerous to take when you have a specific illness.

For example, persons with hepatitis should not be treated with certain antibiotics or other strong medicines, because their liver is damaged, and the medicines are more likely to poison the body (see page 172).

Persons who are dehydrated or have disease of the kidneys

1. Persons who are dehydrated or have disease of the kidneys should be especially careful with medicines they take. Do not give more than one does of a medicine that could poison the body unless (or until) the person is urinating normally.

For example, if a child has high fever and is dehydrated (see page 76), do not give him more than one dose of acetaminophen or aspirin until he begins to urinate. Never give sulfa to a person who is dehydrated.

• When used correctly…
  • PENICILLINS
  • MACROLIDES
  • TETRACYCLINES
  • CHLORAMPHENICOL
  • SULFAS SULFONAMIDES
  • AMINOGLYCOSIDES
  • CEPHALOSPORINS
  • QUINOLONES
• GUIDELINES FOR THE USE OF ALL ANTIBIOTICS
• GUIDELINES FOR THE USE OF CERTAIN ANTIBIOTICS
• WHAT TO DO IF AN ANTIBIOTIC DOES NOT SEEM TO HELP
• IMPORTANCE OF LIMITED USE OF ANTIBIOTICS
  • 1. Poisoning and reactions
  • 2. Upsetting the natural balance
  • 3. Resistance to treatment

When used correctly…

When used correctly, antibiotics are extremely useful and important medicines. They fight certain infections and diseases caused by bacteria. Well-known antibiotics are penicillin, tetracycline, erythromycin, cotrimoxazole, and ciprofloxacin.

The different antibiotics work in different ways against specific infections. All antibiotics have dangers in their use, but some are far more dangerous than others. Take great care in choosing and using antibiotics.

There are many kinds of antibiotics, and each kind is sold under several ‘brand names’. This can be confusing. However, the most important antibiotics fall into a few major groups:

PENICILLINS

generic name: penicillin, ampicillin, amoxicillin

examples of brands: Pen-V-K

MACROLIDES

generic name: erythromycin

examples of brands: Erythrocin

TETRACYCLINES

generic name: tetracycline, doxycycline

examples of brands: Terramycin

CHLORAMPHENICOL

examples of brands: Chloromycetin

SULFAS SULFONAMIDES

generic name: cotrimoxazole, sulfisoxazole

examples of brands: Bactrim, Gantrisin

AMINOGLYCOSIDES

generic name: gentamicin

examples of brands: Garamycin

CEPHALOSPORINS

generic name: ceftriaxone, cephalexin

examples of brands: Keflex

QUINOLONES

generic name: ciprofloxacin

examples of brands: Cipro

If you have a brand-name antibiotic and do not know to which group it belongs, read the fine print on the bottle or box. For example, if you have some Paraxin ‘S’ but do not know what is in it, read the fine print. It says ‘chloramphenicol’.

Look up chloramphenicol in the GREEN PAGES (page 356). You will find it must be used only for a few very serious illnesses, like typhoid, and is especially dangerous when given to the newborn.

Never use an antibiotic unless you know to what group it belongs, what diseases it fights, and the precautions you must take to use it safely.

Information on the uses, dosage, risks, and precautions for the antibiotics recommended in this book can be found in the GREEN PAGES. Look for the name of medicine in the alphabetical list at the beginning of those pages.

56

GUIDELINES FOR THE USE OF ALL ANTIBIOTICS

1. If you do not know exactly how to use the antibiotic and what infections it can be used for, do not use it.

2. Use only an antibiotic that is recommended for the infection you wish to treat. (Look for the illness in this book.)

3. Know the risks in using the antibiotic and take all the recommended precautions (see the GREEN PAGES).

4. Use the antibiotic only in the recommended does, no more, no less. The dose depends on the illness and the age or weight of the sick person.

5. Never use injections of antibiotics if taking them by mouth is likely to work as well. Inject only when absolutely necessary.

6. Antibiotics must be given for their full course. Stopping before you have finished all the days of treatment, even if you feel better, can make the infection return in a form that is even harder to cure. (Some illnesses, like tuberculosis and leprosy, need to be treated for many months or years after the person feels better. Follow the instructions for each illness.)

7. If the antibiotic causes a skin rash, itching, difficult breathing, or any serious reactions, the person must stop using it and never use it again (see page 70).

8. Only use antibiotics when the need is great. When antibiotics are used too much they begin not to work as well.

GUIDELINES FOR THE USE OF CERTAIN ANTIBIOTICS

1. Before you inject penicillin or ampicillin, always have ready ampules of Adrenalin (epinephrine) to control an allergic reaction if one occurs (page 70).

2. For persons who are allergic to penicillin, use another antibiotic such as erythromycin or cotrimoxazole (see page 354 and page 357).

3. Do not use tetracycline, ampicillin, or another broad spectrum antibiotic for an illness that can probably be controlled with penicillin or another narrow spectrum antibiotic (see page 58). Broad spectrum antibiotics attack many more kinds of bacteria than narrow spectrum antibiotics.

4. Use chloramphenicol only for certain severe or life-threatening illnesses, such as typhoid, when no other effective medicine is available. It is a dangerous drug. Never use it for mild illness (see page 313).

5. Do not give tetracycline to pregnant women or to children under 8 years old. It can damage new teeth and bones (see page 355).

6. Use streptomycin only for tuberculosis, and always together with other anti-tuberculosis medicines (see page 361).

7. All medicines in the aminoglycoside group (including kanamycin and gentamicin) are quite toxic (poisonous). Too often they are prescribed for mild infections where they may do more harm than good. Use only for certain very serious infections for which these medicines are recommended.

8. Eating yogurt or curdled milk helps to replace necessary bacteria killed by antibiotics like ampicillin and to return the body’s natural balance to normal (see next page).

57

WHAT TO DO IF AN ANTIBIOTIC DOES NOT SEEM TO HELP

For most common infections antibiotics begin to bring improvement in a day or two. If the antibiotic you are using does not seem to help, it is possible that:

1. The illness is not what you think. You may be using the wrong medicine. Try to find out more exactly what the illness is, and use the right medicine.

2. The dose of the antibiotic is not correct. Check it.

3. The bacteria have become resistant to this antibiotic (they no longer are harmed by it). Try another one of the antibiotics recommended for that illness.

4. You may not know enough to cure the illness. Get medical help, especially if the condition is serious or getting worse.

Antibiotics do no good for the common cold. Use antibiotics only for infections they are known to help.

58

IMPORTANCE OF LIMITED USE OF ANTIBIOTICS

The use of all medicines should be limited. But this is especially true of antibiotics, for the following reasons:

1. Poisoning and reactions

Antibiotics not only kill bacteria, they can also harm the body, either by poisoning it or by causing allergic reactions. Many people die each year because they take antibiotics they do not need.

2. Upsetting the natural balance

Not all bacteria in the body are harmful. Some are necessary for the body to function normally. Antibiotics often kill the good bacteria along with the harmful ones.

Babies who are given antibiotics sometimes develop fungus or yeast infections of the mouth (thrush, page 232) or skin (moniliasis, page 242). This is because the antibiotics kill the bacteria that help keep fungus under control.

For similar reasons, persons who take ampicillin and other broad-spectrum antibiotics for several days may develop diarrhea. Antibiotics may kill some kinds of bacteria necessary for digestion, upsetting the natural balance of bacteria in the gut.

3. Resistance to treatment

In the long run, the most important reason the use of antibiotics should be limited, is that WHEN ANTIBIOTICS ARE USED TOO MUCH, THEY BECOME LESS EFFECTIVE.

When attacked many times by the same antibiotic, bacteria become stronger and are no longer killed by it. They become resistant to the antibiotic. For this reason, certain dangerous diseases like typhoid are becoming more difficult to treat than they were a few years ago.

In some places typhoid has become resistant to chloramphenicol, normally the best medicine for treating it.

Chloramphenicol has been used far too much for minor infections, infections for which other antibiotics would be safer and work as well, or for which no antibiotic at all is needed.

Throughout the world important diseases are becoming resistant to antibiotics, largely because antibiotics are used too much for minor infections. If antibiotics are to continue to save lives, their use must be much more limited than it is at present. This will depend on their wise use by doctors, health workers, and the people themselves.

For most minor infections antibiotics are not needed and should not be used.

Minor skin infections can usually be successfully treated with mild soap and water, or hot soaks, and perhaps painting them with gentian violet (page 370). Minor respiratory infections are best treated by drinking lots of liquids, eating good food, and getting plenty of rest. For most diarrheas, antibiotics are not necessary and may even be harmful. What is most important is to drink lots of liquids (page 155), and provide enough food as soon as the child will eat.

Do not use antibiotics for infections the body can fight successfully by itself. Save them for when they are most needed.

For more information on learning to use antibiotics sensibly, see [_Helping Health Workers Learn_](#addresses-for-teaching-materials), Chapter 19.

• SYMBOLS
• FRACTIONS
• MEASURING
  • measuring penicillin
• MEDICINE IN LIQUID FORM
  • How to Make Sure that the Teaspoon Used for Medicine Measures 5 ml
• HOW TO GIVE MEDICINES TO SMALL CHILDREN
  • how much medicine should you give to children when you only have the instructions for adults?
• HOW TO TAKE MEDICINES
  • when you give medicines to anyone . . .
  • taking medicines on a full or empty stomach

SYMBOLS

’=’ means “is equal to” or “is the same as”

’+’ means “and” or “plus”

FRACTIONS

How fractions are sometimes written:

1 tablet = one whole tablet = 1/2 tablet = half of a tablet

1 1/2 tablet = one and one-half tablets

1/4 tablet = one quarter, or one-fourth of a tablet

1/8 tablet = one-eighth of a tablet (dividing it into 8 equal pieces and taking 1 piece)

MEASURING

Medicine is usually weighed in grams (g), milligrams (mg), or micrograms (mcg).

1000 mg = 1 g (one thousand milligrams make one gram)

1 mg = 0.001 g (one milligram is one one-thousandth part of a gram)

1000 mcg = 1 mg (one thousand micrograms make one milligram)

Examples

• One adult aspirin tablet contains 300 milligrams of aspirin. (.3 g, 0.3 g, 0.300 g, 300 mg. All these are different ways of saying 300 milligrams.)

• One baby aspirin contains 75 milligrams of aspirin. ( .075 g, 0.075 g, 75.0 mg, 75 mg. All these are different ways of saying 75 milligrams. )

Note: In some countries some medicines are still weighed in grains; gr = grain and 1 gr = 65 mg. This means a 5 gr aspirin tablet weighs about 300 mg.

60

Many times it is important to know how many grams or milligrams are in a medicine.

For example, if you want to give a small piece of adult aspirin to a child, instead of baby aspirin, but you do not know how big a piece to give…

read the small print on the labels of each. It says: aspirin: acetylsalicylic acid 0.3 g. (acetylsalicylic acid = aspirin)

4 (75mg) baby aspirins add = to 1 (300mg) regular aspirin

0.3 g = 300 mg and 0.075 g = 75 mg. So, you can see that one adult aspirin weighs 4 times as much as one baby aspirin.

So if you cut an adult aspirin into 4 pieces, you can give the child 1 piece in place of a baby aspirin. Both are equal, and the piece of adult aspirin costs less.

CAUTION: Many medicines, especially the antibiotics, come in different weights and sizes. For example, tetracycline may come in 3 sizes of capsules:

• 250mg
• 100mg
• 50mg

Be careful to only give medicine in the recommended amounts. It is very important to check how many grams or milligrams the medicine contains.

For example: if the prescription says: Take tetracycline, 1 capsule of 250 mg 4 times a day, and you have only 50 mg capsules, you have to take five 50 mg capsules 4 times a day (20 capsules a day).

50 mg + 50 mg + 50 mg + 50 mg + 50 mg = 250 mg

measuring penicillin

Penicillin is often measured in units.

U = unit 1,600,000 U = 1 g or 1,000 mg

Many forms of penicillin (pills and injections) come in doses of 400,000 U. 400,000 U = 250 mg

61

MEDICINE IN LIQUID FORM

Syrups, suspensions, tonics, and other liquid medicines are measured in milliliters:

ml = milliliter 1 liter = 1000 ml

Often liquid medicines are prescribed in tablespoons or teaspoons:

• 1 teaspoon (tsp) = 5 ml
• 1 tablespoon (Tbs) = 15 ml
• 3 teaspoons = 1 tablespoon

When instructions for a medicine say: Take 1 tsp, this means take 5 ml.

Many of the ‘teaspoons’ people use hold as much as 8 ml or as little as 3 ml.

When using a teaspoon to give medicine, it is important that it measure 5 ml. No more, no less.

How to Make Sure that the Teaspoon Used for Medicine Measures 5 ml

1. Buy a 5 ml measuring spoon.

2. Buy a medicine that comes with a plastic spoon. This measures 5 ml when it is full and may also have a line that shows when it is half full (2.5 ml). Save this spoon and use it to measure other medicines.

3. Fill any small spoon that you have at home with 5 ml of water, using a syringe or something else to measure, and make a mark on the spoon at the level of the liquid.

62

HOW TO GIVE MEDICINES TO SMALL CHILDREN

Many medicines that come as pills or capsules also come in syrups or suspensions (special liquid form) for children. If you compare the amount of medicine you get, the syrups are usually more expensive than pills or capsules. You can save money by making your own syrup in the following way:

• Grind up the pill very well or open the capsule
• Mix the powder with boiled water (that has cooled) and sugar or honey.
• You must add lots of sugar or honey when the medicine is very bitter (tetracycline or chloroquine).

When making syrups for children from pills or capsules, be very careful not to give too much medicine. Also, do not give honey to babies under 1 year of age. Though it is rare, some babies can have a dangerous reaction.

CAUTION: To prevent choking, do not give medicines to a child while she is lying on her back, or if her head is pressed back. Always make sure she is sitting up or that her head is lifted forward. Never give medicines by mouth to a child while she is having a fit, or while she is asleep or unconscious.

how much medicine should you give to children when you only have the instructions for adults?

Generally, the smaller the child, the less medicine he needs. Giving more than needed can be dangerous. If you have information about the doses for children, follow it carefully. If you do not know the dose, figure it out by using the weight or age of the child. Children should generally be given the following portions of the adult dose:

Adults: 1 dose

Children 8 to 13 years(66 lbs): 1/2 dose

Children 4 to 7 years(33 lbs): 1/4 dose

Children 1 to 3 years(17.6 lbs): 1/8 dose

Child under 1 year old (11 lbs - 5KG): the dose for a child of 1 year, but ask medical advice when possible.

1 kilogram (kg) = 2.2 pounds (lbs)

63

HOW TO TAKE MEDICINES

It is important to take medicines more or less at the time recommended. Some medicines should be taken only once a day, but others must be taken more often. If you do not have a clock, it does not matter.

If the directions say ‘1 pill every 8 hours’, take 3 a day: one in the morning, one in the afternoon, and one at night. If they say ‘1 pill every 6 hours’, take 4 each day: one in the morning, one at midday, one in the afternoon, and one at night.

If the directions are ‘1 every 4 hours’, take 6 a day, allowing more or less the same time between pills.

Whenever you give a medicine to someone else, it is a good idea to write the instructions and also to have the person repeat to you how and when to take the medicine. Make very sure he understands.

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 of medicine they should take and carefully 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 of the night. This means 1/2 tablet 4 times a day. This means 1/4 tablet twice a day. This means 1 capsule 3 times a day. This means 2 teaspoons twice a day.

64

when you give medicines to anyone . . .

Always write all the following information on the note with the medicine, even if the person cannot read:

• the person’s name • the name of the medicine • what it is for • the dosage

A page of these dosage blanks is included at the end of the book. Cut them out and use them as needed. When you run out, you can make more yourself.

When you give medicine to someone, it is a good idea to keep a record of this same information. If possible, keep a complete Patient Report (see p. 44).

taking medicines on a full or empty stomach

Some medicines work best when you take them when the stomach is empty, that is, one hour before meals.

Other medicines are less likely to cause upset stomach or heartburn (chest pain) when taken along with a meal or right afterwards. This information can be put on the same note as the drawing for dosage.

Take these medicines 1 hour before or 2 hours after meals:

• penicillin • ampicillin • doxycycline • tetracycline

It is better not to drink milk 1 hour before or after taking doxycycline or tetracycline.

Take these medicines together with or soon after meals (or with a lot of water):

• aspirin and medicine that contains aspirin • ibuprofen • iron (ferrous sulfate) • vitamins • erythromycin

Antacids do the most good if you take them when the stomach is empty, 1 or 2 hours after meals and at bedtime.

Note: It is best to take medicines while you are standing or sitting up. Also, try to drink a glass of water each time you take a medicine. If you are taking a sulfa medicine, it is important to drink lots of water, at least 8 glasses a day, to prevent harm to the kidneys.

• WHEN TO INJECT AND WHEN NOT TO
• WHAT TO DO WHEN THE DOCTOR PRESCRIBES INJECTIONS
• EMERGENCIES WHEN IT IS IMPORTANT TO GIVE INJECTIONS
• WHEN NOT TO INJECT
• MEDICINES NOT TO INJECT
• RISKS AND PRECAUTIONS
  • DANGEROUS REACTIONS FROM INJECTING CERTAIN MEDICINES
  • How to Avoid Serious Reactions to a Penicillin Injection
  • HOW TO PREPARE A SYRINGE FOR INJECTION
  • WHERE TO GIVE AN INJECTION
• HOW TO INJECT
• HOW INJECTIONS CAN DISABLE CHILDREN
• HOW TO CLEAN (STERILIZE) EQUIPMENT
  • Here are some ways to sterilize equipment:

WHEN TO INJECT AND WHEN NOT TO

Injections are not needed often. Most sicknesses that require medical treatment can be treated as well or better with medicines taken by mouth. Each year, millions of people, especially children, become ill, disabled, or die as a result of unnecessary injections. Combating misuse and overuse of medicines is as important to good health as vaccination, clean water, or the correct use of latrines. As a general rule:

It is more dangerous to inject medicine than to take it by mouth.

Injections should be used only when absolutely necessary. Except in emergencies, they should be given only by health workers or persons trained in their use.

The only times medicines should be injected are:

1. When the recommended medicine does not come in a form that can be taken by mouth.
2. When the person vomits often, cannot swallow, or is unconscious.
3. In certain unusual emergencies and special cases (see the next page).

WHAT TO DO WHEN THE DOCTOR PRESCRIBES INJECTIONS

Doctors and other health workers sometimes prescribe injections when they are not needed. After all, they can charge more money for injections. They forget the problems and dangers of giving injections in rural areas.

1. If a health worker or healer wants to give you an injection, be sure the medicine is appropriate and that she takes all the necessary precautions.

2. If a doctor prescribes injections, explain that you live where no one is well trained to give injections and ask if it would be possible to prescribe a medicine to take by mouth.

3. If a doctor wants to prescribe injections of vitamins, liver extract, or vitamin B12, but has not had your blood tested, tell him you would prefer to see another doctor.

66

EMERGENCIES WHEN IT IS IMPORTANT TO GIVE INJECTIONS

In case of the following sicknesses, get medical help as fast as you can. If there will be any delay in getting help or in taking the sick person to a health center, inject the appropriate medicine as soon as possible.

For details of the doses, consult the pages listed below. Before injecting, know the possible side effects and take the needed precautions (see the Green Pages).

•

Sicknesses: Severe pneumonia, Gangrene

Inject these medicines: benzylpenicillin

•

Sicknesses: Infections after childbirth

Inject these medicines: ampicillin and gentamicin taken with metronidazole by mouth.

•

Sicknesses: Tetanus

Inject these medicines: penicillin and antitetanus immunoglobulin with metronidazole by mouth.

•

Sicknesses: Appendicitis or Peritonitis

Inject these medicines: ampicillin OR ciprofloxacin, OR ceftriaxone, with metronidazole by mouth.

•

Sicknesses: Poisonous snakebite, Scorpion sting (in children,

Inject these medicines: antitoxins and antivenon

•

Sicknesses: Meningitis when you do not suspect tuberculosis

Inject these medicines: ampicillin and ceftriaxone OR gentamicin

•

Sicknesses: Meningitis when you suspect tuberculosis

Inject these medicines: ampicillin together with streptomycin and, if possible, other TB medicines.

•

Sicknesses: Vomiting when it cannot be controlled

Inject these medicines: antihistamines, for example, promethazine

•

Sicknesses: Severe allergic reaction and allergic shock

Inject these medicines: epinephrine Adrenalin (page 70) and, if possible, diphenhydramine (Benadryl)

•

The following chronic illnesses may require injections, but they are rarely emergencies. It is best to consult a health worker for treatment.

•

Sicknesses: Tuberculosis

Inject these medicines: streptomycin together with other TB medicines taken by mouth

•

Sicknesses: Syphilis

Inject these medicines: benzathine penicillin) and benzathine penicillin

•

Sicknesses: Gonorrhea

Inject these medicines: ceftriaxone OR spectinomycin with other medicines taken by mouth

•

67

WHEN NOT TO INJECT

NEVER give injections if you can get medical help quickly.

NEVER give an injection for a sickness that is not serious.

NEVER give injections for a cold or the flu.

NEVER inject a medicine that is not recommended for the illness you want to treat.

NEVER give an injection unless your needle has been boiled or sterilized.

NEVER inject a medicine unless you know and take all the recommended precautions.

MEDICINES NOT TO INJECT

In general, it is better never to inject the following:

1. Vitamins. Rarely are injected vitamins any better than vitamins taken by mouth. Injections are more expensive and more dangerous. Use vitamin pills or syrups rather than injections. Better still, eat foods rich in vitamins (see page 111).

2. Liver extract, vitamin B12, and iron injections (such as Imferon). Injecting these can cause abscesses or dangerous reactions (shock, page 70). Ferrous sulfate pills will do more good for almost all cases of anemia (page 392).

3. Calcium. Injected into a vein calcium is extremely dangerous, if not given very slowly. An injection in the buttock may cause a large abscess. Untrained people should never inject calcium.

4. Penicillin. Nearly all infections that require penicillin can be effectively treated with penicillin taken by mouth. Penicillin is more dangerous when injected. Use injectable penicillin only for dangerous infections.

5. Chloramphenicol or tetracycline. These medicines do as much or more good when taken by mouth. Use capsules or syrups rather than injections (page 355 and page 356).

6. Intravenous (I.V.) solutions. These should be used only for severe dehydration and given only by someone who is well trained. When not given correctly they can cause dangerous infections or death (page 53).

7. Intravenous medicines. There is so much danger in injecting any medicine in the vein that only well trained health workers should do it. However, never inject into a muscle (the buttock) medicine that says ‘for intravenous use only’. Also, never inject in the vein medicine that says ‘for intramuscular use only’.

68

RISKS AND PRECAUTIONS

The risks of injecting any medicines are (1) infection caused by germs entering with the needle and (2) allergic or poisonous reactions caused by the medicine.

1. To lower the chance of infection when injecting, take great care that everything is completely clean. It is very important to boil the needle and syringe before injecting. After boiling, do not touch the needle with your fingers or with anything else.

Never use the same needle and syringe to inject more than one person without boiling it again first.

Carefully follow all of the instructions for injecting (see following pages).

Be sure to wash your hands well before preparing or giving injections.

1. It is very important to know what reactions a medicine can produce and to take the recommended precautions before injecting.

If any of the following signs of allergic or poisonous reaction appear, never give the same or similar medicine again:

• hives (patchy swellings on skin) or a rash with itching

• swelling anywhere

• difficulty breathing

• signs of shock (see page 70)

• dizzy spells with nausea (wanting to vomit)

• problems with vision

• ringing in the ears or deafness

• severe back pain

• difficulty urinating

An abscess like this one comes from injecting with a needle that has not been well boiled and is not sterile (completely clean and germ free).

Hives, or a rash with itching, can appear a few hours or up to several days after getting an injection. If the same medicine is given to the person again, it may cause a very severe reaction or even death (see page 70).

This child was injected with a needle that was not sterile (boiled and completely free of germs).

The dirty needle caused an infection that produced a large, painful abscess (pocket of pus) and gave the child a fever. Finally, the abscess burst as shown in the picture below.

This child was injected for a cold. It would have been far better to give him no medicine at all. Rather than doing good, the injection caused the child suffering and harm.

CAUTION: If possible, always give medicine by mouth instead of by injection especially to children.

69

To avoid problems like these:

Inject only when absolutely necessary.

♦ Boil the syringe and needle just before giving the injection and be very careful to keep them completely clean.

♦ Use only the medicine recommended for the disease and be sure it is still in good condition and not spoiled.

♦ Inject in the correct place.

Do not inject infants and small children in the buttock. Instead, inject them in the upper, outer part of the thigh. (Notice that this child was injected too low on the buttock, where it is possible to damage the nerve.)

70

DANGEROUS REACTIONS FROM INJECTING CERTAIN MEDICINES

The following groups of medicines sometimes produce a dangerous reaction called ALLERGIC SHOCK a short time after injection:

• penicillins (including ampicillin) {scorpion antivenom

• antitoxins that are made from horse serum snake antivenom

The risk of a serious reaction is greater in a person who has previously been injected with one of these medicines or with another medicine of the same group.

This risk is especially great if the medicine caused an allergic reaction (hives, rash, itching, swelling, or trouble breathing) a few hours or days after the injection was given.

Rarely, ALLERGIC SHOCK may result from the sting of a wasp or bee or from medicine taken by mouth.

To prevent a serious reaction from an injection:

1. Use injections only when absolutely necessary.

2. Before injecting one of the medicines listed above, always have ready 2 ampules of epinephrine (Adrenalin, page 385) and an ampule of an antihistamine like promethazine (Phenergan, page 385) or diphenhydramine (Benadryl, page 386).

3. Before injecting, always ask if at any other time a similar injection caused itching or other reactions. If the person says yes, do not use this medicine or any other medicine of the same group, either injected or taken by mouth.

4. In very serious cases, like scorpion or snakebite, if there is a good chance that the antitoxin might produce an allergic reaction (if the person suffers from allergies or asthma or has had horse serum before), inject promethazine or diphenhydramine 15 minutes before giving the antitoxin: adults, 25 to 50 mg; children, 10 to 25 mg, depending on their size (see page 386).

5. After injecting any medicine, always stay with the person for 30 minutes to watch for any of the following signs of ALLERGIC SHOCK:

• cool, moist, pale, gray skin (cold sweat)

• weak, rapid pulse or heartbeat

• difficulty breathing

• loss of consciousness

1. If these signs appear, immediately inject epinephrine (Adrenalin): adults, 1/2 ml; children, 1/3 to 1/4 ml, depending on their size. Treat the person for SHOCK (see page 77). Follow by giving an antihistamine in double the normal dose.

71

How to Avoid Serious Reactions to a Penicillin Injection

1. For mild to moderate infections: give penicillin pills instead of injections

2. Before injecting ask the person:

“Have you ever had a rash, itching, swelling, or trouble breathing after getting an injection of penicillin?”

If the answer is yes, do not use penicillin, ampicillin, or amoxicillin. Use another antibiotic like erythromycin (page 354) or a sulfonamide (page 356).

1. Before injecting penicillin: always have ampules of EPINEPHRINE (Adrenalin) ready.

2. After injecting: stay with the person for at least 30 minutes.

3. If the person becomes very pale, his heart beats very fast, he has dif culty breathing, or he starts to faint, immediately inject into a muscle (or just under the skin) half an ampule of EPINEPHRINE (Adrenalin, a quarter of an ampule in small children) and repeat in 10 minutes if necessary.

72

HOW TO PREPARE A SYRINGE FOR INJECTION

Before preparing a syringe, wash hands with soap and water.

1. Take the syringe apart and boil it and the needle for 20 minutes.

2. Pour out the boiled water without touching the syringe or the needle.

3. Put the needle and the syringe together, touching only the base of the needle and the button of the plunger.

4. Clean the ampule of distilled water well, then break off the top.

5. Fill the syringe. (Be careful that the needle does not touch the outside of the ampule.)

6. Rub the rubber of the bottle with clean cloth wet with alcohol or boiled water.

7. Inject the distilled water into the bottle with the powdered medicine.

8. Shake until the medicine dissolves.

9. Fill the syringe again.

10. Remove all air from the syringe.

Be very careful not to touch the needle with anything, not even the cotton with alcohol. If by chance the needle touches your finger or something else, boil it again.

73

WHERE TO GIVE AN INJECTION

Before injecting, wash hands with soap and water.

It is preferable to inject in the muscle of the buttocks, always in the upper outer quarter.

HOW TO INJECT

1. Clean the skin with soap and water (or alcohol, but to prevent severe pain, be sure the alcohol is dry before injecting).

2. Put the needle straight in, all the way. (If it is done with one quick movement, it hurts less.)

3. Before injecting, pull back on the plunger. (If blood enters the syringe, take the needle out and put it in somewhere else).

4. If no blood enters, inject the medicine slowly.

5. Remove the needle and clean the skin again.

6. After injecting, rinse the syringe and needle at once. Squirt water through the needle and then take the syringe apart and wash it. Boil before using again.

WARNING: Do not inject into an area of skin that is infected or has a rash. Do not inject infants and small children in the buttock. Inject them in the upper outer part of the thigh.

74

HOW INJECTIONS CAN DISABLE CHILDREN

When used correctly, certain injected medicines, such as vaccinations, are important to protect a child’s health and prevent disability. But if injections are given with needles or syringes that are not sterilized, the injections may cause a serious infection.

Unclean needles and syringes can spread germs that cause HIV or other serious diseases, such as hepatitis, from one person to another. Dirty needles and syringes can also cause infections that lead to paralysis or death. Never inject more than 1 person with the same needle or syringe without disinfecting it first.

Some injected medicines can cause dangerous allergic reactions, poisoning, deafness, or other harmful effects. For example, pregnant women are often given hormone injections to speed up childbirth and ‘give strength’, but these injections are dangerous for the mother and can cause brain damage or death of the baby.

For more information on how injections disable children, see Disabled Village Children, Chapter 3.

For ideas on teaching people about the danger of unnecessary injections, see Helping Health Workers Learn, Chapters 18, 19, and 27.

HOW TO CLEAN (STERILIZE) EQUIPMENT

Many infectious diseases, such as HIV (see page 399), hepatitis (see page 172), and tetanus (see page 182), can spread from a sick person to a healthy person through the use of syringes, needles, and other instruments that are not sterile (this includes the instruments used for piercing ears, acupuncture, tattoos, or circumcision). Many skin infections and abscesses also start because of this. Any time the skin is cut or pierced, it should be done only with equipment that has been sterilized.

Here are some ways to sterilize equipment:

• Boil for 30 minutes. (If you do not have a clock, add 1 or 2 grains of rice to the water. When the rice is cooked, the equipment will be sterile.)

• Or use pressure steaming for 30 minutes in a pressure cooker (or an autoclave).

• Or soak for 20 minutes in a solution of 1 part chlorine bleach to 7 parts water, or in a solution of 70% ethanol alcohol. If possible, prepare these solutions fresh each day, because they lose their strength. (Be sure to sterilize the inside of a syringe by pulling some solution inside and then squirting it out.)

When you are helping someone who has an infectious disease, wash your hands often with soap and water.

• BASIC CLEANLINESS AND PROTECTION
• FEVER
  • Very High Fevers
• SHOCK
• LOSS OF CONSCIOUSNESS
  • How to position an unconscious person:
• WHEN SOMETHING GETS STUCK IN THE THROAT
• DROWNING
• WHAT TO DO WHEN BREATHING STOPS
  • mouth-to-mouth breathing
• EMERGENCIES CAUSED BY HEAT
  • Heat Cramps
  • Heat Exhaustion
  • Heat Stroke
• HOW TO CONTROL BLEEDING FROM A WOUND
• HOW TO STOP NOSEBLEEDS
• CUTS, SCRAPES, SMALL WOUNDS: How to treat.
• LARGE CUTS: how to close them
• BANDAGES
• INFECTED WOUNDS
• WOUNDS THAT ARE LIKELY TO BECOME DANGEROUSLY INFECTED
• BULLET, KNIFE, AND OTHER SERIOUS WOUNDS
• Deep Chest Wounds
• Bullet Wounds in the Head
• Deep Wounds in the Abdomen
• EMERGENCY PROBLEMS OF THE GUT
  • ACUTE ABDOMEN
  • LESS SERIOUS ILLNESS
  • OBSTRUCTED GUT
  • Appendicitis, Peritonitis
• BURNS
  • Minor Burns that Do Not Form Blisters (1st degree)
  • Burns that Cause Blisters, Chemical Burns, and Electric Burns (2nd degree).
  • Deep Burns (3rd degree)
  • Special Precautions for Very Serious Burns
  • Burns around the Joints
• BROKEN BONES (fractures)
  • HOW TO SET A BROKEN WRIST
  • BROKEN NECKS AND BACKS
  • BROKEN RIBS
  • BROKEN BONES THAT BREAK THROUGH THE SKIN (open fractures)
  • BROKEN THIGH OR HIP BONE
• HOW TO MOVE A BADLY INJURED PERSON
• DISLOCATIONS (bones that have come out of place at a joint)
• STRAINS AND SPRAINS (bruising or tearing in a twisted joint)
• POISONING
• SNAKEBITE
  • RATTLESNAKE
  • POISONOUS SNAKE
  • PROBABLY A NON-POISONOUS SNAKE
• BITE OF THE BEADED LIZARD (gila monster)
• SCORPION STING
• SPIDER BITES: BLACK WIDOW AND OTHERS

BASIC CLEANLINESS AND PROTECTION

When a person is hurt, the most important thing is to help. But you also must protect yourself from HIV and other blood-borne diseases. When someone is bleeding:

1. If possible, show the injured person how to stop the bleeding themselves, by applying direct pressure on the wound.

2. If they cannot do this, keep the blood off yourself by wearing gloves or a clean plastic bag on your hands, and placing a clean, thick cloth directly over the wound before applying pressure.

Avoid objects soiled with blood. Be careful not to prick yourself with needles or other sharp objects around the person you are helping. Cover cuts or other wounds with dry, clean bandages to protect them.

Be especially careful when you have to provide first aid where there are many people wounded from an accident or fighting.

If you do get blood or other body fluids on you, wash your hands with soap and water as soon as possible. If other parts of your body were touched by body fluids (especially your eyes), wash them thoroughly with lots of water.

FEVER

When a person’s body temperature is too hot, he has a fever. Fever is not a sickness, but a sign of many different sicknesses. A high fever (over 39°C or over 102°F) can be a sign of a dangerous problem, especially in a small child. When a person has a fever:

1. Uncover him completely. Small children should be undressed completely and left naked until the fever goes down.

Never wrap the child in clothing or blankets. To wrap up a child with fever is dangerous

Fresh air or a breeze will not harm a person with fever. On the contrary, a fresh breeze helps lower the fever.

1. Also take aspirin to lower fever (see page 378). For children, it is safer to give acetaminophen (paracetamol, page 380). Be careful not to give too much.

2. Anyone who has a fever should drink lots of water, juices, or other liquids. For small children, especially babies, drinking water should be boiled first (and then cooled). Make sure the child passes urine regularly. If she does not pass much urine, or the urine is dark, give a lot more water.

3. When possible, find and treat the cause of the fever.

76

Very High Fevers

A very high fever can be a sign of a dangerous illness. Bring the fever down as soon as you can and treat the cause of the fever, if possible. High fever can cause seizures (convulsions) and is most dangerous for small children.

When a fever goes very high, over 40°, it must be lowered at once:

1. Put the person in a cool place.

2. Remove all clothing.

3. Fan him.

4. Pour water over him, or put cloths soaked in cool water on his chest and forehead. Fan the cloths and change them often to keep them cool. Continue to do this until the fever goes down (below 38°).

5. Give him plenty of cool (not cold) water to drink.

6. Give a medicine to bring down fever. Aspirin or acetaminophen works well, but for children under 12 years old it is safer to use acetaminophen.

Dosage for acetaminophen (using 300 mg. adult tablets):

• Persons over 12 years: 2 tablets every 4 hours

• Children 6 to 12 years: 1 tablet every 4 hours

• Children 3 to 6 years: 1/2 tablet every 4 hours

• Children under 3 years: 1/4 tablet every 4 hours

If a person with fever cannot swallow the tablets, grind them up, mix the powder with some water, and put it up the anus as an enema or with a syringe without the needle.

If a high fever does not go down soon, if the person is unconscious, or if seizures (fits, convulsions) begin, continue cooling with water and seek medical help at once.

77

SHOCK

Shock is a life threatening condition that can result from a large burn, losing a lot of blood, severe illnesses, dehydration, or severe allergic reaction.

Heavy bleeding inside the body, although not seen, can also cause shock.

Signs of shock:

• weak, rapid pulse (more than 100 per minute for an adult, more than 140 per minute for a child over 2 years old, and more than 190 per minute for a baby)

• ‘cold sweat’; pale, cold, damp skin

• blood pressure drops dangerously low

• mental confusion, weakness, or loss of consciousness.

What to do to prevent or treat shock:

At the first sign of shock, or if there is risk of shock:

• Loosen any belts or tight clothing the person may be wearing.

• Have the person lie down with his feet a little higher than his head, like this: However, if he has a severe head injury, put him in a ‘half sitting’ position (page 91).

• Stop any bleeding. Use gloves or a plastic bag to keep the blood off your hands.

• If the person feels cold, cover him with a blanket.

• If he is conscious and able to drink, give him sips of water or other drinks. If he looks dehydrated, give a lot of liquid, and Rehydration Drink (page 152). If he does not respond quickly, give intravenous fluids if you know how.

• Treat his wounds, if he has any.

• If he is in pain, give him aspirin or another pain medicine, but not one with a sedative such as codeine.

• Keep calm, reassure the person, and seek medical help.

If the person is unconscious:

• Lay him on his side with his head low.

• If he has vomited, clear his mouth immediately. Be sure his head is low, tilted back, and to one side (see above) so he does not breathe vomit into his lungs. If he has a neck or spine injury, do not tilt his head or move his back.

• Do no give him anything by mouth until he becomes conscious.

• If you or someone nearby knows how, give intravenous solution (normal saline) at a fast drip.

• Seek medical help fast.

78

LOSS OF CONSCIOUSNESS

Common causes of loss of consciousness are:

• drunkenness

• a hit on the head (getting knocked out)

• shock (page 77)

• seizures (page 178)

• poisoning (page 103)

• fainting (from fright, weakness, low blood sugar, etc.)

• heat stroke (page 81)

• stroke (page 327)

• heart attack (page 325)

If a person is unconscious and you do not know why, immediately check each of the following:

1. Is he breathing well?

If not, tilt his head way back and pull the jaw and tongue forward. If something is stuck in his throat, pull it out. If he is not breathing, use mouth-to-mouth breathing at once (see page 80).

1. Is he losing a lot of blood?

If so, control the bleeding (see page 82).

1. Is he in shock (moist, pale skin; weak, rapid pulse)?

If so, lay him with his head lower than his feet and loosen his clothing (see page 77).

1. Could it be heat stroke (no sweat, high fever, hot, red skin)?

If so, shade him from the sun, keep his head higher than his feet, and soak him with cold water (ice water if possible) and fan him (see page 81).

How to position an unconscious person:

• very pale skin: (shock, fainting, etc.): flat, pillow under feet.

• red or normal skin: (heat stroke, stroke, heart problems, head injury): with head higher (put 2 bricks under the head feet of the bed.)

If there is any chance that the unconscious person is badly injured:

It is best not to move him until he becomes conscious. If you have to move him, do so with great care, because if his neck or back is broken, any change of position may cause greater injury (see page 100).

Look for wounds or broken bones, but move the person as little as possible. Do not bend his back or neck.

Never give anything by mouth to a person who is unconscious.

79

WHEN SOMETHING GETS STUCK IN THE THROAT

When food or something else sticks in a person’s throat and he cannot breathe, quickly do this:

♦ Bend him over at the waist.

♦ Use the palm of your hand to give 5 firm blows on the middle of the back.

If this does not work:

♦ Stand behind him and wrap your arms around his waist.

♦ Put your fist against his belly above the navel and below the ribs.

♦ Press into his belly with a sudden strong upward jerk. This forces the air from his lungs and should free his throat. Repeat several times if necessary. (For fat persons, pregnant women, persons in wheelchairs, or small children, place hands on the chest, not the belly.)

If the person is a lot bigger than you, or is already unconscious, lay him on his back, tilt his head to one side, and sit over him like this, with the heel of your lower hand on his belly between his navel and ribs. Make a quick, strong upward push.

Repeat several times if necessary. If he still cannot breathe, try mouth-to- mouth breathing (see next page).

DROWNING

A person who has stopped breathing has only 4 minutes to live! Act fast!

Start mouth-to-mouth breathing at once (see next page), if possible, even before the drowning person is out of the water, as soon as it is shallow enough to stand.

ALWAYS START MOUTH-TO-MOUTH BREATHING AT ONCE.

80

WHAT TO DO WHEN BREATHING STOPS

mouth-to-mouth breathing

Common causes for breathing to stop are:

• something stuck in the throat

• the tongue or thick mucus blocking the throat of an unconscious person

• drowning, choking on smoke, or poisoning

• a strong blow to the head or chest

• a heart attack

A person can die within 4 minutes if he does not breathe.

Do all of the following as quickly as you can:

Step 1:

Quickly use a finger to remove anything stuck in the mouth or throat.

Step 2:

Quickly but gently lay the person face up. Gently tilt his head back, and pull his jaw forward.

Step 3:

Pinch his nostrils closed with your fingers, open his mouth wide, cover his mouth with yours, and blow strongly into his lungs so that his chest rises. Pause to let the air come back out and blow again. Repeat about once every 5 seconds. With babies and small children, cover the nose and mouth with your mouth and breathe very gently about once every 3 seconds.

Continue mouth-to-mouth breathing until the person can breathe by himself, or until there is no doubt he is dead. Sometimes you must keep trying for an hour or more.

Note: Unless there is an open sore or bleeding in the mouth, it is not possible to give or get hepatitis or HIV from mouth-to-mouth breathing.

If a person stops breathing, begin mouth-to-mouth breathing IMMEDIATELY.

81

EMERGENCIES CAUSED BY HEAT

Heat Cramps

In hot weather people who work hard and sweat a lot sometimes get painful cramps in their legs, arms, or stomach. These occur because the body lacks salt.

Treatment:

Put a teaspoon of salt in a liter of boiled water and drink it. Repeat once every hour until the cramps are gone. Have the person sit or lie down in a cool place and gently massage the painful areas.

Heat Exhaustion

Signs:

A person who works and sweats a lot in hot weather may become very pale, weak, and nauseous, and perhaps feel faint. The skin is cool and moist. The pulse is rapid and weak. The temperature of the body may rise but is usually normal (see page 31).

Treatment:

Have the person lie down in a cool place, raise his feet, and rub his legs. Give salt water to drink: 1/2 teaspoon of salt in a liter of water. (Give nothing by mouth while the person is unconscious.)

Heat Stroke

Heat stroke is not common, but is very dangerous. It occurs especially in older people, very fat people, and alcoholics during hot weather.

Signs:

The skin is red, very hot, and dry. Not even the armpits are moist. The person has a very high fever, sometimes more than 42°C, and a rapid heartbeat. Often he is unconscious.

Treatment:

The body temperature must be lowered immediately. Put the person in the shade. Soak him with cold water (ice water if possible) and fan him. Continue until the fever drops. Seek medical help.

DIFFERENCES BETWEEN HEAT-EXHAUSTION AND HEAT-STROKE

HEAT-EXHAUSTION:

• sweaty, pale, cool skin • large pupils • weakness

HEAT-STROKE:

• dry, red, hot skin • high fever • the person is very ill or unconscious

For emergencies caused by cold, see page 408 and page 409.

82

HOW TO CONTROL BLEEDING FROM A WOUND

1. Raise the injured part.

2. With a clean thick cloth (or your hand if there is no cloth) press directly on the wound. Keep pressing until the bleeding stops. This may take 20 minutes or sometimes an hour or more. This type of direct pressure will stop the bleeding of nearly all wounds, sometimes even when a part of the body has been cut off.

Occasionally direct pressure will not control bleeding, especially when the wound is very large or an arm or leg has been cut off.

If this happens:

♦ Keep pressing on the wound.

♦ Keep the wounded part as high as possible.

♦ You can maintain pressure by binding the wound tightly with a bandage or a piece of clean clothing.

♦ Squeeze at pressure points on the artery that brings blood to that part of the body. Pressure points are where, using the flat part of your fingers, you can push the artery against a bone to shut off or slow down the flow of blood.

♦ Keep pressing for 20 minutes before looking to see if the bleeding has stopped. Keep pressing with your other hand on the wound itself. Applying pressure is hard work, do not give up!

PRECAUTIONS:

• Using a tourniquet to stop the bleeding usually results in total loss of the arm or leg. Only use a tourniquet if you have no other option. Never use a string or wire. It can cut right through the skin.

• Never use dirt, kerosene, lime, or coffee to stop bleeding.

• When bleeding or injury is severe, raise the feet and lower the head to prevent shock (see page 77).

• Keep blood from getting into any cuts or sores on your skin (see page 75).

83

HOW TO STOP NOSEBLEEDS

1. Sit quietly and upright.

2. Blow the nose gently to remove mucus and blood.

3. Have the person pinch the nose firmly for 10 minutes or until the bleeding has stopped.

If this does not control the bleeding . . .

Pack the nostril with a wad of cotton, leaving part of it outside the nose. If possible, first wet the cotton with Vaseline or lidocaine with epinephrine (page 379).

Then pinch the nose firmly again. Do not let go for 10 minutes or more. Do not tip the head back.

Leave the cotton in place for a few hours after the bleeding stops; then take it out very carefully.

In older persons especially, bleeding may come from the back part of the nose and cannot be stopped by pinching it.

In this case, have the person hold a cork, corn cob, or other similar object between his teeth and, leaning forward, sit quietly and try not to swallow until the bleeding stops. (The cork helps keep him from swallowing, and that gives the blood a chance to clot.)

Prevention:

If a person’s nose bleeds often, smear a little Vaseline inside the nostrils twice a day. Or sniff water with a little salt in it (see page 164).

Eating oranges, tomatoes, and other fruits may help to strengthen the veins so that the nose bleeds less.

84

CUTS, SCRAPES, SMALL WOUNDS: How to treat.

First, wash your hands very well with soap and water.

If the wound is bleeding or oozing, wear gloves or plastic bags on your hands. Wash the skin around the wound with soap and cool, boiled water.

Now wash the wound well with cool, boiled water (and soap, if the wound has a lot of dirt in it. Soap helps clean but can damage the flesh).

When cleaning the wound, be careful to clean out all the dirt. Lift up and clean under any flaps of skin. You can use clean tweezers, or a clean cloth or gauze, to remove bits of dirt, but always boil them first to be sure they are sterile.

If possible, squirt out the wound with cool boiled water in a syringe or suction bulb.

Any bit of dirt that is left in a wound can cause an infection.

After the wound has been cleaned, apply a thin layer of antibiotic cream like Neosporin if you have it. Then place a piece of clean gauze or cloth over the top.

It should be light enough so that the air can get to the wound and help it to heal. Change the gauze or cloth every day and look for signs of infection (see page 88).

If you have a dirty wound or a puncture wound, and have never had a tetanus immunization (see page 388), get one within 2 days.

Cleanliness is of first importance in preventing infection and helping wounds to heal.

NEVER put animal or human feces or mud on a wound. These can cause dangerous infections, such as tetanus.

NEVER put alcohol, tincture of iodine, or Merthiolate directly into a wound; doing so will damage the flesh and make healing slower.

85

LARGE CUTS: how to close them

A recent cut that is very clean will heal faster if you bring the edges together so the cut stays closed.

Close a deep cut only if all of the following are true:

• the cut is less than 12 hours old,

• the cut is very clean, and

• it is impossible to get a health worker to close it the same day.

Before closing the cut, wash it very well with cool, boiled water (and soap, if the wound is dirty). If possible, squirt it out with a syringe and water. Be absolutely sure that no dirt or soap is left hidden in the cut.

There are two methods to close a cut:

• ‘BUTTERFLY’ BANDAGES OF ADHESIVE TAPE

• STITCHES OR SUTURES WITH THREAD

To find out if a cut needs stitches see if the edges of the skin come together by themselves. If they do, usually no stitches are needed.

To stitch a wound:

♦ Boil a sewing needle and a thin thread (nylon or silk is best) for 20 minutes.

♦ Wash the wound with cool, boiled water, as has been described.

♦ Wash your hands very well with boiled water and soap.

♦ Sew the wound like this: Make the first stitch in the middle of the cut, and tie it closed. If the skin is tough, hold the needle with a pair of pliers (or needle holder) that has been boiled. Make enough other stitches to close the whole cut.

Leave the stitches in place for 5 to 14 days (on the face 5 days; the body 10 days; the hand or foot 14 days). Then remove the stitches: cut the thread on one side of the knot and pull the knot until the thread comes out.

WARNING: Only close wounds that are very clean and less than 12 hours old. Old, dirty, or infected wounds must be left open. Bites from people, dogs, pigs, or other animals should also be left open. Closing these can cause dangerous infections.

If the wound that has been closed shows any signs of infection, remove the stitches immediately and leave the wound open (see page 88).

86

BANDAGES

Bandages are used to help keep wounds clean. For this reason, bandages or pieces of cloth used to cover wounds must always be clean themselves. Cloth used for bandages should be washed and then dried with an iron or in the sun, in a clean, dust free place.

Make sure the wound has first been cleaned, as shown on page 84. If possible, cover the wound with a sterile gauze pad before bandaging. These pads are often sold in sealed envelopes in pharmacies.

Or prepare your own sterile gauze or cloth. Wrap it in thick paper, seal it with tape, and bake it for 20 minutes in an oven. Putting a pan of water in the oven under the cloth will keep it from charring.

If a bandage gets wet or dirt gets under it, take the bandage off, wash the cut again, and put on a clean bandage. Change the bandage every day.

87

EXAMPLES OF BANDAGES

It is better to have no bandage at all than one that is dirty or wet.

CAUTION: Be careful that a bandage that goes around a limb is not so tight it cuts off the flow of blood.

Many small scrapes and cuts do not need bandages. They heal best if washed with soap and water and left open to the air. The most important thing is to keep them clean.

Note: For children it is often better to bandage the whole hand or foot instead of one finger or toe. The bandage will not come off as easily.

88

INFECTED WOUNDS

HOW TO RECOGNIZE AND TREAT THEM

A wound is infected if:

• it becomes red, swollen, hot, and painful,

• it has pus,

• or if it begins to smell bad.

The infection is spreading to other parts of the body if:

• it causes fever,

• there is a red line above the wound,

• or if the lymph nodes become swollen and tender. Lymph nodes, often called ‘glands’, are little traps for germs that form small lumps under the skin when they get infected.

Swollen lymph nodes behind the ear are a sign of an infection on the head or scalp, often caused by sores or lice. Or German measles may be the cause.

Swollen nodes below the ear and on the neck indicate infections of the ear, face, or head (or tuberculosis).

Swollen nodes below the jaw indicate infections of the teeth or throat.

Swollen nodes in the armpit indicate an infection of the arm, head, or breast (or sometimes breast cancer).

Swollen nodes in the groin indicate an infection of the leg, foot, genitals, or anus.

Treatment of infected wounds:

♦ Put hot compresses over the wound for 20 minutes 4 times a day. Or hold an infected hand or foot in a bucket of hot water.

♦ Keep the infected part at rest and elevated (raised above the level of the heart).

♦ If the infection is severe, use an antibiotic like dicloxacillin (page 350), or clindamycin (page 358), or an injectable penicillin (See page 351 to page 353), and also give metronidazole (page 368).

WARNING: If the wound has a bad smell, if brown or gray liquid oozes out, or if the skin around it turns black and forms air bubbles or blisters, this may be gangrene. Seek medical help fast. Meanwhile, follow the instructions for gangrene on page 213.

89

WOUNDS THAT ARE LIKELY TO BECOME DANGEROUSLY INFECTED

These wounds are most likely to become dangerously infected:

• puncture wounds and other deep wounds that do not bleed much

• wounds made where animals are kept: in corrals, pig pens, etc.

• large wounds with severe mashing or bruising

• bites, especially from pigs, dogs, or people

• bullet wounds

Special care for this type of ‘high risk’ wound:

1. Wash the wound well with boiled water and soap. Remove all pieces of dirt, blood clots, and dead or badly damaged flesh. Squirt out the dirt using a syringe or suction bulb.

2. If the wound is very deep or if it is from a knife or bullet, give an antibiotic such as cloxacillin (page 350) or clindamycin (page 358).

3. If the wound is a bite, give an antibiotic such as penicillin (page 351), doxycycline (page 355), or cotrimoxazole (page 357). Also give metronidazole (page 368).

4. Never close this type of wound with stitches or ‘butterfly’ bandages. Leave the wound open. If it is very large, a skilled health worker or a doctor may be able to close it later.

The danger of tetanus is very great in people who have not been vaccinated against this deadly disease.

To lower the risk, a person who has not been vaccinated against tetanus should get a tetanus vaccination (page 147) and, if possible, an injection of tetanus immune globulin (page 388). If the wound is from an animal bite and there is a chance of rabies (see page 181), get injections of rabies vaccine and rabies immunoglobulin right away.

90

BULLET, KNIFE, AND OTHER SERIOUS WOUNDS

Danger of infection: Any deep bullet or knife wound runs a high risk of dangerous infection. For this reason an antibiotic, such as cloxacillin (page 350) or clindamycin (page 358) should be used at once.

Persons who have not been vaccinated against tetanus should, if possible, be given an injection of antitetanus immunoglobulin (page 388), and also be vaccinated against tetanus.

If possible, seek medical help.

Bullet Wounds in the Arms or Legs:

♦ If the wound is bleeding a lot, control the bleeding as shown on page 82.

♦ If the bleeding is not serious, let the wound bleed for a short while. This will help clean it out.

♦ Wash the wound with cool, boiled water. In the case of a gunshot wound, wash the surface (outside) only. It is usually better not to poke anything into the hole. After cleaning, apply a clean bandage.

♦ Give antibiotics.

CAUTION:

If there is any possibility that the bullet has hit a bone, the bone may be broken.

Using or putting weight on the wounded limb (standing, for example) might cause a more serious break, like this:

If a break is suspected, it is best to splint the limb and not to use it for several weeks.

When the wound is serious, raise the wounded part a little higher than the heart and keep the injured person completely still.

YES: This way the wound will heal faster and is less likely to become infected.

YES: Make a sling like this to support an arm with a gunshot wound or other serious injury.

NO: Walking on an injured leg or sitting with the leg hanging down will slow healing and encourage infection.

91

Deep Chest Wounds

Chest wounds can be very dangerous. Seek medical help at once.

♦ If the wound has reached the lungs and air is being sucked through the hole when the person breathes, cover the wound at once so that no more air enters. Spread Vaseline or vegetable fat on a gauze pad or clean bandage and wrap it tightly over the hole like this: (CAUTION: If this tight bandage makes breathing more difficult, try loosening or removing it.)

♦ Put the injured person in the position in which he feels most comfortable.

♦ If there are signs of shock, give proper treatment (see page 77).

♦ Give antibiotics and painkillers.

Bullet Wounds in the Head

♦ Place the injured person in a ‘half sitting’ position.

♦ Cover the wound with a clean bandage.

♦ Give antibiotics (penicillin).

♦ Seek medical help.

92

Deep Wounds in the Abdomen

Any wound that goes into the belly or gut is dangerous. Seek medical help immediately. But in the meantime:

Cover the wound with a clean bandage.

If the guts are partly outside the wound, cover them with a clean cloth soaked in lightly salted, cool, boiled water. Do not try to push the guts back in. Make sure the cloth stays wet.

If the wounded person is in shock, raise his feet higher than his head.

Give absolutely nothing by mouth: no food, no drink, not even water, unless it will take more than 2 days to get to a health center. Then give water only, in small sips.

If the wounded person is awake and thirsty, let him suck on a piece of cloth soaked in water.

Inject antibiotics (see the following page for instructions).

Never give an enema, even if the belly swells up or the injured person does not move his bowels for days. If the gut is torn, an enema or purge can kill him.

DO NOT WAIT FOR A HEALTH WORKER.

IMMEDIATELY TAKE THE INJURED PERSON TO THE CLOSEST HEALTH CENTER OR HOSPITAL. He will need an operation.

EMERGENCY PROBLEMS OF THE GUT

Acute abdomen is a name given to a number of sudden, severe conditions of the gut for which prompt surgery is often needed to prevent death.

Appendicitis, peritonitis, and gut obstruction are examples (see following pages).

In women, pelvic inflammatory disease (often with vaginal discharge, see page 243), or an ectopic pregnancy (page 280) can also cause an acute abdomen.

The exact cause of acute abdomen may be uncertain until a surgeon cuts open the belly and looks inside.

93

Medicine for a wound that goes into the gut (Also for appendicitis or peritonitis)

Until you can get medical help, do the following:

Inject ampicillin (page 352), 1 g (four 250 mg ampules) every 6 hours. Also give metronidazole (page 369), 500 mg every 6 hours.

If there is no ampicillin:

Give ciprofloxacin (page 356), 500 mg every 12 hours. Also give metronidazole. OR inject ceftriaxone (page 358), 2 g every 24 hours. Also give metronidazole.

If you do not have these antibiotics in injectable form, give ampicillin or ciprofloxacin by mouth, together with metronidazole and very little water.

If a person has continuous severe gut pain with vomiting, but does not have diarrhea, suspect an acute abdomen.

ACUTE ABDOMEN

Take to a hospital, surgery may be needed:

• continuous severe pain that keeps getting worse

• constipation and vomiting

• belly swollen, hard, person protects it

• severely ill

LESS SERIOUS ILLNESS

Probably can be treated in the home or health center:

• pain that comes and goes (cramps)

• moderate or severe diarrhea

• sometimes signs of an infection, perhaps a cold or sore throat

• he has had pains like this before

• only moderately ill

If a person shows signs of acute abdomen, get him to a hospital as fast as you can.

94

OBSTRUCTED GUT

An acute abdomen may be caused by something that blocks or ‘obstructs’ a part of the gut, so that food and stools cannot pass.

More common causes are:

• a ball or knot of roundworms (Ascaris, page 140)

• a loop of gut that is pinched in a hernia (page 177)

• a part of the gut that slips inside the part below it (intussusception)

Almost any kind of acute abdomen may show some signs of obstruction. Because it hurts the damaged gut to move, it stops moving.

Signs of an obstructed gut:

• Get this person to a hospital as fast as possible. His life is in danger and surgery may be needed.

• Sudden vomiting with great force! The vomit may shoot out a meter or more. It may have green bile in it or smell and look like feces.

• Steady, severe pain in the belly.

This child’s belly is swollen, hard, and very tender. It hurts more when you touch it. He tries to protect his belly and keeps his legs doubled up. His belly is often ‘silent’. (When you put your ear to it, you hear no sound of normal gurgles.)

He is usually constipated (little or no bowel movements). If there is diarrhea, it is only a little bit. Sometimes all that comes out is some bloody mucus.

Appendicitis, Peritonitis

These dangerous conditions often require surgery. Seek medical help fast.

Appendicitis is an infection of the appendix, a finger shaped sac attached to the large intestine in the lower right hand part of the belly. An infected appendix sometimes bursts open, causing peritonitis.

Peritonitis is an acute, serious infection of the lining of the cavity or bag that holds the gut. It results when the appendix or another part of the gut bursts or is torn.

95

Signs of appendicitis:

• The main sign is a steady pain in the belly that gets worse and worse.

• The pain often begins around the navel (‘bellybutton’) but it soon moves to the lower right side.

• There may be loss of appetite, vomiting, constipation, or a mild fever.

Tests for Appendicitis or Peritonitis

IF IT SEEMS THAT A PERSON HAS APPENDICITIS OR PERITONITIS:

♦ Seek medical help immediately. If possible, take the person where he can have surgery.

♦ Do not give anything by mouth and do not give an enema. Only if the person begins to show signs of dehydration, give sips of water or Rehydration Drink (page 152) made with sugar and salt, but nothing more.

♦ The person should rest very quietly in a half-sitting position.

Note: When peritonitis is advanced, the belly becomes hard like a board, and the person feels great pain when his belly is touched even lightly. His life is in danger. Take him to a medical center immediately and on the way give him the medicines indicated at the top of page 93.

Have the person cough and see if this causes sharp pain in the belly.

Or, slowly but forcefully, press on the abdomen a little above the left groin until it hurts a little.

Then quickly remove the hand.

If a very sharp pain (rebound pain) occurs when the hand is removed, appendicitis or peritonitis is likely.

If no rebound pain occurs above the left groin, try the same test above the right groin.

96

BURNS

Prevention:

Most burns can be prevented. Take special care with children: Do not let small babies go near a fire.

Keep lamps and matches out of reach.

Turn handles of pans on the stove so children cannot reach them.

Keep chemicals in closed containers and keep them away from children.

Minor Burns that Do Not Form Blisters (1st degree)

To help ease the pain and lessen the damage caused by a minor burn, put the burned part in cool water at once. No other treatment is needed. Take aspirin or acetaminophen for pain. Avoid giving aspirin to children.

Burns that Cause Blisters, Chemical Burns, and Electric Burns (2nd degree).

Do not break blisters. Do not put ice on the burn. If the blisters are broken, wash gently with soap and boiled water that has been cooled. Rinse with water for 30 minutes. Then put a piece of sterile gauze on the burn loosely so it does not put pressure on the wound. Never smear on grease or butter.

Covering the burn with honey or the inside meat of an aloe plant helps prevent and control infection and speed healing. Gently wash off the old honey or aloe and put on new at least twice a day.

It is very important to keep the burn as clean as possible. Protect it from dirt, dust, and flies.

If signs of infection appear, pus, bad smell, fever, or swollen lymph nodes, apply compresses of warm salt water (1 teaspoon salt to 1 liter water) 3 times a day. Boil both the water and cloth before use. With great care, remove the dead skin and flesh.

You can spread on a little antibiotic ointment such as Neosporin (page 370). In severe cases, consider taking an antibiotic such as dicloxacillin (page 350), clindamycin (page 358), or ciprofloxacin (page 358).

Deep Burns (3rd degree)

These are burns that destroy the skin and expose raw or charred flesh, or do not show until a few hours after a chemical gets on the skin.

They are always serious, as are any burns that cover large areas of the body. Take the person to a health center at once.

In the meantime wrap the burned part with a very clean cloth or towel moistened with clean water.

If it is impossible to get medical help, treat the burn as described above.

If you do not have Vaseline, leave the burn in the open air, covering it only with a loose cotton cloth or sheet to protect it from dust and flies.

Keep the cloth very clean and change it each time it gets dirty with liquid or blood from the burn. Give an antibiotic.

Never put grease, fat, hides, coffee, herbs, or feces on a burn.

97

Special Precautions for Very Serious Burns

Any person who has been badly burned can easily go into shock (see page 77) because of combined pain, fear, and the loss of body fluids from the oozing burn.

Comfort and reassure the burned person. Give him aspirin or acetaminophen for the pain and codeine if you can get it. Bathing open wounds in slightly salty water also helps calm pain. Put 1 teaspoon of salt for each liter of cool, boiled water.

Give the burned person plenty of liquid. If the burned area is large (more than twice the size of his hand), make up the following drink:

• To a liter of water add:

• half a teaspoon of salt

• and half a teaspoon of bicarbonate of soda.

• Also put in 2 or 3 tablespoons of sugar or honey and some orange or lemon juice if possible.

• The burned person should drink this as often as possible, especially until he urinates frequently. He should drink 4 liters a day for a large burn, and up to 12 liters a day for a very large burn.

• It is important for persons who are badly burned to eat foods rich in protein (See page 110 and page 111). No type of food needs to be avoided.

Burns around the Joints

When someone is badly burned between the fingers, in the armpit, or at other joints, gauze pads with Vaseline on them should be put between the burned surfaces to prevent them from growing together as they heal.

Also, fingers, arms, and legs should be straightened completely several times a day while healing.

This is painful but helps prevent stiff scars that limit movement. While the burned hand is healing, the fingers should be kept in a slightly bent position.

Sterile gauze pads with Vaseline

98

BROKEN BONES (fractures)

When a bone is broken, the most important thing to do is keep the bone in a fixed position. This prevents further damage and lets it mend.

Before trying to move or carry a person with a broken bone, keep the bones from moving with splints, strips of bark, or a sleeve of cardboard. Later a plaster cast can be put on the limb at a health center, or perhaps you can make a ‘cast’ according to local tradition (see page 14).

Setting broken bones: If the bones seem more or less in the right position, it is better not to move them, this could do more harm than good.

If the bones are far out of position and the break is recent, you can try to ‘set’ or straighten them before putting on cast. The sooner the bones are set, the easier it will be. Before setting, if possible give diazepam to relax the muscles and calm pain (see page 389). Or give codeine (page 383).

HOW TO SET A BROKEN WRIST

Pull the hand with a slow, steady force for 5 to 10 minutes, increasing the force, to separate the bones. With one person still pulling the hand, have another gently line up and straighten the bones.

WARNING: It is possible to do a lot of damage while trying to set a bone. Ideally, it should be done with the help of someone with experience. Do not jerk or force.

how long does it take for broken bones to heal?

The worse the break or the older the person, the longer healing takes.

Children’s bones mend rapidly. Those of old people sometimes never join. A broken arm should be kept in a cast for about a month, and no force put on it for another month. A broken leg should remain in a cast for about 2 months.

A broken upper leg or hip often needs special attention. It is best to splint the whole body like this:

and to take the injured person to a health center at once.

99

BROKEN NECKS AND BACKS

If there is any chance a person’s back or neck has been broken, be very careful when moving him. Try not to change his position. If possible, bring a health worker before moving him. If you must move him, do so without bending his back or neck. For instructions on how to move the injured person, see the next page.

BROKEN RIBS

These are very painful, but almost always heal on their own. It is better not to splint or bind the chest. The best treatment is to take aspirin or acetaminophen (avoid giving aspirin to children), and rest.

To keep the lungs healthy, take 4 to 5 deep breaths in a row, every 2 hours. Do this daily until you can breathe normally. At first, this will be very painful. It may take months before the pain is gone completely.

A broken rib does not often puncture a lung. But if a rib breaks through the skin, or if the person coughs blood or develops breathing difficulties (other than pain), use antibiotics and seek medical help.

BROKEN BONES THAT BREAK THROUGH THE SKIN (open fractures)

Since the danger of infection is very great in these cases, it is always better to get help from a health worker or doctor in caring for the injury.

Wear gloves or plastic bags on your hands and clean the wound and the exposed bone very gently but thoroughly with cool, boiled water.

Cover with a clean cloth.

Never put the bone back into the wound until the wound and the bone are absolutely clean.

Splint the limb to prevent more injury.

If the bone has broken the skin, use an antibiotic immediately to help prevent infection: dicloxacillin (page 350), clindamycin (page 358), or ceftriaxone (page 358).

BROKEN THIGH OR HIP BONE

CAUTION: Never rub or massage a broken limb or a limb that may possibly be broken.

100

HOW TO MOVE A BADLY INJURED PERSON

With great care, lift the injured person without bending him anywhere. Take special care that the head and neck do not bend.

Have another person put the stretcher in place.

With the help of everyone, place the injured person carefully on the stretcher.

Tightly folded clothing

If the neck is injured or broken, put tightly folded clothing or sandbags on each side of the head to keep it from moving.

When carrying, try to keep the feet up, even on hills.

101

DISLOCATIONS (bones that have come out of place at a joint)

Three important points of treatment:

♦ Try to put the bone back into place. The sooner the better!

♦ Keep it bandaged firmly in place so it does not slip out again (about a month).

♦ Avoid forceful use of the limb long enough for the joint to heal completely (2 or 3 months).

how to set a dislocated shoulder

Have the injured person lie face down on a table or other firm surface with his arm hanging over the side. Pull down on the arm toward the floor, using a strong, steady force, for 15 to 20 minutes. Then gently let go. The shoulder should ‘pop’ back into place.

Or attach something to the arm that weighs 5 to 10 kg (start with 5 kg, but do not go higher than 10 kg) and leave it there for 15 to 20 minutes.

After the shoulder is in place, bandage the arm firmly against the body. Keep it bandaged for a week to a month.

To prevent the shoulder from becoming completely stiff, un-bandage the arm for a few minutes 3 times a day and, with the arm hanging at the side, move it gently in narrow circles.

Do not lift any weight with the arm for a month so the shoulder does not pop out of place again.

If you cannot put the dislocated limb back in place, look for medical help at once. The longer you wait, the harder it will be to correct.

102

STRAINS AND SPRAINS (bruising or tearing in a twisted joint)

Many times it is impossible to know whether a hand or foot is bruised, sprained, or broken. It helps to have an X-ray taken.

But usually, breaks and sprains are treated more or less the same. Keep the joint motionless. Wrap it with something that gives firm support. Use crutches to give a sprained foot as much rest as possible. Serious sprains need at least 3 or 4 weeks to heal. Broken bones take longer.

To relieve pain and swelling, keep the sprained part raised high. During the first day or two, put ice wrapped in cloth or plastic, or cold, wet cloths over the swollen joint for 20 to 30 minutes once every hour.

This helps reduce swelling and pain. After 24 to 48 hours (when the swelling is no longer getting worse), soak the sprain in hot water several times a day.

For the first day soak the sprained After 1 or 2 days use hot soaks. joint in cold water.

You can keep the twisted joint in the correct position for healing by using a homemade cast (see page 14) or an elastic bandage.

Wrapping the foot and ankle with an elastic bandage will also prevent or reduce swelling. Start from the toes and wrap upward, as shown here. Be careful not to make the bandage too tight, and remove it briefly every hour or two. Also take aspirin or acetaminophen.

If the pain and swelling do not start to go down after 48 hours, seek medical help.

CAUTION: Never rub or massage a sprain or broken bone. It does no good and can do more harm.

If the foot seems very loose or ‘floppy’ or if the person has trouble moving his toes, look for medical help. Surgery may be needed.

103

POISONING

Many children die from swallowing things that are poisonous. To protect your children, take the following precautions:

Keep all poisons out of reach of children.

Never keep kerosene, gasoline, or other poisons in cola or soft drink bottles, because children may try to drink them.

SOME COMMON POISONS TO WATCH OUT FOR:

• rat poison

• DDT, lindane, sheep dip, and other insecticides or plant poisons

• medicine (any kind when much is swallowed; take special care with iron pills)

• tincture of iodine

• bleach

• cigarettes

• rubbing or wood alcohol

Treatment:

• poisonous leaves, seeds, berries, or mushrooms

• castor beans

• matches

• kerosene, paint thinner, gasoline, petrol, lighter fluid

• lye or caustic soda

• salt, if too much is given to babies and small children

• spoiled food (see page 135)

If you suspect poisoning, do the following immediately:

♦ If the child is unconscious, lay him on his side. If he stops breathing, give him mouth-to-mouth breathing (page 80).

♦ If the child is awake and alert, give him plenty of water or milk to drink to dilute the poison (about 1 glass of water every 15 minutes).

♦ If you have activated charcoal (page 388), give it right away, mixed into a glass of water.

♦ If the child is awake and alert and you are sure vomiting is safe, you can make him vomit. Put your finger in his throat or make him drink very salty water.

♦ CAUTION: Do not make a person vomit if he has swallowed kerosene, gasoline (petrol), bleach, paint thinner, some pesticides, strong acids or corrosive substances (lye), or if he is unconscious.

Cover the person if he feels cold, but avoid too much heat. If poisoning is severe, look for medical help.

104

SNAKEBITE

Note: Try to get information on the kinds of snakes in your area and put it on this page.

RATTLESNAKE

North America. Mexico, and Central America.

When someone has been bitten by a snake, try to find out if the snake was poisonous or harmless. Their bite marks are usually different:

POISONOUS SNAKE

The bite of most poisonous snakes leaves marks of the 2 fangs (and sometimes, little marks made by the other teeth).

PROBABLY A NON-POISONOUS SNAKE

If the bite of a snake leaves only 2 rows of teeth marks, but no fang marks, it is less likely that the snake is poisonous. But it still could be.

People often believe that certain harmless snakes are poisonous. Try to find out which of the snakes in your area are truly poisonous and which are not.

Contrary to popular opinion, boa constrictors and pythons are not poisonous.

Please do not kill non-poisonous snakes, because they do no harm. On the contrary, they kill mice and other pests that do lots of damage. Some even kill poisonous snakes.

105

Treatment for poisonous snakebite:

1. Stay quiet; do not move the bitten part. The more it is moved, the faster the poison will spread through the body. If the bite is on the foot, the person should not walk at all. Send for medical help.

2. Remove jewelry because swelling can spread rapidly.

3. Wrap the bitten area with a wide elastic bandage or clean cloth to slow the spread of poison. Keeping the arm or leg very still, wrap it tightly, but not so tight it stops the pulse at the wrist or on top of the foot. If you cannot feel the pulse, loosen the bandage a little.

4. Wind the bandage over the hand or foot, and up the whole arm or leg. Make sure you can still feel the pulse.

5. Then, put on a splint to prevent the limb from moving (see page 14).

6. Carry the person, on a stretcher if possible, to the nearest health center.

If you can, also take the snake, because different snakes may require different antivenoms (antitoxins, see page 387).

If an antivenom is needed, leave the bandage on until the injection is ready, and take all precautions for ALLERGIC SHOCK (see page 70).

Also give tetanus antitoxin (page 388). If there is no need for antivenom, remove the bandage.

Poisonous snakebite is dangerous. Send for medical help, but always do the things explained above at once.

Most folk remedies for snakebite do little if any good (see page 3).

Some treatments can cause infection or make the effects of the venom worse.

Do not:

• cut the skin or the flesh around the bite

• tie anything tight around the bite or the person’s body • put ice on or around the bite

• shock the person with electricity

• try to suck the blood or the venom out of the bite

Have anti-venoms for snakes in your area ready and know how to use them, before someone is bitten!

Never drink alcohol after a snakebite. It makes things worse!

106

BITE OF THE BEADED LIZARD (gila monster)

The bite of the beaded lizard is treated just like a poisonous snakebite, except that there are no good antivenoms for it.

The bite can be very dangerous. Wash the bite area well. Avoid movement and keep the bite below the level of the heart.

SCORPION STING

Some scorpions are far more poisonous than others. To adults, scorpion stings are rarely dangerous. Take aspirin or acetaminophen and if possible put ice on the sting to help calm the pain.

For the numbness and pain that sometimes last weeks or months, hot compresses may be helpful (see page 193).

To children under 5 years old, scorpion stings can be dangerous, especially if the sting is on the head or body. In some countries scorpion antitoxin is available (page 387).

To do much good it must be injected within 2 hours after the child has been stung. Give acetaminophen for the pain. If the child stops breathing, use mouth to mouth breathing (see page 80). Also give tetanus antitoxin (see page 388).

If the child who was stung is very young or has been stung on the main part of the body, or if you know the scorpion was of a deadly type, seek medical help fast.

SPIDER BITES: BLACK WIDOW AND OTHERS

The majority of spider bites, including that of the tarantula, are painful but not dangerous. The bite of a few kinds of spiders, such as the ‘black widow’ and related species, can make an adult quite ill.

They can be dangerous for a small child. A black widow bite often causes painful muscle cramps all over the body, and extreme pain in the stomach muscles which become rigid. (Sometimes this is confused with appendicitis!)

Give acetaminophen or aspirin and look fo medical help. Most cures sold in stores are a waste of money and do not help. Diazepam (page 390) may help reduce muscular spasms.

If signs of shock develop, treat for allergic shock (page 70).

Injections of cortisone may be needed in children. Also give tetanus antitoxin (see page 388).

A good antivenom exists but is hard to get.

• SICKNESSES CAUSED BY NOT EATING WELL
  • in children
  • in anyone
• WHY IT IS IMPORTANT TO EAT RIGHT
• PREVENTING MALNUTRITION
• MAIN FOODS AND HELPER FOODS
• EATING RIGHT TO STAY HEALTHY
  • GO FOODS (energy helpers)
  • MAIN FOODS
  • GROW FOODS
  • GLOW FOODS
• HOW TO RECOGNIZE MALNUTRITION
  • mild malnutrition
  • severe malnutrition
  • dry malnutrition, or marasmus
  • THIS CHILD IS JUST SKIN AND BONES.
  • other forms of malnutrition
  • wet malnutrition (kwashiorkor)
  • Examples
• ways of eating better when you do not have much money or land
  • Better Foods at Low Cost
  • Here are some suggestions for getting more vitamins, minerals, and proteins at low cost.
• WHERE TO GET VITAMINS: pills, injections, syrups, or foods?
• THINGS TO AVOID IN OUR DIET
• THE BEST DIET FOR SMALL CHILDREN
  • 0 > 6 The first 6 months of life
  • 0 > 6 Two examples of correct formulas
  • 6 > 12 From 6 months to 1 year of age
  • 12 > One year and older
  • 12 > Best diet for small children
• HARMFUL IDEAS ABOUT DIET
• SPECIAL DIETS FOR SPECIFIC HEALTH PROBLEMS
  • Anemia
  • Rickets
  • High Blood Pressure (Hypertension)
  • People Who Are Too Heavy
  • Constipation
  • Diabetes
  • Acid Indigestion, Heartburn, and Stomach Ulcers
  • Goiter (a Swelling or Lump on the Throat)

SICKNESSES CAUSED BY NOT EATING WELL

Good food is needed for a person to grow well, work hard, and stay healthy. Many common sicknesses come from not eating enough.

A person who is weak or sick because he does not eat enough, or does not eat the foods his body needs, is said to be poorly nourished, or malnourished. He suffers from malnutrition. Poor nutrition can result in the following health problems:

in children

• failure of a child to grow or gain weight normally (see p. 297)
• slowness in walking, talking, or thinking
• big bellies, thin arms and legs
• common illnesses and infections that last longer, are more severe, and more often cause death
• lack of energy, child is sad and does not play
• swelling of feet, face, and hands, often with sores or marks on the skin
• thinning, straightening, or loss of hair, or loss of its color and shine
• poor vision at night, dryness of eyes, blindness

in anyone

• weakness and tiredness
• loss of appetite
• anemia
• sores in the corners of the mouth
• painful or sore tongue
• ‘burning’ or numbness of the feet

Although the following problems may have other causes, they are sometimes caused and are often made worse by not eating well:

• diarrhea
• frequent infections
• ringing or buzzing in the ears
• headache
• bleeding or redness of the gums
• skin bruises easily
• nosebleeds
• stomach discomfort
• dryness and cracking of the skin
• heavy pulsing of the heart or of the ‘pit’ of the stomach (palpitations)
• anxiety (nervous worry) and various nerve or mental problems • cirrhosis (liver disease)

Poor nutrition during pregnancy causes weakness and anemia in the mother and increases the risk of her dying during or after childbirth. It is also a cause of miscarriage, or of the baby being born dead, too small, or with a disability.

Eating right helps the body resist sickness

Not eating well may be the direct cause of the health problems just listed. But most important, poor nutrition weakens the body’s ability to resist all kinds of diseases, especially infections:

• Poorly nourished children are much more likely to get severe diarrhea, and to die from it, than are children who are well nourished.

• Measles is especially dangerous where many children are malnourished.

• Tuberculosis is more common, and gets worse more rapidly, in those who are malnourished.

• Cirrhosis of the liver, which comes in part from drinking too much alcohol, is more common and worse in persons who are poorly nourished.

• Even minor problems like the common cold are usually worse, last longer, or lead to pneumonia more often in persons who are poorly nourished.

Eating right helps the sick get well

108

Not only does good food help prevent disease, it helps the sick body fight disease and become well again. So when a person is sick, eating enough nutritious food is especially important.

Unfortunately, some mothers stop feeding a child or stop giving certain nutritious foods when he is sick or has diarrhea, so the child becomes weaker, cannot fight off the illness, and may die. Sick children need food! If a sick child will not eat, encourage him to do so.

Feed him as much as he will eat and drink. And be patient. A sick child often does not want to eat much. So feed him something many times during the day. Also, try to make sure that he drinks a lot of liquid so that he pees (passes urine) several times a day. If the child will not take solid foods, mash them and give them as a mush or gruel.

Often the signs of poor nutrition first appear when a person has some other sickness. For example, a child who has had diarrhea for several days may develop swollen hands and feet, a swollen face, dark spots, or peeling sores on his legs. These are signs of severe malnutrition. The child needs more good food! And more often. Feed him many times during the day.

During and after any sickness, it is very important to eat well.

EATING WELL AND KEEPING CLEAN ARE THE BEST GUARANTEES OF GOOD HEALTH.

109

WHY IT IS IMPORTANT TO EAT RIGHT

People who do not eat right develop malnutrition. This can happen from not eating enough food of any kind (general malnutrition or ‘undernutrition’), from not eating the right kinds of foods (specific types of malnutrition), or from eating too much of certain foods (getting too fat, see p. 126).

Anyone can develop general malnutrition, but it is especially dangerous for:

• children, because they need lots of food to grow well and stay healthy;

• women of child bearing age, especially if they are pregnant or breastfeeding, because they need extra food to stay healthy, to have healthy babies, and to do their daily work;

• elderly persons, because often they lose their teeth and their taste for food, so they cannot eat much at one time, even though they still need to eat well to stay healthy;

• people with HIV, because they need more food to fight their infection.

A malnourished child does not grow well. She generally is thinner and shorter than other children. Also, she is more likely to be irritable, to cry a lot, to move and play less than other children, and to get sick more often. If the child also gets diarrhea or other infections, she will lose weight. A good way to check if a child is poorly nourished is to measure the distance around her upper arm.

Checking Children for Malnutrition: The Sign of the Upper Arm

After 1 year of age, any child whose middle upper arm measures less than 11 1⁄2 cm. around is malnourished , no matter how ‘fat’ his feet, hands, and face may look. If the arm measures between 11 1⁄2 and 12 1⁄2 cm., he is at risk of becoming malnourished.

Another good way to tell if a child is well nourished or poorly nourished is to weigh him regularly: once a month in the first year, then once every 3 months. A healthy, well nourished child gains weight regularly. The weighing of children and the use of the Child Health Chart are discussed fully in Chapter 21.

PREVENTING MALNUTRITION

To stay healthy, our bodies need plenty of good food. The food we eat has to fill many needs. First, it should provide enough energy to keep us active and strong. Also, it must help build, repair, and protect the different parts of our bodies. To do all this we need to eat a combination of foods every day.

110

MAIN FOODS AND HELPER FOODS

In much of the world, most people eat one main low-cost food with almost every meal. Depending on the region, this may be rice, maize, millet, wheat, cassava, potato, breadfruit, or banana. This main food usually provides most of the body’s daily food needs.

However, the main food alone is not enough to keep a person healthy. Certain helper foods are needed. This is especially true for growing children, women who are pregnant or breastfeeding, and older people.

Even if a child regularly gets enough of the main food to fill her, she may become thin and weak. This is because the main food often has so much water and fiber in it, that the child’s belly fills up before she gets enough energy to help her grow.

We can do 2 things to help meet such children’s energy needs:

• Feed children more often, at least 5 times a day when a child is very young, too thin, or not growing well. Also give her snacks between meals.

CHILDREN, LIKE CHICKENS, SHOULD ALWAYS BE PECKING.

• Also add high energy ‘helper foods’ such as oils and sugar or honey to the main food. It is best to add vegetable oil or foods containing oils, nuts, groundnuts (peanuts), or seeds, especially pumpkin or sesame seeds.

If the child’s belly fills up before 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 child needs only this much rice when some vegetable oil is mixed in.

High energy foods added to the main food help to supply extra energy. Also, 2 other kinds of helper foods should be added to the main food:

When possible, add body–building foods (proteins) such as beans, milk, eggs, groundnuts, fish, and meat.

Also try to add protective foods such as orange or yellow fruits and vegetables, and also dark green leafy vegetables. Protective foods supply important vitamins and minerals.

111

EATING RIGHT TO STAY HEALTHY

The ‘main food’ your family eats usually provides most, but not all, of the body’s energy and other nutritional needs. By adding helper foods to the main food you can make low cost nutritious meals. You do not have to eat all the foods listed here to be healthy.

Eat the main foods you are accustomed to, and add whatever ‘helper foods’ are available in your area. Try to include ‘helper foods’ from each group, as often as possible.

REMEMBER: Feeding children enough and feeding them often (3 to 5 times a day) is usually more important than the types of food you feed them.

GO FOODS (energy helpers)

Examples:

• Fats (vegetable oils, butter, ghee, lard)
• Foods rich in fats (coconut, olives, fatty meat)
• Nuts (groundnuts, almonds, walnuts, cashews)
• Oil seeds (pumpkin, melon, sesame, sunflower)

• Sugars (sugar, honey, molasses, sugar cane, jaggery)

• Note: Nuts and oil seeds are also valuable as body-building helpers.

MAIN FOODS

Examples:

• Cereals and grains (wheat, maize, rice, millet, sorghum)
• Starchy roots** (cassava, potatoes, taro)
• Starchy fruits (banana, plantain, breadfruit)

Note: Main foods are cheap sources of energy. The cereals also provide some protein, iron, and vitamins, at low cost.

GROW FOODS

proteins or body-building helpers

Examples:

• Legumes (beans, peas, and lentils)
• Nuts (groundnuts, walnuts, cashews, and almonds)
• Oil seeds (sesame and sunflower)
• Animal products (milk, eggs, cheese, yogurt, fish, chicken, meat, small animals such as mice, and insects)

GLOW FOODS

vitamins and minerals or protective helpers

Examples:

• Vegetables (dark green leafy plants, tomatoes, carrots, pumpkin, sweet potato, and peppers)
• Fruits (mangoes, oranges, papayas)

Note to nutrition workers: This plan for meeting food needs resembles teaching about ‘food groups’, but places more importance on giving enough of the traditional ‘main food’ and above all, giving frequent feedings with plenty of energy-rich helpers. This approach is more adaptable to the resources and limitations of poor families.

112

HOW TO RECOGNIZE MALNUTRITION

Among poor people, malnutrition is often most severe in children, who need lots of nutritious food to grow well and stay healthy. There are different forms of malnutrition:

mild malnutrition

This is the most common form, but it is not always obvious. The child simply does not grow or gain weight as fast as a well- nourished child. Although he may appear rather small and thin, he usually does not look sick. However, because he is poorly nourished, he may lack strength (resistance) to fight infections. So he becomes more seriously ill and takes longer to get well than a well nourished child.

Children with this form of malnutrition suffer more from diarrhea and colds. Their colds usually last longer and are more likely to turn into pneumonia. Measles, tuberculosis, and many other infectious diseases are far more dangerous for these malnourished children. More of them die.

It is important that children like these get special care and enough food before they become seriously ill. This is why regular weighing or measuring around the middle upper arm of young children is so important. It helps us to recognize mild malnutrition early and correct it.

Follow the guidelines for preventing malnutrition.

severe malnutrition

This occurs most often in babies who stopped breastfeeding early or suddenly, and who are not given sufficient high energy foods often enough. Severe malnutrition often starts when a child has diarrhea or another infection. We can usually recognize children who are severely malnourished without taking any measurements. The 2 main examples are:

dry malnutrition, or marasmus

This child does not get enough of any kind of food. He is said to have dry malnutrition or marasmus. In other words, he is starved. His body is small, very thin and wasted. He is little more than skin and bones.

This child needs more food, especially energy foods.

THIS CHILD IS JUST SKIN AND BONES.

This child’s condition is called wet malnutrition because his feet, hands, and face are swollen. This can happen when a child does not eat enough ‘body building’ helper foods, or proteins. More often it happens when he does not get enough energy foods, and his body burns up whatever proteins he eats for energy.

Eating beans, lentils, or other foods that have been stored in a damp place and are a little moldy may also be part of the cause.

This child needs more food more often, a lot of foods rich in energy, and some foods rich in protein (see p. 111).

Also, try to avoid foods that are old, and may be spoiled or moldy.

other forms of malnutrition

First the child becomes swollen. The other signs come later.

THIS CHILD IS SKIN, BONES, AND WATER.

113

wet malnutrition (kwashiorkor)

Other forms of malnutrition may result when certain vitamins and minerals are missing from the foods people eat. Many of these specific types of malnutrition are discussed more fully later in this chapter and in other parts of this book:

• Night blindness in children who do not get enough vitamin A (see p. 226).

• Rickets from lack of vitamin D (see p. 125).

• Various skin problems, sores on the lips and mouth, or bleeding gums from not eating enough fruits, vegetables, and other foods containing certain vitamins (see page 208 and 232).

• Anemia in people who do not get enough iron (see p. 124).

• Goiter from lack of iodine (see p. 130).

For more information about health problems related to nutrition, see Helping Health Workers Learn, Chapter 25, and Disabled Village Children, Chapters 13 and 30.

114

Examples

This mother and child are from a poor family and are both poorly nourished. The father works hard, but he does not earn enough to feed the family well.

The patches on the mother’s arms are a sign of pellagra, a type of malnutrition. She ate mostly maize and not enough nutritious foods such as beans, eggs, fruit, meat, and dark green vegetables.

The mother did not breastfeed her baby. She fed him only maize porridge. Although this filled his belly, it did not provide enough nutrition for him to grow strong.

As a result, this 2 year old child is severely malnourished. He is very small and thin with a swollen belly, his hair is thin, and his physical and mental development will be slower than normal. To prevent this, mothers and their children need to eat better.

115

ways of eating better when you do not have much money or land

There are many reasons for hunger and poor nutrition. One main reason is poverty.

In many parts of the world a few people own most of the wealth and the land.

They may grow crops like coffee or tobacco, which they sell to make money, but which have no food value.

Or the poor may farm small plots of borrowed land, while the owners take a big share of the harvest. The problem of hunger and poor nutrition will never be completely solved until people learn to share with each other fairly.

But there are many things people can do to eat better at low cost, and by eating well gain strength to stand up for their rights. On pages w13 and w14 of “Words to the Village Health Worker” are several suggestions for increasing food production.

These include improved use of land through rotating crops, contour ditches, and irrigation; also ideas for breeding fish, beekeeping, grain storage, and family gardens. If the whole village or a group of families works together on some of these things, a lot can be done to improve nutrition.

When considering the question of food and land, it is important to remember that a given amount of land can feed only a certain number of persons. For this reason, some people argue that ‘the small family lives better’. However, for many poor families, to have many children is an economic necessity.

By the time they are 10 or 12 years old, children of poor families often produce more than they cost. Having a lot of children increases the chance that parents will receive the help and care they need in old age.

In short, lack of social and economic security creates the need for parents to have many children. Therefore, the answer to gaining a balance between people and land does not lie in telling poor people to have small families.

It lies in redistributing the land more fairly, paying fair wages, and taking other steps to overcome poverty. Only then can people afford small families and hope to achieve a lasting balance between people and land. (For a discussion of health, food, and social problems, see Helping Health Workers Learn.)

When money is limited, it is important to use it wisely. This means cooperation and looking ahead. Too often the father of a poor family will spend the little bit of money he has on alcohol and tobacco rather than on buying nutritious food, a hen to lay eggs, or something to improve the family’s health. Men who drink together would do well to get together sometime when they are sober, to discuss these problems and look for a healthy solution.

Also, some parents buy sweets or soft drinks (fizzy drinks) for their children when they could spend the same money buying eggs, milk, nuts or other nutritious foods. This way their children could become more healthy for the same amount of money. Discuss this with the families and look for solutions.

IF YOU HAVE A LITTLE MONEY AND WANT TO HELP YOUR CHILD GROW STRONG:

Do not buy him a soft drink or sweets, buy him 2 eggs or a handful of nuts.

116

Better Foods at Low Cost

Many of the world’s people eat a lot of bulky, starchy foods, without adding enough helper foods to provide the extra energy, body building, and protection they need. This is partly because many helper foods are expensive, especially those that come from animals, like milk and meat.

People can be strong and healthy when most of their proteins and other helper foods come from plants.

Most people cannot afford much food from animals. Animals require more land for the amount of food they provide. A poor family can usually be better nourished if they grow or buy plant foods like beans, peas, lentils, and groundnuts together with a main food such as maize or rice, rather than buy costly animal foods like meat and fish.

However, where family finances and local customs permit, it is wise to eat, when possible, some food that comes from animals. This is because even plants high in protein (body-building helpers) often do not have all of the different proteins the body needs.

Try to eat a variety of plant foods. Different plants supply the body with different proteins, vitamins, and minerals. For example, beans and maize together meet the body’s needs much better than either beans or maize alone. And if other vegetables and fruits are added, this is even better.

117

Here are some suggestions for getting more vitamins, minerals, and proteins at low cost.

1. Breast milk. This is the cheapest, healthiest, and most complete food for a baby. The mother can eat plenty of plant foods and turn them into the perfect baby food, breast milk. Breastfeeding is not only best for the baby, it saves money and prevents diseases!

2. Eggs and chicken. In many places eggs are one of the cheapest and best forms of animal protein. They can be cooked and mixed with foods given to babies who cannot get breast milk. Or they can be given along with breast milk as the baby grows older.

Eggshells that are boiled, finely ground, and mixed with food can provide needed calcium for pregnant women who develop sore, loose teeth or muscle cramps.

Chicken is a good, often fairly cheap form of animal protein, especially if the family raises its own chickens.

1. Liver, heart, kidney, and blood. These are especially high in protein, vitamins, and iron (for anemia) and are often cheaper than other meat. Also fish is often cheaper than other meat, and is just as nutritious.

2. Beans, peas, lentils, and other legumes are a good cheap source of protein. If allowed to sprout before cooking and eating, they are higher in vitamins. Baby food can be made from beans by cooking them well, and then straining them through a sieve, or by peeling off their skins, and mashing them.

Beans, peas, and other legumes are not only a low-cost form of protein. Growing these crops makes the soil richer so that other crops will grow better afterwards. For this reason, crop rotation and mixed crops are a good idea (see p. w13).

1. Dark green leafy vegetables have some iron, a lot of vitamin A, and some protein. The leaves of sweet potatoes, beans and peas, pumpkins and squash, and baobab are especially nutritious. They can be dried, powdered, and mixed with babies’ gruel.

Note: Light green vegetables like cabbage and lettuce have less nutritional value. It is better to grow ones with dark colored leaves.

1. Cassava (manioc) leaves contain 7 times as much protein and more vitamins than the root. If eaten together with the root, they add food value, at no additional cost. The young leaves are best.

2. Lime soaked maize (corn). When soaked in lime (cal) before cooking, as is the custom in much of Latin America, maize is richer in calcium. Soaking in lime also allows more of the vitamins (niacin) and protein to be used by the body.

3. Rice, wheat, and other grains are more nutritious if their outer skins are not removed during milling. Moderately milled rice and whole wheat contain more proteins, vitamins, and minerals than the white, over milled product.

Note: The protein in wheat, rice, maize, and other grains can be better used by the body when they are eaten with beans or lentils.

1. Cook vegetables, rice, and other foods in little water. And do not overcook. This way fewer vitamins and proteins are lost. Be sure to drink the leftover water, or use it for soups or in other foods.

2. Many wild fruits and berries are rich in vitamin C as well as natural sugars. They provide extra vitamins and energy. (Be careful not to eat berries or fruit that are poisonous.)

3. Cooking in iron pots or putting a piece of old iron or horseshoe in the pan when cooking beans and other foods adds iron to food and helps prevent anemia. More iron will be available if you also add tomatoes.

118

For another source of iron, put some iron nails in a little lemon juice for a few hours. Then make lemonade with the juice and drink it.

1. In some countries, low-cost baby food preparations are available, made from different combinations of soybean, cotton seed, skim milk, or dried fish. Some taste better than others, but most are well balanced foods. When mixed with gruel, cooked cereal, or other baby food, they add to its nutrition content at low cost.

WHERE TO GET VITAMINS: pills, injections, syrups, or foods?

Anyone who eats a good mixture of foods, including vegetables and fruits, gets all the vitamins he needs. It is always better to eat well than to buy vitamin pills, injections, syrups, or tonics.

Sometimes nutritious foods are scarce. If a person is already poorly nourished, or has a serious illness like HIV, he should eat as well as he can and perhaps take vitamins besides.

Vitamins taken by mouth work as well as injections, cost less, and are not as dangerous. Do not inject vitamins! It is better to swallow them, preferably in the form of nutritious foods.

If you want vitamins, buy eggs or other nutritious foods instead of pills or injections.

If you buy vitamin preparations, be sure they have all these vitamins and minerals:

♦ Niacin (niacinamide)

♦ Vitamin B1 (thiamine)

♦ Vitamin B2 (riboflavin)

In addition, certain people need extra:

♦ Folic Acid (folicin), for pregnant women

♦ Iron (ferrous sulfate, etc.), especially for pregnant women.

(For people with anemia, multi-vitamin pills do not have enough iron to help much. Iron pills are more helpful.)

♦ Vitamin B6 (pyridoxine), for small children and persons taking medicine for tuberculosis

♦ Calcium, for children and breastfeeding mothers who do not get enough calcium in foods such as milk, cheese, or foods prepared with lime

♦ Vitamin A

♦ Vitamin C (ascorbic acid)

♦ Vitamin D

♦ Iodine (in areas where goiter is common) for small children

119

THINGS TO AVOID IN OUR DIET

A lot of people believe that there are many kinds of foods that will hurt them, or that they should not eat when they are sick. They may think of some kinds of foods as ‘hot’ and others as ‘cold’, and not permit hot foods for ‘hot’ sicknesses or cold foods for ‘cold’ sicknesses.

Or they may believe that many different foods are bad for a mother with a newborn child. Some of these beliefs are reasonable but others do more harm than good. Often the foods people think they should avoid when they are sick are the very foods they need to get well.

A sick person has even greater need for plenty of nutritious food than a healthy person. We should worry less about foods that might harm a sick person and think more about foods that help make him healthy, for example: high energy foods together with fruit, vegetables, legumes, nuts, milk, meat, eggs, and fish.

As a general rule:

The same foods that are good for us when we are healthy are good for us when we are sick.

Also, the things that harm us when we are healthy do us even more harm when we are sick.

Avoid these things:

• alcoholic drinks

• tobacco

• greasy food

• a lot of sugar and sweets

• too much coffee

• Alcohol causes or makes worse diseases of the liver, stomach, heart, and nerves. It also causes social problems.

• Smoking can cause chronic (long-term) coughing or lung cancer and other problems (see p. 149). Smoking is especially bad for people with lung diseases like tuberculosis, asthma, and bronchitis.

• Too much greasy food or coffee can make stomach ulcers and other problems of the digestive tract worse.

• Too much sugar and sweets spoil the appetite and rot the teeth. However, some sugar with other foods may help give needed energy to a sick person or poorly nourished child.

A few diseases require not eating certain other foods. For example, people with high blood pressure, certain heart problems, or swollen feet should use little or no salt. Too much salt is not good for anyone. Stomach ulcers and diabetes also require special diets (see pages 127).

120

THE BEST DIET FOR SMALL CHILDREN

0 > 6 The first 6 months of life

For the first 6 months give the baby breast milk and nothing else. It is better than any baby food or milks you can buy. Breast milk helps protect the baby against diarrhea and many infections. It is best not to give extra water or teas, even in hot weather.

Some mothers stop breastfeeding early because they think that their milk is not good enough for their baby, or that their breasts are not making enough milk. However, a mother’s milk is always very nutritious for her baby, even if the mother herself is thin and weak.

If a woman has HIV, sometimes she can pass HIV to a baby in her breast milk. But if she does not have access to clean water, her baby is more likely to die from diarrhea, dehydration, and malnutrition than AIDS. Now medicines can prevent the spread of HIV to babies through breast milk (see p. 398).

But only you can evaluate the conditions in your home and community and decide what to do.

Nearly all mothers can produce all the breast milk their babies need:

♦ The best way for a mother to keep making enough breast milk is to breastfeed the baby often, eat well, and drink lots of liquids.

♦ Do not give the baby other foods before he is 6 months old, and always breastfeed before giving the other foods.

♦ If a mother’s breasts produce little or no milk, she should continue to eat well, drink lots of liquids and let the baby suck her breasts often.

After each breastfeeding, give the baby, by cup (not bottle), some other type of milk, like boiled cow’s or goat’s milk, canned milk, or powdered milk. (Do not use condensed milk.) Add a little sugar or vegetable oil to any of these milks.

Note: Whatever type of milk is used, some cooled, boiled water should be added.

0 > 6 Two examples of correct formulas

NO.1

• 2 parts boiled, cooled cow’s milk

• 1 part boiled, cooled water

• 1 large spoonful sugar or oil for each large glass

NO.2

• 2 parts canned evaporated milk

• 3 parts boiled, cooled water

• 1 large spoonful sugar or oil for each large glass

If non–fat milk is used, add another spoonful of oil.

♦ If possible, boil the milk and water. It is safer to feed the baby with a cup (or cup and spoon) than to use a baby bottle. Baby bottles and nipples are hard to keep clean and can cause infections and diarrhea (see p. 154). If a bottle is used, boil it and the nipple each time before the baby is fed.

♦ If you cannot buy milk for the child, make a porridge from rice, cornmeal, or other cereal. Always add to this some skinned beans, eggs, meat, chicken, or other protein. Mash these well and give them as a liquid. If possible add sugar and oil.

WARNING: Cornmeal or rice water alone is not enough for a baby. The child will not grow well. He will get sick easily and may die. The baby needs a main food with added helper foods.

121

6 > 12 From 6 months to 1 year of age

1. Keep giving breast milk, if possible until the baby is 2 or 3 years old.

2. When the baby is 6 months old, start giving her other foods in addition to breast milk. Always give the breast first, and then the other foods. It is good to start with a gruel or porridge made from the main food (p. 111) such as maize meal or rice cooked in water or milk. Then start adding a little cooking oil for extra energy. After a few days, start adding other helper foods (see p. 110). But start with just a little of the new food, and add only 1 at time or the baby may have trouble digesting them. These new foods need to be well cooked and mashed. At first they can be mixed with a little breast milk to make them easier for the baby to swallow.

3. Prepare inexpensive, nutritious feedings for the baby by adding helper foods to the main food (see p. 110). Most important is to add foods that give extra energy (such as oil) and, whenever possible, extra iron (such as dark green leafy vegetables).

Remember, a young child’s stomach is small and cannot hold much food at one time. So feed her often, and add high-energy helpers to the main food:

A spoonful of cooking oil added to a child’s food means he has to eat only 3/4 as much of the local main food in order to meet his energy needs. The added oil helps make sure he gets enough energy (calories) by the time his belly is full.

CAUTION: The time when a child is most likely to become malnourished is from 6 months to 2 years old. This is because breast milk by itself does not provide enough energy for a baby after 6 months of age. Other foods are needed, but often the foods given do not contain enough energy either. If the mother also stops breastfeeding, the child is even more likely to become malnourished.

For a child of this age to be healthy we should:

♦ Keep feeding her breast milk as much as before.

♦ Feed her other nutritious foods also, always starting with just a little.

♦ Feed her at least 5 times a day and also give her snacks between meals.

♦ Make sure the food is clean and freshly prepared.

♦ Filter, boil, or purify the water she drinks.

♦ Keep the child and her surroundings clean.

♦ When she gets sick, feed her extra well and more often, and give her plenty of liquids to drink. For mothers infected with HIV: After 6 months, your baby will be bigger and stronger, and will have less danger of dying from diarrhea. If you have been breastfeeding her, now you should switch to other milks and feed the baby other foods. This way the baby will have less risk of getting HIV.

122

12 > One year and older

After a child is 1 year old, he can eat the same foods as adults, but should continue to breastfeed (or drink milk whenever possible).

Every day, try to give the child plenty of the main food that people eat, together with ‘helper’ foods that give added high energy, proteins, vitamins, iron, and minerals (as shown on p. 111) so that he will grow up strong and healthy.

To make sure that the child gets enough to eat, serve him in his own dish, and let him take as long as he needs to eat his meal.

Children and candy: Do not accustom small children to eating a lot of candy and sweets or drinking soft drinks (colas). When they have too many sweets, they no longer want enough of the other foods they need. Also, sweets are bad for their teeth.

However, when food supply is limited or when the main foods have a lot of water or fiber in them, adding a little sugar and vegetable oil to the main food provides extra energy and allows children to make fuller use of the protein in the food they get.

12 > Best diet for small children

THE FIRST SIX MONTHS:

• breast milk

• and nothing else

FORM 6 MONTHS TO 2 YEARS:

• breast milk

• cow, goat

• or other well-cooked, nutritious foods

123

HARMFUL IDEAS ABOUT DIET

1. The diet of mothers after giving birth:

In many areas there is a dangerous popular belief that a woman who has just had a baby should not eat certain foods. This folk diet, which forbids some of the most nutritious foods and may only let the new mother eat things like cornmeal, noodles, or rice soup, makes her weak and anemic. It may even cause her death, by lowering her resistance to hemorrhage (bleeding) and infection.

After giving birth a mother needs to eat the most nutritious foods she can get.

In order to fight infections or bleeding and to produce enough milk for her child, a new mother should eat the main food together with plenty of body building foods like beans, eggs, chicken, and if possible, milk products, meat, and fish. She also needs protective foods like fruits and vegetables, and high energy helpers (oils and fatty foods). None of these foods will harm her; they will protect her and make her stronger.

1. It is not true that oranges, guavas, or other fruits are bad for a person who has a cold, the flu, or cough. In fact, fruits like oranges and tomatoes have a lot of vitamin C, which may help fight colds and other infections.

2. It is not true that certain foods like pork, spices, or guavas cannot be eaten while taking medicine. However, when a person has a disease of the stomach or other parts of the digestive system, eating a lot of fat or greasy foods may make this worse whether or not one is taking medicines.

Here is a healthy mother who ate many kinds of nutritious foods after giving birth

Here lies a mother who was not given nutritious foods after giving birth

124

SPECIAL DIETS FOR SPECIFIC HEALTH PROBLEMS

Anemia

A person with anemia has thin blood. This happens when blood is lost or destroyed faster than the body can replace it. Blood loss from large wounds, bleeding ulcers, or dysentery can cause anemia. So can malaria, which destroys red blood cells. Not eating enough foods rich in iron can cause anemia or make it worse.

Women can become anemic from blood loss during monthly bleeding (menstrual periods) or childbirth if they do not eat the foods their bodies need. Pregnant women are at risk of becoming severely anemic, because they need to make extra blood for their growing babies.

In children anemia can come from not eating foods rich in iron. It can also come from not starting to give some foods in addition to breast milk, after the baby is 6 months old. Common causes of severe anemia in children are hookworm infection (see p. 142), chronic diarrhea, and dysentery.

The signs of anemia are:

• pale or transparent skin

• pale insides of eyelids

• white fingernails

• pale gums

• weakness and fatigue

Treatment and prevention of anemia:

• If the anemia is very severe, face and feet may be swollen, the heartbeat rapid, and the person may have shortness of breath.

• Children and women who like to eat dirt are usually anemic.

♦ Eat foods rich in iron. Meat, fish, and chicken are high in iron. Liver is especially high. Dark green leafy vegetables, beans, peas, and lentils also have some iron. It also helps to cook in iron pots (see p. 117). To help the body absorb more iron, eat raw vegetables and fruit with meals, and avoid drinking coffee and tea with food.

♦ If the anemia is moderate or severe, the person should take iron (ferrous sulfate pills, p. 392). This is especially important for pregnant women who are anemic. For nearly all cases of anemia, ferrous sulfate tablets are much better than liver extract or vitamin B12. As a general rule, iron should be given by mouth, not injected, because iron injections can be dangerous and are no better than pills.

♦ If the anemia is caused by dysentery (diarrhea with blood), hookworm, malaria, or another disease, this should also be treated.

♦ If the anemia is severe or does not get better, seek medical help. This is especially important for a pregnant woman.

Many women are anemic. Anemic women run a greater risk of miscarriage and of dangerous bleeding in childbirth. It is very important that women eat as much of the foods high in iron as possible, especially during pregnancy. Allowing 2 to 3 years between pregnancies lets the woman regain strength and make new blood (see Chapter 20).

125

Rickets

Children whose skin is almost never exposed to the sunlight may become bowlegged and develop other bone deformities (rickets). This problem can be combatted by giving the child fortified milk and vitamin D (found in fish liver oil). However, the easiest and cheapest form of prevention is to be sure direct sunlight reaches the child’s skin for at least 10 minutes a day or for longer periods more often. (Be careful not to let his skin burn.) Never give large doses of vitamin D over long periods, as it can poison the child.

Signs of rickets:

• bony necklace

• curved bones

• big joints bowed legs

SUNLIGHT IS THE BEST PREVENTION AND TREATMENT OF RICKETS.

High Blood Pressure (Hypertension)

High blood pressure can cause many problems, such as heart disease, kidney disease, and stroke. Fat people are especially likely to have high blood pressure.

Signs of dangerously high blood pressure:

• frequent headaches

• pounding of the heart and shortness of breath with mild exercise

• weakness and dizziness

• occasional pain in the left shoulder and chest

All these problems may also be caused by other diseases. Therefore, if a person suspects he has high blood pressure, he should see a health worker and have his blood pressure measured.

A BLOOD PRESSURE CUFF for measuring blood pressure is a bracelet that you slip up an arm.

WARNING: High blood pressure at first causes no signs, and it should be lowered before danger signs develop. People who are overweight or suspect they might have high blood pressure should have their blood pressure checked regularly. For instructions on measuring blood pressure, See page 410 and page 411.

What to do to prevent or care for high blood pressure:

♦ If overweight, lose weight (see next page).

♦ Avoid fatty foods, especially pig fat, and foods with a lot of sugar or starch. Always use vegetable oil instead of pig fat.

♦ Prepare and eat food with little or no salt.

♦ Do not smoke. Do not drink much alcohol.

♦ When the blood pressure is very high, the health worker may give medicines to lower it. Many people can lower their blood pressure by losing weight if they are fat (next page), and by learning to relax.

126

People Who Are Too Heavy

To be very fat is not healthy. Very heavy people are more likely to get high blood pressure, stroke, gallstones, some kinds of diabetes, arthritis in legs and feet, and other problems. Sometimes being too heavy brings on illness, and sometimes illness may cause you to become too heavy.

As our diets change and traditional foods are replaced by processed foods, especially “junk foods” high in calories but low in nutrition, people tend to gain weight in ways that are not healthy.

Losing weight may help with the illnesses mentioned above. Losing weight is also important if you are having difficulty doing your daily activities. You can lose weight by:

♦ eating less greasy, fatty, or oily foods.

♦ eating less sugar or sweet foods.

♦ getting more exercise.

♦ stop eating processed foods and eat fresh fruits and vegetables instead.

Constipation

A person who has hard stools and has not had a bowel movement for 3 or more days is said to be constipated. Constipation is often caused by a poor diet (especially not eating enough fruits, green vegetables, or foods with natural fiber like whole grain bread) or by lack of exercise.

Drinking more water and eating more fruits, vegetables, and foods with natural fiber like whole grain bread, cassava, wheat bran, rye, carrots, turnips, raisins, nuts, pumpkin or sunflower seeds, is better than using laxatives.

It also helps to add a little vegetable oil to food each day. Older people especially may need to walk or exercise more in order to have regular bowel movements.

A person who has not had a bowel movement for 4 or more days, if he does not have a sharp pain in his stomach, can take a mild salt laxative like milk of magnesia. But do not take laxatives often.

Do not give laxatives to babies or young children. If a baby is severely constipated, gently put a little cooking oil in her rectum. Or, if necessary, gently break up and remove the hard stool (feces) with a greased finger.

Never use strong laxatives or purgatives, especially if there is stomach pain.

127

Diabetes

Persons with diabetes have too much sugar in their blood. This problem can start when a person is young (Type 1 diabetes) or older (Type 2 diabetes). Type 1 diabetes is usually more serious, and young people need a medicine called insulin to control it. But most people with diabetes have Type 2, starting after age 40.

Early signs of diabetes:

• always thirsty

• urinates (pees) often and a lot • always tired

• always hungry

• weight loss

Later, more serious signs:

• itchy skin

• periods of blurry eyesight

• some loss of feeling in hands or feet

• frequent vaginal infections

• sores on the feet that do not heal

• loss of consciousness (in extreme cases)

All these signs may be caused by other person diseases. In order to find out whether a has diabetes, test her urine to see if there is sugar in it. One way to test the urine is to taste it. If it tastes sweet to you, have 2 other persons taste it. Have them also taste the urine of 3 other people. If everyone agrees that the same person’s urine is sweeter, she is probably diabetic.

Another way of testing urine is to use special paper strips (for example, Uristix). If these change color when dipped in the urine, it has sugar in it.

If the person is a child or young adult, he should be seen by an experienced health worker or doctor.

When a person gets diabetes after he is 40 years old, it can often be best controlled without medicines, by eating correctly and getting plenty of exercise. The diabetic person’s diet is very important and must be followed carefully for life.

The diabetic diet: Fat people with diabetes should lose weight until their weight is normal. Diabetics must not eat any sugar or sweets, or foods that taste sweet. It is important for them to eat lots of fresh vegetables and high fiber foods, such as whole grain breads. But diabetics should also eat some other starchy foods, like beans, rice, and potatoes, and also foods high in protein.

Diabetes in adults can sometimes be helped by drinking the sap of the prickly pear cactus (nopal, Opuntia). To prepare, cut the cactus into small pieces and crush them to squeeze out the liquid. Drink 1 1⁄2 cups of the liquid 3 times each day before meals.

To prevent infection and injury to the skin, clean the teeth after eating, keep the skin clean, and always wear shoes to prevent foot injuries. For poor circulation in the feet (dark color, numbness), rest often with the feet up. Follow the same recommendations as for varicose veins (p. 175).

128

Acid Indigestion, Heartburn, and Stomach Ulcers

Acid indigestion and ‘heartburn’ often come from eating too much heavy or greasy food or from drinking too much alcohol or coffee. These make the stomach produce extra acid, which causes discomfort or a ‘burning’ feeling in the stomach or mid chest.

Some people mistake the chest pain, called ‘heartburn’, for a heart problem rather than indigestion. If the pain gets worse when lying down, it is probably heartburn.

Frequent or lasting acid indigestion is a warning sign of an ulcer. An ulcer is a chronic sore in the digestive system, usually caused by bacteria.

Too much acid in the stomach prevents it from healing. It may cause a chronic, dull (sometimes sharp) pain in the pit of the stomach. As with acid indigestion, often the pain lessens when the person eats food or drinks a lot of water.

The pain usually gets worse an hour or more after eating, if the person misses a meal, or after he drinks alcohol or eats fatty or spicy foods. Pain is often worse at night. Without a special examination (endoscopy) it is often hard to know whether a person with frequent stomach pain has an ulcer or not.

If the ulcer is severe, it can cause vomiting, sometimes with fresh blood, or with digested blood that looks like coffee grounds. Stools with blood from an ulcer are usually black, like tar.

WARNING: Some ulcers are painless or ‘silent’, and the first sign is blood in vomit, or black, sticky stools. This is a medical emergency. The person can quickly bleed to death. GET MEDICAL HELP FAST.

129

Prevention and Treatment:

Whether stomach or chest pain is caused by heartburn, acid indigestion, or an ulcer, a few basic recommendations will probably help calm the pain and prevent it from coming back.

♦ Do not eat too much. Eat small meals and eat frequent snacks between meals.

♦ Notice what foods or drinks make the pain worse and avoid them. These usually include alcoholic drinks, coffee, spices, pepper, carbonated drinks (soda, pop, colas), and fatty or greasy foods.

♦ If the heartburn is worse at night when lying flat, try sleeping with the upper body somewhat raised.

♦ Drink a lot of water. Try to drink 2 big glasses of water both before and after each meal. Also drink a lot of water frequently between meals. If the pain comes often, keep drinking water like this, even in those times when you have no pain.

♦ Avoid tobacco. Smoking or chewing tobacco increases stomach acid and makes the problem worse.

♦ Take antacids. The best, safest antacids contain magnesium and aluminum hydroxide. (See page 380for information, dose, and warnings about different antacids.)

♦ If the above treatments do not work, you may have an ulcer. Use 2 medicines to treat the bacteria that causes the ulcer: either amoxicillin (p. 352) or tetracycline (p. 355); and metronidazole (p. 368). Also take omeprazole (Prilosec, p. 381) or ranitidine (Zantac, see p. 381) to reduce the production of acid in the stomach. These medicines help to calm the pain and heal the sore.

♦ Aloe vera is a plant found in many countries that heal ulcers. Chop the spongy leaves into small pieces, soak them in water overnight, and then drink one glass of the slimy, bitter water every 2 hours.

An ulcer is an open sore in the stomach or gut.

CAUTION:

1. Some antacids, such as sodium bicarbonate (baking soda) and Alka-Seltzer may quickly calm acid indigestion, but soon cause more acid. They should be used only for occasional indigestion, never for ulcers. This is also true for antacids with calcium.

2. Some medicines, such as aspirin and ibuprofen, make ulcers worse. Persons with signs of heartburn or acid indigestion should avoid them, use acetaminophen instead of aspirin. Cortico-steroids also make ulcers worse (see p. 51).

It is important to treat an ulcer early. Otherwise it may lead to dangerous bleeding or peritonitis.

Ulcers sometimes get better if the person is careful with what he eats and drinks.

Anger, tension, and nervousness increase acid in the stomach. Learning to relax and keep calm will help. Treatment with antibiotics is necessary to prevent the ulcer from returning.

Avoid having minor stomach problems get worse by not eating too much, by not drinking much alcohol or coffee, and by not smoking or using tobacco.

130

Goiter (a Swelling or Lump on the Throat)

A goiter is a swelling or big lump on the throat that results from abnormal growth of a gland called the thyroid.

Most goiters are caused by a lack of iodine in the diet. Also, a lack of iodine in a pregnant woman’s diet sometimes causes babies to die or to be born mentally slow and/or deaf (hypothyroidism, p. 318). This can happen even though the mother does not have a goiter.

Goiter and hypothyroidism are most common in mountain areas where there is little natural iodine in the soil, water, or food. In these areas, eating a lot of certain foods like cassava makes it more likely for a person to get a goiter.

How to prevent or cure a goiter and prevent hypothyroidism: Everyone living in areas where people get goiters should use iodized salt. Use of iodized salt prevents the common kind of goiter and will help many goiters go away. (Old, hard goiters can only be removed by surgery, but this is usually not necessary.)

If it is not possible to get iodized salt, it may be possible to get iodine oil to take by mouth or injection. Or, mix 1 drop of povidone iodine in 1 liter of water and drink a glass of the mixture every week.

Most home cures for goiter do not do any good. However, eating crab and other seafood can do some good because they contain iodine. Mixing a little seaweed with food also adds iodine. But the easiest way is to use iodized salt.

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, if you live in an area where goiters are common, or you are beginning to develop a goiter, try to avoid eating much cassava or cabbage.

Note: If a person with a goiter trembles a lot, is very nervous, and has eyes that bulge out, this may be a different kind of goiter (toxic goiter). Seek medical advice.

• CLEANLINESS, and problems that come from lack of cleanliness
  • BASIC GUIDELINES OF CLEANLINESS
    • Personal Cleanliness (Hygiene)
    • Cleanliness in the Home
    • Cleanliness in Eating and Drinking
  • How to Protect Your Children’s Health
  • Public Cleanliness (Sanitation)
  • BETTER LATRINES
    • Closed latrine
    • Fly-trapping VIP latrine
• WORMS AND OTHER INTESTINAL PARASITES
  • Roundworm (Ascaris)
  • Pinworm, Threadworm, Seatworm (Enterobious)
  • Whipworm (Trichuris, Trichocephalus)
  • Tapeworm
• Trichinosis
• Amebas
• Giardia
• BLOOD FLUKES (SCHISTOSOMIASIS, BILHARZIA)
• VACCINATIONS (IMMUNIZATIONS)SIMPLE, SURE PROTECTION
• OTHER WAYS TO PREVENT SICKNESS AND INJURY
  • Habits that Affect Health
    • DRINKING
    • SMOKING
    • CARBONATED DRINKS (soft drinks, sodas, Coke)

An ounce of prevention is worth a pound of cure! If we all took more care to eat well, to keep ourselves, our homes, and our villages clean, and to be sure that our children are vaccinated, we could stop most sicknesses before they start. In Chapter 11 we discussed eating well. In this chapter we talk about cleanliness and vaccination

CLEANLINESS, and problems that come from lack of cleanliness

Cleanliness is of great importance in the prevention of many kinds of infections, infections of the gut, the skin, the eyes, the lungs, and the whole body. Personal cleanliness (or hygiene) and public cleanliness (or sanitation) are both important.

Many common infections of the gut are spread from one person to another because of poor hygiene and poor sanitation. Germs and worms (or their eggs) are passed by the thousands in the stools or feces (shit) of infected persons. These are carried from the feces of one person to the mouth of another by dirty fingers or contaminated food or water. Diseases that are spread or transmitted from feces-to- mouth in this way, include:

• diarrhea and dysentery (caused by amebas and bacteria)
• intestinal worms (several types)
• hepatitis, typhoid fever, and cholera
• certain other diseases, like polio, are sometimes spread this same way

The way these infections are transmitted can be very direct.

For example: A child who has worms and who forgot to wash his hands after his last bowel movement, offers his friend a cracker. His fingers, still dirty with his own stool, are covered with hundreds of tiny worm eggs (so small they cannot be seen). Some of these worm eggs stick to the cracker. When his friend eats the cracker, he swallows the worm eggs, too.

Soon the friend will also have worms. His mother may say this is because he ate sweets. But no, it is because he ate shit!

131

Many times pigs, dogs, chickens, and other animals spread intestinal disease and worm eggs. For example:

• A man with diarrhea or worms has a bowel movement behind his house

• A pig eats his stool, dirtying its nose and feet.

• Then the pig goes into the house.

• In the house a child is playing on the floor. In this way, a bit of the man’s stool gets on the child, too.

• Later the child starts to cry, and the mother takes him in her arms.

• Then the mother prepares food, forgetting to wash her hands after handling the child.

• The family eats the food.

• And soon, the whole family has diarrhea or worms.

132

Many kinds of infections, as well as worm eggs, are passed from one person to another in the way just shown.

If the family had taken any of the following precautions, the spread of the sickness could have been prevented:

• if the man had used a latrine or out-house,

• if the family had not let the pigs come into the house,

• if they had not let the child play where the pig had been,

• if the mother had washed her hands after touching the child and before preparing food.

If there are many cases of diarrhea, worms, and other intestinal parasites in your village, people are not being careful enough about cleanliness.

If many children die from diarrhea, it is likely that poor nutrition is also part of the problem. To prevent death from diarrhea, both cleanliness and good nutrition are important (see page 154 and Chapter 11).

133

BASIC GUIDELINES OF CLEANLINESS

Personal Cleanliness (Hygiene)

1. Always wash your hands with soap when you get up in the morning, after having a bowel movement, and before cooking or eating.

2. Bathe often every day when the weather is hot. Bathe after working hard or sweating. Frequent bathing helps prevent skin infections, dandruff, pimples, itching, and rashes. Sick persons, including babies, should be bathed daily.

3. In areas where hookworm is common, do not go barefoot or allow children to do so. Hookworm infection causes severe anemia. These worms enter the body through the soles of the feet (see page 142).

4. Brush your teeth every day and after each time you eat sweets. If you do not have a toothbrush and toothpaste, rub your teeth with salt and baking soda (see page 230). For more information about the care of teeth, see Chapter 17.

134

Cleanliness in the Home

1. Do not let pigs or other animals come into the house or places where children play.

2. Do not let dogs lick children or climb up on beds. Dogs, too, can spread disease.

3. If children or animals have a bowel movement near the house, clean it up at once. Teach children to use a latrine or at least to go farther from the house.

4. Hang or spread sheets and blankets in the sun often. If there are bedbugs, pour boiling water on the cots and wash the sheets and blankets all on the same day (see page 200).

5. De-louse the whole family often (see page 200). Lice and fleas carry many diseases. Dogs and other animals that carry fleas should not come into the house.

6. Do not spit on the floor. Spit can spread disease. When you cough or sneeze, cover your mouth with your hand or a cloth or handkerchief.

7. Clean house often. Sweep and wash the floors, walls, and beneath furniture. Fill in cracks and holes in the floor or walls where roaches, bedbugs, and scorpions can hide.

135

Cleanliness in Eating and Drinking

1. Ideally, all water that does not come from a pure water system should be boiled, filtered, or purified before drinking.

This is especially important for small children, people with HIV, and times when there is a lot of diarrhea or cases of typhoid, hepatitis, or cholera. However, to prevent disease, having enough water is more important than having pure water.

Also, asking poor families to use a lot of time or money for fire wood to boil drinking water may do more harm than good, especially if it means less food for the children or more destruction of forests. For more information on clean water, see A Community Guide to Environmental Health, Chapter 5.

A good, low-cost way to purify water is to put it in a clean, clear bottle or a clear plastic bag and leave it in direct sunlight for at least 6 hours. If it is cloudy, leave the water exposed to sun for at least 2 days. This method will kill most germs in the water.

1. Do not let flies and other insects land or crawl on food. These insects carry germs and spread disease. Do not leave food scraps or dirty dishes lying around, as these attract flies and breed germs. Protect food by keeping it covered or in boxes or cabinets with wire screens.

2. Before eating fruit that has fallen to the ground, wash it well. Do not let children pick up and eat food that has been dropped, wash it first.

3. Only eat meat and fish that is well cooked. Be careful that roasted meat, especially pork and fish, do not have raw parts inside. Raw pork carries dangerous diseases.

4. Chickens carry germs that can cause diarrhea. Wash your hands after preparing chicken before you touch other foods.

5. Do not eat food that is old or smells bad. It may be poisonous. Do not eat canned food if the can is swollen or squirts when opened. Be especially careful with canned fish. Also, be careful with chicken that has passed several hours since it was cooked. Before eating left-over cooked foods, heat them again, very hot. If possible, give only foods that have been freshly prepared, especially to children, elderly people, and very sick people.

6. People with tuberculosis, flu, colds, or other diseases that spread easily should eat separately from others. Plates and utensils used by sick people should be cleaned very well before being used by others.

136

How to Protect Your Children’s Health

1. A sick child like this one should sleep apart from children who are well. Sick children or children with sores, itchy skin, or lice should always sleep separately from those who are well. Children with infectious diseases like whooping cough, measles, or the common cold should sleep in separate rooms, if possible, and should not be allowed near babies or small children.

2. Protect children from tuberculosis. People with long-term coughing or other signs of tuberculosis should cover their mouths whenever they cough. They should never sleep in the same room with children. They should see a health worker and be treated as soon as possible. Children living with a person who has tuberculosis should be vaccinated against TB (B.C.G. Vaccine).

3. Bathe children, change their clothes, and cut their fingernails often. Germs and worm eggs often hide beneath long fingernails.

4. Treat children who have infectious diseases as soon as possible, so that the diseases are not spread to others.

5. Follow all the guidelines of cleanliness mentioned in this chapter. Teach children to follow these guidelines and explain why they are important. Encourage children to help with projects that make the home or village a healthier place to live.

6. Be sure children get enough good food. Good nutrition helps protect the body against many infections. A well-nourished child will usually resist or fight off infections that can kill a poorly nourished child (read Chapter 11).

137

Public Cleanliness (Sanitation)

1. Keep wells and public water holes clean. Do not let animals go near where people get drinking water. If necessary, put a fence around the place to keep animals out.

Do not defecate (shit) or throw garbage near the water hole. Take special care to keep rivers and streams clean upstream from any place where drinking water is taken.

1. Burn all garbage that can be burned. Garbage that cannot be burned should be buried in a special pit or place far away from houses and the places where people get drinking water.

2. Build latrines (out-houses, toilets) so pigs and other animals cannot reach the human waste. A deep hole with a little house over it works well. The deeper the hole, the less problem there is with flies and smell.

Here is a drawing of a simple out-house that is easy to build.

It helps to throw a little lime, dirt, or ashes in the hole after each use to reduce the smell and keep flies away.

Out-houses should be built at least 20 meters from homes or the source of water. If you do not have an out-house, go far away from where people bathe or get drinking water. Teach your children to do the same.

Ideas for better latrines are found on the next pages. Also latrines can be built to produce good fertilizer for gardens. See A Community Guide to Environmental Health, Chapter 7.

138

BETTER LATRINES

The latrine or out-house shown on the previous page is very simple and costs almost nothing to make. But it is open at the top and lets in flies.

Closed latrines are better because the flies stay out and the smell stays in. A closed latrine has a platform or slab with a hole in it and a lid over the hole. The slab can be made of wood or cement. Cement is better because the slab fits more tightly and will not rot.

One way to make a cement slab:

1. Dig a shallow pit, about 1 meter square and 7 cm. deep. Be sure the bottom of the pit is level and smooth.

2. Make or cut a wire mesh or grid 1 meter square. The wires can be 1⁄4 to 1⁄2 cm. thick and about 10 cm. apart. Cut a hole about 25 cm. across in the middle of the grid.

3. Put the grid in the pit. Bend the ends of the wires, or put a small stone at each corner, so that the grid stands about 3 cm. off the ground.

4. Put an old bucket in the hole in the grid.

5. Mix cement with sand, gravel, and water and pour it until it is about 5 cm. thick. (With each shovel of cement mix 2 shovels of sand and 3 shovels of gravel.)

6. Remove the bucket when the cement is beginning to get hard (about 3 hours). Then cover the cement with damp cloths, sand, hay, or a sheet of plastic and keep it wet. Remove the slab after 3 days.

If you prefer to sit when you use the latrine, make a cement seat like this: Make a mold, or you can use 2 buckets of different sizes, one inside the other.

139

Closed latrine

To make the closed latrine, the slab should be placed over a round hole in the ground. Dig the hole a little less than 1 meter across and between 1 and 2 meters deep. To be safe, the latrine should be at least 20 meters from all houses, wells, springs, rivers or streams. If it is anywhere near where people go for water, be sure to put the latrine downstream.

• more than 20 m.

• Keep your latrine clean.

• Wash the slab often.

• Be sure the hole in the slab has a cover and that the cover is kept in place.

• A simple cover can be made of wood.

Fly-trapping VIP latrine

• y screen

• vent pipe

• Keep door closed.

• 3 m.

To make the Ventilated Improved Pit (VIP) latrine, make a larger slab (2 meters square) with 2 holes in it. Over one hole put a ventilation pipe, covered with fly screen (wire screen lasts longer). Over the other hole build an out house, which must be kept dark inside. Leave this hole uncovered.

This latrine helps get rid of odors and flies: smells escape through the pipe, and flies get trapped there and die!

140

WORMS AND OTHER INTESTINAL PARASITES

There are many types of worms and other tiny animals (parasites) that live in people’s intestines and cause diseases. Those which are larger are sometimes seen in the stools (feces, shit):

1. ROUNDWORM (Ascaris)

2. PINWORM (threadworm)

3. WHIPWORM (Trichuris)

4. HOOKWORM

5. TAPEWORM

The only worms commonly seen in the stools are roundworms, pinworms, and tapeworms. Hookworms and whipworms may be present in the gut in large numbers without ever being seen in the stools.

Note on worm medicines:

Many ‘worm medicines’ contain piperazine. These work only for roundworms and pinworms and should not be given to babies and small children. Mebendazole (Vermox) is safer and attacks many more kinds of worms.

Albendazole and pyrantel also work for many kinds of worms, but they may be expensive. Thiabendazole attacks many kinds of worms, but causes dangerous side effects and should usually not be used.

See pages 373 to 375 for more information on all these medicines.

Roundworm (Ascaris)

20 to 30 cm. long. Color: pink or white

How they are spread:

Feces-to-mouth. Through lack of cleanliness, the roundworm eggs pass from one person’s stools to another person’s mouth.

Effect on health:

Once the eggs are swallowed, young worms hatch and enter the bloodstream;

this may cause general itching. The young worms then travel to the lungs, sometimes causing a dry cough or at worst, pneumonia with coughing of blood. The young worms are coughed up, swallowed, and reach the intestines, where they grow to full size.

Many roundworms in the intestines may cause discomfort, indigestion, and weakness. Children with many roundworms often have very large, swollen bellies.

Rarely, roundworms may cause asthma, or a dangerous obstruction or blockage in the gut (see page 94). Especially when the child has a fever, the worms sometimes come out in the stools or crawl out through the mouth or nose. Occasionally they crawl into the airway and cause gagging.

Prevention

Use latrines, wash hands before eating or handling food, protect food from flies, and follow the guidelines of cleanliness described in the first part of this chapter.

Treatment:

Mebendazole will usually get rid of roundworms. For dosage see page 373. Piperazine also works (see page 374). Some home remedies work fairly well. For a home remedy using papaya See page 13.

WARNING: Do not use thiabendazole for roundworms. It often makes the worms move up to the nose or mouth and can cause gagging.

141

Pinworm, Threadworm, Seatworm (Enterobious)

1 cm. long. Color: white. Very thin and threadlike.

How they are transmitted:

These worms lay thousands of eggs just outside the anus (ass hole). This causes itching, especially at night. When a child scratches, the eggs stick under his nails, and are carried to food and other objects. In this way they reach his own mouth or the mouths of others, causing new infections of pinworms.

Effect on health:

These worms are not dangerous. Itching may disturb the child’s sleep.

Treatment and Prevention:

♦ A child who has pinworms should wear tight diapers or pants while sleeping to keep him from scratching his anus.

♦ Wash the child’s hands and buttocks (anal area) when he wakes up and after he has a bowel movement. Always wash his hands before he eats.

♦ Cut his fingernails very short.

♦ Change his clothes and bathe him often wash the buttocks and nails especially well.

♦ Put Vaseline in and around his anus at bedtime to help stop itching.

♦ Give mebendazole worm medicine. For dosage, see page 373. Piperazine also works. When one child is treated for these worms, it is wise to treat the whole family at the same time. For a home remedy using garlic, see page 12.

♦ Cleanliness is the best prevention for threadworms. Even if medicine gets rid of the worms, they will be picked up again if care is not taken with personal hygiene. Pinworms only live for about 6 weeks. By carefully following the guidelines of cleanliness, most of the worms will be gone within a few weeks, even without medicine.

142

Whipworm (Trichuris, Trichocephalus)

3 to 5 cm. long. Color: pink or gray.

This worm, like the roundworm, is passed from the feces of one person to the mouth of another person. Usually this worm does little harm, but it may cause diarrhea. In children it occasionally causes part of the intestines to come out of the anus (prolapse of the rectum).

Prevention:

The same as for roundworm.

Treatment:

If the worms cause a problem, give mebendazole. For dosage, see page 374. For prolapse of the rectum, turn the child upside down and pour cool water on the intestine. This should make it pull back in.

Hookworm

1 cm. long. Color: red.

Hookworms cannot usually be seen in the feces.

A stool analysis is needed to prove that they are there.

How hookworms are spread:

1. The baby hookworms enter a person’s bare feet. This can cause red marks on the feet and itching.

2. In a few days they reach the lungs through the blood stream. They may cause a dry cough (rarely with blood).

3. The person coughs up the young worms and swallows them.

4. A few days later the person may have diarrhea or a stomach-ache.

5. The hookworms attach themselves to the walls of the gut. Many worms can cause weakness and severe anemia.

6. The hookworm eggs leave the body in the person’s stools. The eggs hatch on moist soil.

Hookworm infection can be one of the most damaging diseases of childhood. Any child who is anemic, very pale, or eats dirt may have hookworms. If possible, his stools should be analyzed.

Treatment:

Use mebendazole, albendazole, or pyrantel. For dosage and precautions, See page 373 to page 375. Treat anemia by eating foods rich in iron and if necessary by taking iron pills (page 124).

Prevent hookworm: Build and use latrines. Do not let children go barefoot.

143

Tapeworm

In the intestines tapeworms grow several meters long. But the small, flat, white pieces (segments) found in the feces are usually about 1 cm. long. Occasionally a segment may crawl out by itself and be found in the underclothing.

People get tapeworms from eating pork (pig meat), beef (cow meat) or other meat or fish that is not well cooked.

Prevention:

Be careful that all meat is well cooked, especially pork. Make sure no parts in the center of roasted meat or cooked fish are still raw.

When a person eats poorly cooked meat, the cysts become tapeworms in his intestines.

The cysts may cause headaches, seizures, or death.

Adult tape worm in man belly segments in man feces

Eggs that enter the person’s mouth from his feces, through lack of cleanliness, can form cysts in his brain.

The pig eats the eggs in the man’s stools.

The worm eggs, the pig has eaten, form cysts in the meat.

Effect on health: Tapeworms in the intestines sometimes cause mild stomach aches, but few other problems.

The greatest danger exists when the cysts (small sacs containing baby worms) get into a person’s brain. This happens when the eggs pass from his stools to his mouth. For this reason, anyone with tapeworms must follow the guidelines of cleanliness carefullyand get treatment as soon as possible.

Treatment:

Take niclosamide (Yomesan, page 375), or praziquantel (page 375). Follow instructions carefully.

144

Trichinosis

These worms are never seen in the stools. They burrow through the person’s intestines and get into her muscles. People get these worms, like tapeworms, from eating infected pork or other meat that is not well cooked.

Effect on health: Depending on the amount of infected meat eaten, the person may feel no effects, or she may become very sick or die. From a few hours to 5 days after eating the infected pork, the person may develop diarrhea and feel sick to her stomach.

In serious cases the person may have:

• fever with chills

• muscle pain

• swelling around the eyes and sometimes swelling of the feet Severe cases may last 3 or 4 weeks.

• small bruises (black or blue spots) on the skin

• bleeding in the whites of the eyes

Treatment: Seek medical help at once. Albendazole or mebendazole may help. For dosages, See page 373 and page 374. (Cortico-steroids may help, but should be given by a health worker or doctor.)

Important: If several people who ate meat from the same pig get sick afterward, suspect trichinosis. This can be dangerous; seek medical attention.

Prevention of trichinosis:

♦ Only eat pork and other meat that has been well cooked.

♦ Do not feed scraps of meat or leftovers from butchering to pigs unless the meat has first been cooked.

Amebas

These are not worms, but tiny animals or parasites that can be seen only with a microscope (an instrument that makes things look much bigger).

How they are transmitted:

The stools of infected people contain millions of these tiny parasites. Because of poor sanitation, they get into the source of drinking water or into food, and other people become infected.

Signs of infection with amebas:

Many healthy people have amebas without becoming sick. However, amebas are a common cause of severe diarrhea or dysentery (diarrhea with blood) especially in persons already weakened by other sickness or poor nutrition. Less commonly, amebas cause painful, dangerous abscesses in the liver.

145

Typical amebic dysentery consists of:

• diarrhea that comes and goes sometimes alternating with constipation

• cramps in the belly and a need to have frequent bowel movements, even when little or nothing or just mucus comes out

• many loose (but usually not watery) stools with lots of mucus, sometimes stained with blood

• in severe cases, much blood; the person may be very weak and ill

• if there is fever, it means there may also be a bacterial infection

Diarrhea with blood may be caused by either amebas or bacteria. However, bacterial dysentery (Shigella) begins more suddenly, the stools are more watery, and there is almost always fever (page 158). As a general rule:

Diarrhea + blood + fever = bacterial infection (Shigella)

Diarrhea + blood + no fever = amebas

Occasionally bloody diarrhea has other causes. To be sure of the cause, a stool analysis may be necessary.

Sometimes amebas get into the liver and form an abscess or pocket of pus. This causes tenderness or pain in the right upper belly.

Pain may extend into the right chest and is worse when the person walks. (Compare this with gallbladder pain, page 329; hepatitis, page 172; and cirrhosis, page 328.)

If the person with these signs begins to cough up a brown liquid, an amebic abscess is draining into his lung.

Treatment:

♦ If possible get medical help and a stool analysis.

♦ Amebic dysentery can be treated with metronidazole, if possible followed by diloxanide furoate. For dosage, length of treatment, and precautions, see page 368.

♦ For amebic abscess, treat as for amebic dysentery. Be sure to take both metronidazole and diloxanide furoate (page 368).

Prevention:

Make and use latrines, protect the source of drinking water, and follow the guidelines of cleanliness. Eating well and avoiding fatigue and drunkenness are also important in preventing amebic dysentery.

Giardia

The giardia, like the ameba, is a microscopic parasite that lives in the gut and is a common cause of diarrhea, especially in children. The diarrhea may be chronic or intermittent (may come and go).

A person who has yellow, bad-smelling diarrhea that is frothy (full of bubbles) but without blood or mucus, probably has giardia.

The belly is swollen with gas and uncomfortable, there are mild intestinal cramps, and the person farts and burps a lot. The burps have a bad taste, like sulfur. There is usually no fever.

Giardia infections sometimes clear up by themselves. Good nutrition helps. Severe cases are best treated with metronidazole (see page 368). Quinacrine (Atabrine, page 369) is cheaper and often works well, but causes worse side effects.

146

BLOOD FLUKES (SCHISTOSOMIASIS, BILHARZIA)

This infection is caused by a kind of worm that gets into the bloodstream. Different types of blood flukes are found in different parts of the world.

One kind, common in Africa and the Middle East, causes blood in the urine. Other types, which cause bloody diarrhea, occur in Africa, South America, and Asia.

In areas where these diseases are known to occur, any person who has blood in his urine or stools should have a sample of it tested for fluke eggs.

Signs:

• The most common sign is blood in the urine (especially when passing the last drops)or, for other kinds of flukes, bloody diarrhea.

• Pain may occur in the lower belly and between the legs; it is usually worst at the end of urinating. Low fever, weakness, and itching may occur. In women, there may be sores that look like a sexually transmitted infection.

• After months or years, the kidneys, liver or spleen may be damaged or enlarged, which can cause pain and eventually even death.

• Sometimes there are no early signs. In areas where schistosomiasis is very common, persons with only mild signs or belly pain should be tested.

Treatment:

See a health worker. Praziquantel works for all types of blood flukes. Oxamniquine works for some kinds of blood flukes (see page 376).

Prevention:

Blood flukes are not spread directly from person to person. Part of their life they must live inside a certain kind of small water snail.

Blood flukes spread like this:

1. Infected person urinates or defecates in water.

2. Urine or feces has worm eggs in it.

3. Worm eggs hatch and go into snails.

4. Young worms leave snail and go into another person.

5. In this way, someone who washes or swims in water where an infected person has urinated or defecated also becomes infected.

To prevent schistosomiasis, cooperate with programs to kill snails and treat infected persons. But most important: Everyone should learn to use latrines and NEVER URINATE OR DEFECATE IN OR NEAR WATER.

For information on guinea worm, which is also spread in water, see page 406 and page 407.

147

VACCINATIONS (IMMUNIZATIONS)SIMPLE, SURE PROTECTION

Vaccines protect against many dangerous diseases. Each country has a schedule of vaccinations, usually given for free. It is better to take your children to the nearest health center to be vaccinated while they are healthy than to take them for treatment when they are sick or dying. The most important vaccines are:

1. DPT, for diphtheria, whooping cough (pertussis), and tetanus. A child needs 4 or 5 injections usually given at 2 months, 4 months, 6 months, and 18 months old. Sometimes one more injection is given between 4 and 6 years old.

2. POLIO (infantile paralysis). The child needs drops in the mouth or an injection 4 or 5 times. In some countries the first vaccination is given at birth and the other 3 doses are given at the same time as the DPT injections. In other countries, the first 3 doses are given at the same time as the DPT injections, the fourth dose is given between 12 and 18 months of age, and a fifth dose is given when the child is 4 years old. In a family where someone has HIV, do not use drops, use injections only.

3. BCG, for tuberculosis. A single injection is given under the skin of the left arm. Children can be vaccinated at birth or anytime afterwards. If any member of the household has tuberculosis, it is important to vaccinate babies in the first few weeks or months after birth. The vaccine makes a sore and leaves a scar.

4. MEASLES. A child needs 1 injection given no younger than 9 months of age, and often a second injection at 15 months or older. In many countries a ‘3 in 1’ vaccine called MMR is given for measles, mumps, and rubella (German measles). One injection is given between 12 and 15 months old, and a second is given between 4 and 6 years of age. Do not give measles vaccinations to a child with HIV.

5. HepB (Hepatitis B). This vaccine is given in a series of 3 injections, at the same time as DPT injections. In some countries the first HepB is given at birth, the second at 2 months old, and the third at 6 months old. Make sure there are at least 4 weeks between the first and second injection, and 8 weeks between the second and third.

6. Hib (for Haemophilus influenza type b, which is a germ that causes meningitis and pneumonia in young children). Generally this vaccine is given in a series of 3 injections together with the first 3 DPT injections.

7. Td or TT (Tetanus toxoid), for tetanus (lockjaw) for adults and children over 12 years old. Throughout the world, tetanus vaccination is recommended with 1 injection every 10 years. In some countries a Td injection is given between 9 and 11 years of age (5 years after the last DPT vaccination), and then every 10 years. Pregnant women should be vaccinated during each pregnancy so that their babies will be protected against tetanus of the newborn (see page 182 and page 250).

8. Rotavirus. Give the oral vaccine 2 or 3 times (depending on the manufacturer) at 2 months, 4 months, and (if needed) 6 months old. It prevents this diarrhea disease, a leading cause of death for young children.

Vaccines for measles, polio, and tuberculosis must be kept frozen or very cold (under 8° C). The vaccines for Hepatitis B, tetanus, and the DPT must be kept very cold (under 8° C) but never frozen.

Vaccine that has been prepared but not used should be thrown away. DPT is still good and useable if it remains cloudy 1 hour after preparing it.

If it becomes clear or has white flecks in it, it is spoiled and will not work. For ways to keep vaccines cold, see Helping Health Workers Learn, Chapter 16.

Vaccinate your children on time. Be sure they get the complete series of each vaccine they need

148

OTHER WAYS TO PREVENT SICKNESS AND INJURY

In this chapter we have talked about ways to prevent intestinal and other infections through hygiene, sanitation, and vaccination. All through this book you will find suggestions for the prevention of sickness and injury from building healthy bodies by eating nutritious foods to the wise use of home remedies and modern medicines.

The Introduction and Words to the Village Health Worker give ideas for getting people working together to change the conditions that cause poor health.

In the remaining chapters, as specific health problems are discussed, you will find many suggestions for their prevention. By following these suggestions you can help make your home and village healthier places to live.

Keep in mind that one of the best ways to prevent serious illness and death is early and sensible treatment.

Before ending this chapter, we would like to mention a few aspects of prevention that are touched on in other parts of the book, but deserve special attention.

Habits that Affect Health

Some of the habits that people have not only damage their own health but in one way or another harm those around them. Many of these habits can be broken or avoided but the first step is to understand why breaking these habits is so important.

DRINKING

If alcohol has brought much joy, it has also brought much suffering especially to the families of those who drink. A little alcohol now and then may do no harm. But too often a little leads to a lot. In much of the world, heavy or excessive drinking is one of the underlying causes of major health problems even for those who do not drink.

Not only can drunkenness harm the health of those who drink (through diseases such as cirrhosis of the liver, page 328, and hepatitis, page 172), but it also hurts the family and community in many ways. Through the loss of judgment when drunk and of self respect when sober it leads to much unhappiness, waste, and violence, often affecting those who are loved most.

How many fathers have spent their last money on drink when their children were hungry? How many sicknesses result because a man spends the little bit of extra money he earns on drink rather than on improving his family’s living conditions? How many persons, hating themselves because they have hurt those they love, take another drink to forget?

Once a person realizes that alcohol is harming the health and happiness of those around him, what can he do? First, he must admit that his drinking is a problem. He must be honest with himself and with others. Some individuals are able to simply decide to stop drinking. More often people need help and support from family, friends, and others who understand how hard it may be to give up this habit.

People who have been heavy drinkers and have stopped are often the best persons to help others do the same. In many areas Alcoholics Anonymous (AA) groups exist where recovering alcoholics help one another to stop drinking (see page 429).

Drinking is not so much a problem of individuals as of a whole community. A community that recognizes this can do much to encourage those who are willing to make changes. If you are concerned about the misuse of alcohol in your community, help organize a meeting to discuss these problems and decide what actions to take.

For more about harm from alcohol, and community action, see Helping Health Workers Learn, Chapters 5 and 27.

Many problems can be resolved when people work together and give each other help an

149

SMOKING

There are many reasons why smoking is dangerous to your own and your family’s health.

1. Smoking increases the risk of cancer of the lungs, mouth, throat, and lips. (The more you smoke, the greater the chance of dying of cancer.)

2. Smoking causes serious diseases of the lungs, including chronic bronchitis and emphysema (and is deadly for persons who already have these conditions or have asthma).

3. Smoking can cause stomach ulcers or make them worse.

4. Smoking increases your chance of suffering or dying from heart disease or stroke.

5. Children whose parents smoke have more cases of pneumonia and other respiratory illness than children whose parents do not smoke.

6. Babies of mothers who smoked during pregnancy are smaller and develop more slowly than babies whose mothers did not smoke.

7. Parents, teachers, health workers, and others who smoke set an unhealthy example for children and young people, increasing the likelihood that they too will begin smoking.

8. Also, smoking costs money. It looks like little is spent, but it adds up to a lot.

In poorer countries, many of the poorest persons spend more on tobacco than the country spends per person on its health program. If money spent on tobacco were spent for food instead, children and whole families could be healthier.

Anyone interested in the health of others should not smoke, and should encourage others not to smoke.

SMOKING DAMAGES

• lungs
• stomach
• heart and circulation
• pregnant women (their babies)
• children of those who smoke
• the family food budget.

150

CARBONATED DRINKS (soft drinks, sodas, Coke)

In some areas these drinks have become very popular. Often a poor mother will buy carbonated drinks for a child who is poorly nourished, when the same money could be better used to buy 2 eggs or other nutritious food.

Carbonated drinks have no nutritional value apart from sugar. And for the amount of sugar they contain, they are very expensive.

Children who are given a lot of carbonated drinks and other sweet things often begin to get cavities and rotten teeth at an early age. Carbonated drinks are especially bad for persons with acid indigestion or stomach ulcer.

Natural drinks you make from fruits are healthier and often much cheaper than carbonated drinks.

IF YOU WANT HEALTHY CHILDREN AND HAVE A LITTLE MONEY TO BUY THEM SOMETHING…

YES: buy them a couple of eggs or other nutritious food, not carbonated drinks!

NO: Do not get your children used to drinking carbonated drinks.

• DEHYDRATION
  • Signs of dehydration:
  • To prevent or treat dehydration
• DIARRHEA AND DYSENTERY
• THE MAIN CAUSES OF DIARRHEA
  • Preventing diarrhea:
  • Treatment of diarrhea:
  • FOODS FOR A PERSON WITH DIARRHEA
• Care of Babies with Diarrhea
• THE CARE OF A PERSON WITH ACUTE DIARRHEA
  • 1. Are there signs of dehydration (little or no urine, sunken eyes, dry mouth, etc.)?
  • 2. Is there fever that lasts more than 6 hours after starting to treat the dehydration?
    • Are there signs of typhoid fever? (temperature rises every day, slow pulse, very ill, etc., see page 188)
    • Diarrhea with blood or mucus?
    • Diarrhea yellow and very frothy?
• VOMITING
• HEADACHES AND MIGRAINES
• COLDS AND THE FLU
• STUFFY AND RUNNY NOSES
• SINUS TROUBLE (SINUSITIS)
• HAY FEVER (ALLERGIC RHINITIS)
• ALLERGIC REACTIONS
• ASTHMA
• COUGH
  • DRY COUGH WITH LITTLE OR NO PHLEGM:
  • COUGH WITH MUCH OR LITTLE PHLEGM:
  • COUGH WITH A WHEEZE OR WHOOP AND TROUBLE BREATHING:
  • CHRONIC OR PERSISTENT COUGH:
  • COUGHING UP BLOOD:
  • HOW TO DRAIN MUCUS FROM THE LUNGS (POSTURAL DRAINAGE)
• BRONCHITIS
• CHRONIC BRONCHITIS
• PNEUMONIA
• HEPATITIS
• ARTHRITIS (PAINFUL, INFLAMED JOINTS)
• BACK PAIN
• VARICOSE VEINS
• PILES (HEMORRHOIDS)
• SWELLING OF THE FEET AND OTHER PARTS OF THE BODY
• HERNIA (RUPTURE)
• SEIZURES (FITS, CONVULSIONS)
• EPILEPSY

DEHYDRATION

Most children who die from diarrhea die because they do not have enough water left in their bodies. This lack of water is called dehydration.

Dehydration results when the body loses more liquid than it takes in. This can happen with severe diarrhea, especially when there is vomiting too. It can also happen in very serious illness, when a person is too sick to take much food or liquid.

People of any age can become dehydrated, but dehydration develops more quickly and is most dangerous in small children.

Any child with watery diarrhea is in danger of dehydration

It is important that everyone, especially mothers, know the signs of dehydration and how to prevent and treat it.

Signs of dehydration:

• thirst is often a first, early sign of dehydration
• little or no urine; the urine is dark yellow
• sudden weight loss
• dry mouth
• sunken, tearless eyes
• sagging in of the ‘soft spot’ in infants
• loss of elasticity or stretchiness of the skin

Very severe dehydration may cause rapid, weak pulse (see Shock, page 77), fast, deep breathing, fever, or seizures (fits, convulsions, page 178).

When a person has watery diarrhea, or diarrhea and vomiting, do not wait for signs of dehydration. Act quickly , read on.

152

To prevent or treat dehydration

When a person has watery diarrhea, act quickly:

• Give lots of liquids to drink: Rehydration Drink is best. Or give a thin cereal porridge or gruel, teas, soups, or even plain water.

• Keep giving food. As soon as the sick child (or adult) will accept food, give frequent feedings of foods he likes and accepts.

• To babies, keep giving breast milk often, and before other drinks.

A special Rehydration Drink helps to prevent or treat dehydration, especially in cases of severe watery diarrhea:

2 WAYS TO MAKE ‘HOME MIX’ REHYDRATION DRINK

WITH SUGAR AND SALT

(Raw sugar or molasses can be used instead of sugar)

• In 1 liter of clean WATER put half of a level teaspoon of SALT and 8 level teaspoons of SUGAR.

• CAUTION: Before adding the sugar, taste the drink and be sure it is less salty than tears.

• To either Drink add half a cup of fruit juice, coconut water, or mashed ripe banana, if available. This provides potassium which may help the child accept more food and drink.

WITH POWDERED CEREAL AND SALT

(Powdered rice is best. Or use nely ground maize, wheat our, sorghum, or cooked and mashed potatoes.)

• In 1 liter of WATER put half a teaspoon of SALT And 8 heaping teaspoons (or 2 handfuls) of powdered CEREAL.

• Boil for 5 to 7 minutes to form a liquid gruel or watery porridge. Cool the Drink quickly and start giving it to the child.

• CAUTION: Taste the Drink each time before you give it to be sure it is not spoiled. Cereal drinks can spoil in a few hours in hot weather.

IMPORTANT

Adapt the Drink to your area. If liter containers or teaspoons are not in most homes, adjust quantities to local forms of measurement. Where people traditionally give cereal gruels to young children, add enough water to make it liquid, and use that. Look for an easy and simple way.

Give the dehydrated person sips of this Drink every 5 minutes, day and night, until he begins to urinate normally. A large person needs 3 or more liters a day.

A small child usually needs at least 1 liter a day, or 1 glass for each watery stool. Keep giving the Drink often in small sips, even if the person vomits. Not all of the Drink will be vomited.

WARNING: If dehydration gets worse or other danger signs appear, go for medical help (see page 159). It may be necessary to give liquid in a vein (intravenous solution).

Note: In some countries packets of Oral Rehydration Salts (ORS) are available for mixing with water. These contain a simple mix of sugar, salt, citrate, zinc, and potassium (see page 381).

However, homemade drinks, especially cereal drinks, when correctly prepared are often cheaper, safer, and more effective than ORS packets.

153

DIARRHEA AND DYSENTERY

When a person has loose or watery stools, he has diarrhea. If mucus and blood can be seen in the stools, he has dysentery.

Diarrhea can be mild or serious. It can be acute (sudden and severe) or chronic (lasting many days).

Diarrhea is more common and more dangerous in young children, especially those who are poorly nourished.

Diarrhea has many causes. Usually no medicines are needed, and the child gets well in a few days if you give him lots of Rehydration Drink and food. (If he does not eat much, give him a little food many times a day.)

Occasionally, special treatment is needed. However, most diarrhea can be treated successfully in the home, even if you are not sure of the exact cause or causes.

THE MAIN CAUSES OF DIARRHEA

• poor nutrition (page 154) weakens the child and makes diarrhea from other causes more frequent and worse

• shortage of water and unclean conditions (no latrines) spread the germs that cause diarrhea

• virus infection or ‘intestinal flu’

• an infection of the gut caused by bacteria (page 131), amebas (page 144), or giardia (page 145)

• worm infections (page 140 to 144) (most worm infections do not cause diarrhea)

• infections outside the gut (ear infections, page 309; tonsillitis, page 309; measles, page 311; urinary infections, page 234)

• malaria (falciparum type, in parts of Africa, Asia, the Paci c, Latin America and the Caribbean, page 186)

• food poisoning (spoiled food, page 135)

• HIV (long-lasting diarrhea may be an early sign of AIDS, page 399)

• inability to digest milk (mainly in severely malnourished children and certain adults)

• difficulties babies have digesting foods that are new to them (page 154)

• allergies to certain foods (seafood, cray sh, etc., page 166); occasionally babies are allergic to cow’s milk or other milks

• side effects produced by certain medicines, such as ampicillin or tetracycline (page 58)

• laxatives, purges, irritating or poisonous plants, certain poisons

• eating too much unripe fruit or heavy, greasy foods

154

Preventing diarrhea:

Although diarrhea has many different causes, the most common are infection and poor nutrition. With good hygiene and good food, most diarrhea could be prevented. And if treated correctly by giving lots of drink and food, fewer children who get diarrhea would die.

Diarrhea is also very dangerous for people with HIV, especially children. Using cotrimoxazole can prevent diarrhea in persons with HIV (see page 357).

Children who are poorly nourished get diarrhea and die from it far more often than those who are well nourished. Yet diarrhea itself can be part of the cause of malnutrition.

Malnutrition causes diarrhea. Diarrhea causes malnutrition

And if malnutrition already exists, diarrhea rapidly makes it worse.

This results in a vicious circle, in which each makes the other worse. For this reason, good nutrition is important in both the prevention and treatment of diarrhea.

Prevent diarrhea by preventing malnutrition. Prevent malnutrition by preventing diarrhea

To learn about the kinds of foods that help the body resist or fight off different illnesses, including diarrhea, read Chapter 11.

The prevention of diarrhea depends both on good nutrition and cleanliness. Many suggestions for personal and public cleanliness are given in Chapter 12. These include the use of latrines, the importance of clean water, and the protection of foods from dirt and flies.

Here are some other important suggestions for preventing diarrhea in babies:

• Breastfeed rather than bottle feed babies. Give only breast milk for the first 6 months. Breast milk helps babies resist the infections that cause diarrhea. If it is not possible to breastfeed a baby, feed her with a cup and spoon. Do not use a baby bottle because it is harder to keep clean and more likely to cause an infection.

• When you begin to give the baby new or solid food, start by giving her just a little, mashing it well, and mixing it with a little breast milk. The baby has to learn how to digest new foods. If she starts with too much at one time, she may get diarrhea. Do not stop giving breast milk suddenly. Start with other foods while the baby is still breastfeeding.

• Keep the baby clean, and in a clean place. Try to keep her from putting dirty things in her mouth.

• Do not give babies unnecessary medicines.

155

Treatment of diarrhea:

For most cases of diarrhea no medicine is needed. If the diarrhea is severe, the biggest danger is dehydration. If the diarrhea lasts a long time, the biggest danger is malnutrition. So the most important part of treatment has to do with giving enough liquids and enough food.

No matter what the cause of diarrhea, always take care with the following:

1 - PREVENT OR CONTROL DEHYDRATION.

A person with diarrhea must drink a lot of liquids. If diarrhea is severe or there are signs of dehydration, give him Rehydration Drink (page 152). Even if he does not want to drink, gently insist that he do so. Have him take several swallows every few minutes.

2 - MEET NUTRITIONAL NEEDS.

A person with diarrhea needs food as soon as he will eat. This is especially important in small children or persons who are already poorly nourished. Also, when a person has diarrhea, food passes through the gut very quickly and is not all used. So give the person food many times a day, especially if he only takes a little at a time.

♦ A baby with diarrhea should go on breastfeeding.

♦ An underweight child should get plenty of energy foods and some body-building foods (proteins) all the time he has diarrhea, and extra when he gets well. If he stops eating because he feels too sick or is vomiting, he should eat again as soon as he can.
Giving Rehydration Drink will help the child be able to eat. Although giving food may cause more frequent stools at first, it can save his life.

♦ If a child who is underweight has diarrhea that lasts for many days or keeps coming back, give him more food more often, at least 5 or 6 meals each day. Often no other treatment is needed.

♦ If possible, give zinc supplements to a baby or child with diarrhea (see page 381).

FOODS FOR A PERSON WITH DIARRHEA

When the person is vomiting or feels too sick to eat, he should drink:

• watery mush or broth of rice, maize powder, or potato

• rice water (with some mashed rice) chicken, meat, egg, or bean broth

• REHYDRATION DRINK

• Breast milk yogurt or fermented milk drinks

As soon as the person is able to eat, in addition to giving the drinks listed at the left, he should eat a balanced selection of the following foods or similar ones:

energy foods

• ripe or cooked bananas

• crackers

• rice, oatmeal, or other well-cooked grain

• fresh maize (well cooked and mashed)

• potatoes

• applesauce (cooked) papaya

• (It helps to add a little sugar or vegetable oil to foods.)

body-building foods

• chicken (boiled or roasted)

• eggs (boiled)

• meat (well cooked, without much fat or grease)

• beans, lentils, or peas (well cooked and mashed)

• fish (well cooked)

• milk (sometimes this causes problems, see the next page)

DO NOT EAT OR DRINK

• fatty or greasy foods

• most raw fruits

• any kind of laxative or purge

• highly seasoned food

• alcoholic drinks

156

Diarrhea and milk:

Breast milk is the best food for babies. It helps prevent and combat diarrhea. Keep giving breast milk when the baby has diarrhea.

Cow’s milk, powdered milk, or canned milk can be good sources of energy and protein. Keep on giving them to a child with diarrhea. In a very few children these milks may cause more diarrhea. If this happens, try giving less milk and mixing it with other foods.

But remember: a poorly nourished child with diarrhea must have enough energy foods and protein. If less milk is given, well cooked and mashed foods such as chicken, egg yolk, meat, fish, or beans should be added.

Beans are easier to digest if their skins have been taken off and they are boiled and mashed.

As the child gets better, he will usually be able to drink more milk without getting diarrhea.

Medicines for diarrhea:

For most cases of diarrhea no medicines are needed. But in certain cases, using the right medicine can be important. However, many of the medicines commonly used for diarrhea do little or no good. Some are actually harmful:

GENERALLY IT IS BETTER NOT TO USE THE FOLLOWING MEDICINES IN THE TREATMENT OF DIARRHEA:

‘Anti diarrhea’ medicines with bismuth subsalicylate (such as Pepto-Bismol or Kaopectate, page 383) make diarrhea thicker and less frequent. But they do not correct dehydration or control infection. Some anti diarrhea medicines, like loperamide (Imodium) or diphenoxylate (Lomotil) may even cause harm or make infections 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 often do more harm than good.

Antibiotics like ampicillin and tetracycline are useful only in some cases of diarrhea (see page 158).

But they themselves sometimes cause diarrhea, especially in small children. If, after taking these antibiotics for more than 2 or 3 days, diarrhea gets worse rather than better, stop taking them the antibiotics may be the cause.

Chloramphenicol (page 356) should never be used for diarrhea

Laxatives and purges should never be given to persons with diarrhea. They will make it worse and increase the danger of dehydration.

157

Special treatment in different cases of diarrhea:

While most cases of diarrhea are best treated by giving plenty of liquids and food, and no medicine, sometimes special treatment is needed.

In considering treatment, keep in mind that some cases of diarrhea, especially in small children, are caused by infections outside the gut. Always check for infections of the ears, the throat, and the urinary system. If found, these infections should be treated. Also look for signs of measles.

If the child has mild diarrhea together with signs of a cold, the diarrhea is probably caused by a virus, or ‘intestinal flu’, and no special treatment is called for. Give lots of liquids and all the food the child will accept.

In certain difficult cases of diarrhea, analysis of the stools or other tests may be needed to know how to treat it correctly. But usually you can learn enough from asking specific questions, seeing the stools, and looking for certain signs Here are some guidelines for treatment according to signs.

1. Sudden, mild diarrhea. No fever. (Upset stomach? ‘Intestinal flu’?)

♦ Drink lots of liquids. Usually no special treatment is needed. It is usually best not to use ‘anti-diarrhea’ medicines such as bismuth subsalicylate (Kaopectate, page 383) or diphenoxylate (Lomotil).

They are never necessary and do not help either to correct dehydration or get rid of infection so why waste money buying them? Never give them to persons who are very ill, or to small children.

1. Diarrhea with vomiting. (Many causes)

♦ If a person with diarrhea is also vomiting, the danger of dehydration is greater, especially in small children. It is very important to give the Rehydration Drink (page 152), tea, soup, or whatever liquids he will take.

Keep giving the Drink, even if the person vomits it out again. Some will stay inside. Give sips every 5 to 10 minutes.

♦ If you cannot control the vomiting or if the dehydration gets worse, seek medical help fast.

1. Diarrhea with mucus and blood. Often chronic. No fever. There may be diarrhea some days and constipation other days. (Possibly amebic dysentery. For more details, See page 144 to page 145.)

♦ Use metronidazole (page 368). Take the medicine according to the recommended dose. If the diarrhea continues after treatment, seek medical advice.

158

1. Severe diarrhea with blood, with fever. (Bacterial dysentery caused by Shigella)

♦ Give ceftriaxone or ciprofloxacin (see page 358). Pregnant women and children under 18 years old should not use ciprofloxacin. (For children under 8 weeks old, seek medical help.)

Shigella is often resistant to ampicillin (page 352), co-trimoxazole (page 357), and azithromycin, but they are still being used.

If the first medicine you try does not bring improvement within 2 days, try another or seek medical help.

Women in the first 3 months of pregnancy should not use co-trimoxazole (see page 357). Azithromycin is safe during pregnancy and for children. For adults, give 1 g (1000 mg) by mouth once a day for 3 days. For children’s doses, see a health worker.

♦ Also give zinc, 20 mg once a day, for 14 days. 5. Severe diarrhea with fever, usually no blood.

♦ Fever may be partly caused by dehydration. Give lots of Rehydration Drink (page 152). If the person is very ill and does not improve within 6 hours after beginning Rehydration Drink, seek medical help.

♦ Check for signs of typhoid fever. If present, treat for typhoid (see page 188).

♦ In areas where falciparum malaria is common, also treat persons with diarrhea and fever for malaria (see page 186), especially if they have an enlarged spleen.

1. Yellow, bad smelling diarrhea with bubbles or froth, without blood or mucus. Often a lot of gas in the belly, and burps that taste bad, like sulfur.

♦ This may be caused by parasites called giardia (see page 145) or perhaps by malnutrition. In either case, plenty of liquid, nutritious food, and rest are often the best treatment.

Severe giardia infections can be treated with metronidazole (page 368). Quinacrine (Atabrine) is cheaper, but has worse side effects (page 369).

1. Chronic diarrhea (diarrhea that lasts a long time or keeps coming back).

♦ This can be in part caused by malnutrition, or by a chronic infection such as that caused by amebas or giardia. See that the child eats more nutritious food more times a day (page 110). If the diarrhea still continues, seek medical help.

1. Diarrhea like rice water. (Cholera)

♦ ‘Rice water’ stools in very large quantities may be a sign of cholera. In countries where this dangerous disease occurs, cholera often comes in epidemics (striking many people at once) and is usually worse in older children and adults.

Severe dehydration can develop quickly, especially if there is vomiting also. It is important to treat the dehydration continuously with rehydration drink and other liquids (see page 152).

Cholera should be reported to the health authorities. Seek medical help.

A ‘cholera bed’ like this can be made for persons with very severe diarrhea. Watch how much liquid the person is losing and be sure he drinks larger amounts of Rehydration Drink. Give him the Drink almost continuously, and have him drink as much as he can.

159

Care of Babies with Diarrhea

Diarrhea is especially dangerous in babies and small children. Often no medicine is needed, but special care must be taken because a baby can die very quickly of dehydration.

♦ Continue breastfeeding and also give sips of Rehydration Drink.

♦ If vomiting is a problem, give breast milk often, but only a little at a time. Also give Rehydration Drink in small sips every 5 to 10 minutes (see Vomiting, page 161).

♦ If there is no breast milk, try giving frequent small feedings of some other milk or milk substitute (like milk made from soybeans) mixed to half normal strength with boiled water. If milk seems to make the diarrhea worse, give some other protein (mashed chicken, eggs, lean meat, or skinned mashed beans, mixed with sugar or well-cooked rice or another carbohydrate, and boiled water).

♦ If possible, give zinc supplements (see page 381).

GIVE HIM BREAST MILK

♦ If the child is younger than 1 month, try to find a health worker before giving any medicine. If there is no health worker and the child is very sick, give him an ‘infant syrup’ that contains ampicillin: half a teaspoon 4 times daily (see page 352). It is better not to use other antibiotics.

When to Seek Medical Help in Cases of Diarrhea

Diarrhea and dysentery can be very dangerous especially in small children.

In the following situations you should get medical help:

• if diarrhea lasts more than 4 days and is not getting better or more than 1 day in a small child with severe diarrhea

• if the person shows signs of dehydration and is getting worse

• if the child vomits everything he drinks, or drinks nothing, or if frequent vomiting continues for more than 3 hours after beginning Rehydration Drink

• if the child begins to have seizures, or if the feet and face swell

• if the person was very sick, weak, or malnourished before the diarrhea began (especially a little child or a very old person)

• if there is much blood in the stools. This can be dangerous even if there is only very little diarrhea (see gut obstruction, page 94).

160

THE CARE OF A PERSON WITH ACUTE DIARRHEA

1. Are there signs of dehydration (little or no urine, sunken eyes, dry mouth, etc.)?

YES: Control the dehydration: Drink lots of liquids and REHYDRATION DRINK. (see page 152)

NO: Prevent dehydration: Drink lots of liquids.

PREVENT OR CORRECT MALNUTRITION:

Give food as soon as the person will eat. Bland, well-mashed foods are best a lot of energy foods with some body-building foods. Continue breastfeeding.

2. Is there fever that lasts more than 6 hours after starting to treat the dehydration?

YES:
Give ampicillin (page 352) or cotrimoxazole (see page 358).

No better within 3 days: then consider:

Are there signs of typhoid fever? (temperature rises every day, slow pulse, very ill, etc., see page 188)

YES: Continue to give cotrimoxazole, ampicillin, or chloramphenicol for 2 weeks. (see page 356). If then No better SEEK MEDICAL HELP.

NO: SEEK MEDICAL HELP

NO: then consider:

Diarrhea with blood or mucus?

YES: Give metronidazole for amebas. (see page 369)

NO: then consider:

Diarrhea yellow and very frothy?

YES: Give metronidazole or quinacrine for giardia. (see page 369). If then No better SEEK MEDICAL HELP.

NO: Give no medicine. Continue giving Rehydration Drink and food. If then No better SEEK MEDICAL HELP.

161

VOMITING

Many people, especially children, have an occasional ‘stomach upset’ with vomiting. Often no cause can be found. There may be mild stomach or gut ache or fever. This kind of simple vomiting usually is not serious and clears up by itself.

Vomiting is one of the signs of many different problems, some minor and some quite serious, so it is important to examine the person carefully.

Vomiting often comes from a problem in the stomach or guts, such as: an infection (see diarrhea, page 153), poisoning from spoiled food (page 135), or ‘acute abdomen’ (for example, appendicitis or something blocking the gut, page 94).

Also, almost any sickness with high fever or severe pain may cause vomiting, especially malaria (page 186), hepatitis (page 172), tonsillitis (page 309), earache (page 309), meningitis (page 185), urinary infection (page 234), gallbladder pain (page 329) or migraine headache (page 162).

Danger signs with vomiting seek medical help quickly!

• dehydration that increases and that you cannot control (page 152)

• severe vomiting that lasts more than 24 hours

• violent vomiting, especially if vomit is dark green, brown, or smells like shit (signs of obstruction, page 94)

• constant pain in the gut, especially if the person cannot defecate (shit) or if you cannot hear gurgles when you put your ear to the belly (see acute abdomen: obstruction, appendicitis, page 94)

• vomiting of blood (ulcer, page 128; cirrhosis, page 328)

To help control simple vomiting:

♦ Eat nothing while vomiting is severe.

♦ Sip a cola drink or ginger ale. Some herbal teas, like camomile, may also help.

♦ For dehydration give small frequent sips of cola, tea, or Rehydration Drink (page 152).

♦ If vomiting does not stop soon, use a vomit control medicine like promethazine (page 385) or diphenhydramine (page 386). But do not give these medicines to children under 2 years old.

Most of these come in pills, syrups, injections, and suppositories (soft pills you push up the anus). Tablets or syrup can also be put up the anus. Grind up the tablet in a little water. Put it in with an enema set or syringe without a needle.

When taken by mouth, the medicine should be swallowed with very little water and nothing else should be swallowed for 5 minutes. Never give more than the recommended dose. Do not give a second dose until dehydration has been corrected and the person has begun to urinate.

If severe vomiting and diarrhea make medication by mouth or anus impossible, give an injection of one of the vomit-control medicines. Promethazine may work best. Take care not to give too much.

162

HEADACHES AND MIGRAINES

SIMPLE HEADACHE can be helped by rest and aspirin. It often helps to put a cloth soaked in hot water on the back of the neck and to massage (rub) the neck

For simple or nervous headache, folk cures sometimes work as well as modern medicine.

folk cure aspirin and shoulders gently. Some other home remedies also seem to help.

Headache is common with any sickness that causes fever. If headache is severe, check for signs of meningitis (page 185).

Headaches that keep coming back may be a sign of a chronic illness, poor nutrition, or chemicals at work or in the environment. It is important to eat well and get enough sleep. If you think that chemicals could be causing the headaches or if they do not go away, talk with a health worker.

A MIGRAINE is a severe throbbing headache often on one side of the head only. Migraine attacks may come often, or months or years apart.

A typical migraine begins with blurring of vision, seeing strange spots of light, or numbness of one hand or foot. This is followed by severe headache, which may last hours or days. Often there is vomiting. Migraines are very painful, but not dangerous.

TO STOP A MIGRAINE, DO THE FOLLOWING AT THE FIRST SIGN:

♦ Take 2 aspirins with a cup of strong coffee or strong black tea.

♦ Lie down in a dark, quiet place. Do your best to relax. Try not to think about your problems.

♦ For especially bad migraine headaches, take aspirin, if possible with codeine, or with another sedative. Or obtain pills of ergotamine with caffeine (Cafergot, page 379). Take 2 pills at first and 1 pill every 30 minutes until the pain goes away. Do not take more than 6 pills in 1 day.

WARNING: Do not use Cafergot during pregnancy.

163

COLDS AND THE FLU

Colds and the flu are common virus infections that may cause runny nose, cough, sore throat, and sometimes fever or pain in the joints. There may be mild diarrhea, especially in young children.

Colds and the flu almost always go away without medicine. Do not use penicillin, tetracycline, or other antibiotics, as they will not help at all and may cause harm.

♦ Drink plenty of water and get enough rest.

♦ Aspirin (page 378) or acetaminophen (page 379) helps lower temperature and relieve body aches and headaches. More expensive ‘cold tablets’ are no better than aspirin. So why waste your money?

♦ No special diet is needed. However, fruit juices, especially orange juice or lemonade, are helpful. For treating coughs and stuffy noses that come with colds, see the next pages.

WARNING: Do not give any kind of antibiotic or injections to a child with a simple cold. They will not help and may cause harm.

If a cold or the flu lasts more than a week, or if the person has fever, coughs up a lot of phlegm (mucus with pus), has shallow fast breathing or chest pain, he could be developing bronchitis or pneumonia (See page 170 and page 171). An antibiotic may be called for.

The danger of a cold turning into pneumonia is greater in old people, in those who have lung problems like chronic bronchitis, in people who cannot move much, and in people with HIV. People with HIV can take cotrimoxazole daily to prevent pneumonia and other infections (see page 357).

Sore throat is often part of a cold. No special medicine is needed, but it may help to gargle with warm water. However, if the sore throat begins suddenly, with high fever, it could be a strep throat. Special treatment is needed (see page 310).

Prevention of colds:

♦ Getting enough sleep and eating well helps prevent colds. Eating oranges, tomatoes, and other fruit containing vitamin C may help. Washing hands often especially before touching your face, nose, mouth, or anything you put into your mouth is also good prevention.

♦ Contrary to popular belief, colds do not come from getting cold or wet (although getting very cold, wet, or tired can make a cold worse). A cold is ‘caught’ from others who have the infection and sneeze the virus into the air.

♦ To keep from giving his cold to others, the sick person should eat and sleep separately and take special care to keep far away from small babies. He should cover his nose and mouth when he coughs or sneezes, and wash his hands often if possible.

♦ To prevent a cold from leading to earache (page 309), try not to blow your nose just wipe it. Teach children to do the same.

164

STUFFY AND RUNNY NOSES

A stuffy or runny nose can result from a cold or allergy (see next page). A lot of mucus in the nose may cause ear infections in children or sinus problems in adults.

To help clear a stuffy nose, do the following:

1. In little children, carefully suck the mucus out of the nose with a suction bulb or syringe without a needle, like this:

2. Older children and adults can put a little salt water into their hand and sniff it into the nose. This helps to loosen the mucus.The water should not be too salty. 1/4 teaspoon of salt mixed in a cup of water is enough.

3. Breathing hot water vapor as described on page page 168 helps clear a stuffy nose.

4. Wipe a runny or stuffy nose, but try not to blow it. Blowing the nose may lead to earache and sinus infections.

5. Persons who often get earaches or sinus trouble after a cold can help prevent these problems by using decongestant nose drops with phenylephrine or ephedrine (page 383). After sniffing a little salt water, put the drops in the nose like this: With the head sideways, put 2 or 3 drops in the lower nostril. Wait a couple of 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 decongestant syrup (with phenylephrine or something similar) may also help.

Prevent ear and sinus infections, try not to blow your nose, just wipe it.

165

SINUS TROUBLE (SINUSITIS)

Sinusitis is an acute or chronic (long-term) inflammation of the sinuses or hollows in the bone that open into the nose. It usually occurs after a person has had an infection of the ears or throat, or after a bad cold.

Signs:

• Pain in the face above and below the eyes, here (It hurts more when you tap lightly just over the bones, or when the person bends over.)

• Thick mucus or pus in the nose, perhaps with a bad smell. The nose is often stuffy.

• Fever (sometimes).

• Certain teeth may hurt.

Treatment:

♦ Drink a lot of water.

♦ Sniff a little salt water into the nose (see page 164), or breathe steam from hot water to clear the nose (see page 168).

♦ Put hot compresses on the face.

♦ Use decongestant nose drops such as phenylephrine (Neo-synephrine, page 383).

♦ Use an antibiotic such as tetracycline (page 355), ampicillin (page 352), or penicillin (page 351).

♦ If the person does not get better, seek medical help.

Prevention:

When you get a cold and a stuffy nose, try to keep your nose clear. Follow the instructions on page 164.

HAY FEVER (ALLERGIC RHINITIS)

Runny nose and itchy eyes can be caused by an allergic reaction to something in the air that a person has breathed in (see the next page). It is often worse at certain times of year.

Treatment:

Use an antihistamine such as chlorpheniramine (page 386). Dimenhydrinate (Dramamine, page 386), usually sold for motion sickness, also works.

Prevention:

Find out what things cause this reaction (for example: dust, chicken feathers, pollen, mold) and try to avoid them.

166

ALLERGIC REACTIONS

An allergy is a disturbance or reaction that affects only certain persons when things they are sensitive or allergic to are:

• breathed in

• eaten

• injected

• or touch the skin

Allergic reactions, which can be mild or very serious, include:

• itching rashes, lumpy patches, or hives (page 203)

• runny nose and itching or burning eyes (hay fever, page 165)

• irritation in the throat, difficulty breathing, or asthma (see next page) • allergic shock (page 70)

• diarrhea (in children allergic to milk a rare cause of diarrhea, page 156)

An allergy is not an infection and cannot be passed from one person to another. However, children of allergic parents also tend to have allergies.

Often allergic persons suffer more in certain seasons or whenever they come in touch with the substances that bother them.

Common causes of allergic reactions are:

• pollen of certain flowers and grasses

• chicken feathers

• dust

• specific food, especially sh, shell sh, beer, etc.

• chemicals in your home, school, or work

• hair from cats and other animals

• certain medicines, especially injections of penicillin or antitoxins made from horse serum (see page 70)

• kapok or feather pillows

• moldy blankets or clothes

167

ASTHMA

A person with asthma has fits or attacks of difficult breathing. Listen for a hissing or wheezing sound, especially when breathing out.

When he breathes in, the skin behind his collar bones and between his ribs may suck in as he tries to get air.

If the person cannot get enough air, his nails and lips may turn blue, and his neck veins may swell. Usually there is no fever.

Asthma can also be caused by unclean air (air pollution), such as smoke from cigarettes, inside cooking fires, burning fields, or cars and trucks.

Asthma often begins in childhood and may be a problem for life. It is not contagious, but is more common in children with relatives who have asthma. It is generally worse during certain months of the year or at night.

An asthma attack may be caused by eating or breathing things to which the person is allergic (see page 166). In children asthma often starts with a cold. Nervousness or worry may bring on an asthma attack.

Asthma can also be caused by unclean air (air pollution), such as smoke from cigarettes, inside cooking fires, burning fields, or cars and trucks.

Treatment:

♦ If asthma gets worse inside the house, the person should go outside to a place where the air is cleanest. Remain calm and be gentle with the person. Reassure him.

♦ Give a lot of liquids. This loosens mucus and makes breathing easier. Breathing water vapor may also help (see page 168).

♦ Strong coffee or black tea can help relieve an asthma attack if you do not have any medicines.

♦ For attacks, treat with the rescue inhaler salbutamol (albuterol, see page 384) as often as needed. This is a spray medicine that you want to breathe in as deeply as possible. See page 384 to learn how to make a spacer for your inhaler.

♦ For frequent attacks, or asthma that makes you gasp for breath while walking or during mild exercise, also use the controller inhaler (beclomethasone, see page 384). Using a controller medicine can prevent attacks, save you money, and make you feel better than always responding to an asthma emergency. Using a “spacer” with your inhaler allows more medicine to get to the lungs.

♦ For severe asthma where you cannot get enough air and do not improve with salbutamol, use prednisolone by mouth right away, and then continue for 3 to 7 days (see page 385). In emergencies if you have no other medicines you can inject epinephrine (adrenalin, see page 385) under the skin.

♦ In rare cases, worms cause asthma. Try giving mebendazole (page 373) to a child who starts having asthma if you think she has worms.

♦ If the person does not get better, seek medical help.

Prevention:

A person with asthma should avoid eating or breathing things that bring on attacks. The house or work place should be kept clean. Keep chickens and other animals outside. Air bedding in the sunshine.

Sometimes it helps to sleep outside in the open air. Drink at least 8 glasses of water each day to keep the mucus loose. Persons with asthma may improve when they move to where the air is cleaner.

If you have asthma do not smoke, smoking damages your lungs even more.

168

COUGH

Coughing is not a sickness in itself, but is a sign of many different sicknesses that affect the throat, lungs, or bronchi (the network of air tubes going into the lungs). Below are some of the problems that cause different kinds of coughs:

DRY COUGH WITH LITTLE OR NO PHLEGM:

• cold or flu (page 163)

• wormswhen passing through the lungs (page 140)

• measles (page 311)

• smoker’s cough (smoking, page 149)

COUGH WITH MUCH OR LITTLE PHLEGM:

• bronchitis (page 170)

• pneumonia (page 171)

• asthma (page 167)

• smoker’s cough, especially when getting up in the morning (page 149)

COUGH WITH A WHEEZE OR WHOOP AND TROUBLE BREATHING:

• asthma (page 167)

• whooping cough (page 313)

• diphtheria (page 313)

• heart trouble (page 325)

• something stuck in the throat (page 79)

CHRONIC OR PERSISTENT COUGH:

• tuberculosis (page 179)

• smoker’s or miner’s cough (page 149)

• asthma (repeated attacks, page 167)

• chronic bronchitis (page 170)

• emphysema (page 170)

COUGHING UP BLOOD:

• tuberculosis (page 179)

• pneumonia (yellow, green, or blood-streaked phlegm, page 171)

• severe worm infection (page 140)

• cancer of the lungs or throat (page 149)

Coughing is the body’s way of cleaning the breathing system and getting rid of phlegm (mucus with pus) and germs in the throat or lungs. So when a cough produces phlegm, do not take medicine to stop the cough, but rather do something to help loosen and bring up the phlegm.

169

Treatment for cough:

1. To loosen mucus and ease any kind of cough, drink lots of water. This works better than any medicine.

Also breathe hot water vapors. Sit on a chair with a bucket of very hot water at your feet. Place a sheet over the bucket to catch the vapors as they rise. Breathe the vapors deeply for 15 minutes. Repeat several times a day. Some people like to add mint or eucalyptus leaves or Vaporub, but hot water works just as well alone.

CAUTION: Do not use eucalyptus or Vaporub if the person has asthma. They make it worse.

1. For all kinds of cough, especially a dry cough, the following cough syrup can be given:

Mix: 1 part honey 1 part lemon juice + Take a teaspoonful every 2 or 3 hours.

WARNING: Do not give honey to babies under 1 year. Make the syrup with sugar instead of honey.

1. For a severe dry cough that does not let you sleep, you can take a syrup with codeine (page 383). Tablets of aspirin with codeine (or even aspirin alone) also help. If there is a lot of phlegm or wheezing, do not use codeine.

2. For a cough with wheezing (difficult, noisy breathing), see Asthma (page 167), Chronic Bronchitis (page 170), and Heart Trouble (page 325).

3. Try to find out what sickness is causing the cough and treat that. If the cough lasts a long time, if there is blood, pus, or smelly phlegm in it, or if the person is losing weight or has continual difficulty breathing, see a health worker.

4. If you have any kind of a cough, do not smoke. Smoking damages the lungs.

HOW TO DRAIN MUCUS FROM THE LUNGS (POSTURAL DRAINAGE)

When a person who has a bad cough is very old or weak and cannot get rid of the sticky mucus or phlegm in his chest, it will help if he drinks a lot of water.

Also do the following:

♦ First, have him breathe hot water vapors to loosen the mucus.

♦ Then pound him lightly on the back with a cupped hand. This will help to bring out the mucus.

170

BRONCHITIS

Bronchitis is an infection of the bronchi or tubes that carry air to the lungs.

It causes a noisy cough, often with mucus or phlegm. Bronchitis is usually caused by a virus, so antibiotics do not generally help.

Use antibiotics only if the bronchitis lasts more than a week and is not getting better, if the person shows signs of pneumonia (see the following page), or if he already has a chronic lung problem.

CHRONIC BRONCHITIS

Signs:

• A cough, with mucus that lasts for months or years. Sometimes the cough gets worse, and there may be fever. A person who has this kind of cough, but does not have another long term illness such as tuberculosis or asthma, probably has chronic bronchitis.

• It occurs most frequently in older persons who have been heavy smokers.

• It can lead to emphysema, a very serious and incurable condition in which the tiny air pockets of the lungs break down. A person with emphysema has a hard time breathing, especially with exercise, and his chest becomes big ‘like a barrel’.

Treatment:

♦ Stop smoking.

♦ Take an anti-asthma medicine with salbutamol (page 384).

♦ Persons with chronic bronchitis should use cotrimoxazole or amoxicillin every time they have a cold or ‘flu’ with a fever.

♦ If the person has trouble coughing up sticky phlegm, have him breathe hot water vapors (page 168) and then help him with postural drainage (see page 169).

Emphysema can result from chronic asthma, chronic bronchitis, or smoking.

If you have a chronic cough (or want to prevent one), DO NOT SMOKE!

171

PNEUMONIA

Pneumonia is an acute infection of the lungs. It often occurs after another respiratory illness such as measles, whooping cough, flu, bronchitis, asthma or after any very serious illness, especially in babies and old people. Also, persons with HIV may develop pneumonia.

Signs:

• Sudden chills and then high fever.

• Rapid, shallow breathing, with little grunts or sometimes wheezing. The nostrils may spread with each breath.

• Fever (sometimes newborns and old or very weak persons have severe pneumonia with little or no fever).

• Cough (often with yellow, greenish, rust colored, or slightly bloody mucus).

• Chest pain (sometimes).

• The person looks very ill.

• Cold sores often appear on the face or lips (page 232).

A very sick child with fast, shallow breathing probably has pneumonia. For a newborn baby, fast breathing means more than 60 breaths a minute.

For a baby between 2 months and 1 year, fast breathing is more than 50 breaths a minute, and for a child between 1 and 5 years old, 40 breaths a minute. (If breathing is rapid and deep, check for dehydration, page 151, or hyperventilation, page 24.) Do not count the breaths while the child is crying or just after she has stopped.

Treatment:

♦ For pneumonia, treatment with antibiotics can make the difference between life and death. Give benzylpenicillin (page 351), cotrimoxazole (page 357), or erythromycin (page 354). In serious cases, inject procaine penicillin (page 352), adults: 1,000,000 units (1 g) a day, or give amoxicillin by mouth (pages page 352 to page 353), 500 mg, 3 times a day. Give small children 1⁄4 to 1⁄2 the adult dose. For children under 6, amoxicillin is usually best.

♦ Give aspirin (page 378) or acetaminophen (page 379) to lower the temperature and lessen the pain. Acetaminophen is safer for children under 12.

♦ Give plenty of liquids. If the person will not eat, give him liquid foods or Rehydration Drink (see page 152).

♦ Ease the cough and loosen the mucus by giving the person plenty of water and having him breathe hot water vapors (see page 168). Postural drainage may also help (see page 169).

♦ If the person is wheezing, an anti-asthma medicine may help (see page 384).

172

HEPATITIS

Hepatitis is an inflammation of the liver usually caused by a virus, but also by bacteria, alcohol, or chemical poisoning. There are 3 major types of hepatitis (A, B, and C) and it can spread from person to person whether or not there are signs of the disease. Even though in some places people call it ‘the fever’ (see page 26), hepatitis often causes little or no rise in temperature.

A person with Hepatitis A or Hepatitis B is often very sick for 2 to 3 weeks, weak for 1 to 4 months after, and then usually gets better. Hepatitis A is usually mild in small children, but more serious in older persons and in pregnant women.

Hepatitis B is more serious and can lead to permanent scarring of the liver (cirrhosis), liver cancer, and even death. Hepatitis C is also very dangerous and can lead to permanent liver infections. It is a major cause of death for people with HIV.

Signs:

• Feels tired. Does not want to eat or smoke. Often goes days without eating anything.

• Sometimes there is a pain on the right side near the liver. Sometimes there is pain in the muscles or joints.

• May have a fever.

• After a few days, the eyes and skin turn yellow.

• Sight or smell of food may cause vomiting.

• The urine may turn dark like Coca Cola, and the stools may become whitish, or the person may have diarrhea.

Treatment:

♦ Antibiotics do not work against hepatitis. In fact some medicines such as acetaminophen will cause added damage to the sick liver. Do not use medicines.

♦ The sick person should rest and drink lots of liquids. If he refuses most food, give him orange juice, papaya, and other fruit plus broth or vegetable soup. It may help to take vitamins. To control vomiting, see page 161.

♦ When the sick person can eat, give a balanced meal. Vegetables and fruit are good, with some protein (pages page 110 to page 111). But do not give a lot of protein (meat, eggs, fish, etc.) because this makes the damaged liver work too hard. Avoid lard and fatty foods. Do not drink any alcohol for at least 6 months.

Prevention:

♦ Small children often have hepatitis without any signs of sickness, but they can spread the disease to others. It is very important that everyone in the house follow all the guidelines of cleanliness with great care (See page 133 to page 139).

♦ The Hepatitis A virus passes from the stool of one person to the mouth of another by way of contaminated water or food. To prevent others from getting sick, bury the sick person’s stools. The sick person, his family and caregivers must try to stay clean and wash their hands often.

♦ The Hepatitis B and Hepatitis C viruses can pass from person to person through sex, injections with unsterile needles, transfusions of infected blood and from mother to baby at birth. Take steps to prevent passing hepatitis to others: use a condom during sex (see page 287), follow the HIV prevention suggestions on page 401, and always boil needles and syringes before each use (see page 74).

♦ Vaccines now exist for Hepatitis A and Hepatitis B but they may be expensive or not be available everywhere. Hepatitis B is dangerous and there is no cure, so if the vaccine is accessible all children should be vaccinated. There is a new medicine for Hepatitis C, but it is very expensive and not widely available.

WARNING: Hepatitis can also be transmitted by giving injections with unsterile needles: Always boil needles and syringes before each use (see page 74).

173

ARTHRITIS (PAINFUL, INFLAMED JOINTS)

Most chronic joint pain, or arthritis, in older people cannot be cured completely. However, the following offer some relief:

♦ Rest. If possible, avoid hard work and heavy exercise that bother the painful joints. If the arthritis causes some fever, it helps to take naps during the day.

♦ Place cloths soaked in hot water on the painful joints (see page 195).

♦ Aspirin helps relieve pain; the dose for arthritis is higher than that for calming other pain. Adults should take 3 tablets, 4 times a day. If your ears begin to ring, take less. To avoid stomach problems caused by aspirin, always take it with food, or a large glass of water. If stomach pain continues, take the aspirin not only with food and lots of water, but also with a spoonful of an antacid such as Maalox or Gelusil.

♦ It is important to do simple exercises to help maintain or increase the range of motion in the painful joints.

If only one joint is swollen and feels hot, it may be infected especially if there is fever. Use an antibiotic such as penicillin (see page 350) and if possible see a health worker.

Painful joints in young people and children may be a sign of other serious illness, such as rheumatic fever (page 310) or tuberculosis (page 179). For more information on joint pain, see Disabled Village Children, Chapters 15 and 16.

BACK PAIN

Back pain has many causes. Here are some: Chronic upper back pain with cough and weight loss may be TB of the lungs (page 179).

Mid back pain in a child may be TB of the spine, especially if the backbone has a hump or lump.

Low back pain that is worse the day after heavy lifting or straining may be a sprain.

Severe low back pain that first comes suddenly when lifting or twisting may be a slipped disc, especially if one leg or foot becomes painful or numb and weak. This can result from a pinched nerve.

Standing or sitting with the shoulder drooped is a common cause of backache.

In older people, chronic back pain is often arthritis. Pain in the upper right back may be from a gallbladder problem (page 329).

Acute (or chronic) pain here may be a urinary problem (page 234).

Low backache is normal for some women during menstrual periods or pregnancy (page 248).

Very low back pain sometimes comes from problems in the uterus, ovaries, or rectum.

174

Treatment and prevention of back pain:

♦ If back pain has a cause like TB, a urinary infection, or gallbladder disease, treat the cause. Seek medical help if you suspect a serious disease.

♦ Simple backache, including that of pregnancy, can often be prevented or made better by: 1.always standing straight 2.sleeping on a firm surface 3.back-bending exercises (done very slowly)

♦ Aspirin and hot soaks (page 195) help calm most kinds of back pain.

♦ For sudden, severe, low back pain that comes from twisting, lifting, bending, or straining, quick relief can sometimes be brought like this:

Have the person lie with one foot tucked under his knee.

Then, holding this shoulder down, gently but steadily push this knee over so as to twist the back.

Do this first on one side and then the other.

CAUTION: Do not try this if the back pain is from a fall or injury.

♦ If back pain from lifting or twisting is sudden and severe with knife-like pain when you bend over, if the pain goes into the leg(s), or if a foot becomes numb or weak, this is serious. A nerve coming from the back may be ‘pinched’ by a slipped disc (pad between the bones of the back). It is best to rest flat on your back for a few days. It may help to put something firm under the knees and mid back.

♦ Take aspirin and use hot soaks. If pain does not begin to get better in a few days, seek medical advice.

175

VARICOSE VEINS

Varicose veins are veins that are swollen, twisted, and often painful. They are often seen on the legs of older people and of women who are pregnant or who have had many children.

Treatment:

There is no medicine for varicose veins. But the following will help:

♦ Do not spend much time standing or sitting with your feet down. If you have no choice but to sit or stand for long periods, try to lie down with your feet up (above the level of the heart) for a few minutes every half hour. When standing, try to walk in place. Or, repeatedly lift your heels off the ground and put them back down. Also, sleep with your feet up (on pillows).

♦ Use elastic stockings (support hose) or elastic bandages to help hold in the veins. Be sure to take them off at night.

♦ Taking care of your veins in this way will help prevent chronic sores or varicose ulcers on the ankles (page 213).

PILES (HEMORRHOIDS)

Piles or hemorrhoids are varicose veins of the anus or rectum, which feel like little lumps or balls. They may be painful, but are not dangerous. They frequently appear during pregnancy and may go away afterwards.

♦ Certain bitter plant juices (witch hazel, cactus, etc.) dabbed on hemorrhoids help shrink them. So do hemorrhoid suppositories (page 391).

♦ Sitting in a bath of warm water can help the hemorrhoid heal.

♦ Piles may be caused in part by constipation. It helps to eat plenty of fruit or food with a lot of fiber, like cassava or bran.

♦ Very large hemorrhoids may require an operation. Get medical advice.

If a hemorrhoid begins to bleed, the bleeding can sometimes be controlled by pressing with a clean cloth directly on the hemorrhoid.

If the bleeding still does not stop, seek medical advice. Or try to control the bleeding by removing the clot that is inside the swollen vein.

First, clean the anus with soap and water. Use a blade that has been sterilized by boiling to cut a small opening in the hemorrhoid. Use sterilized tweezers to pull out the clot. Put pressure on the cut with a clean cloth until bleeding stops.

CAUTION: Do not try to cut the hemorrhoid out. The person can bleed to death.

176

SWELLING OF THE FEET AND OTHER PARTS OF THE BODY

Swelling of the feet may be caused by a number of different problems, some minor and others serious. But if the face or other parts of the body are also swollen, this is usually a sign of serious illness.

Women’s feet sometimes swell during the last three months of pregnancy. This is usually not serious. It is caused by the weight of the child that presses on the veins coming from the legs in a way that limits the flow of blood.

However, if the woman also has high blood pressure, swollen face, a lot of protein in her urine, or sudden weight gain, she may be suffering from pre-eclampsia (see page 249). Seek medical help fast.

Old people who spend a lot of time sitting or standing in one place often get swollen feet because of poor circulation. However, swollen feet in older persons may also be due to heart trouble (page 325) or, less commonly, kidney disease (page 234).

Swelling of the feet in small children may result from anemia (page 124) or malnutrition (page 107). In severe cases of malnutrition the face and hands may also become swollen (see Kwashiorkor, page 113).

Treatment:

To reduce swelling, treat the sickness that causes it. Use little or no salt in food. Herbal teas that make people urinate a lot usually help (see corn silk, page 12). Also do the following:

WHEN YOUR FEET ARE SWOLLEN:

Do not spend time sitting with your feet GOOD down. This makes them swell more.

When you sit, put your feet up high. This way the swelling becomes less. Put your feet up several times a day. Your feet should be above the level of your heart.

Also sleep with your feet raised.

177

HERNIA (RUPTURE)

A hernia is an opening or tear in the muscles covering the belly. This permits a loop of gut to push through and form a lump under the skin. Hernias usually come from lifting something heavy, or straining (as during childbirth). Some babies are born with a hernia (see page 317). In men, hernias are common in the groin. Swollen lymph nodes (page 88) may also cause lumps in the groin. However . . .

A hernia is usually here, and you can feel it with a finger, like this.

It gets bigger when you cough (or lift).

Lymph nodes are usually here and do not get bigger when you cough.

How to prevent a hernia:

Lift heavy things like this

How to live with a hernia:

♦ Avoid lifting heavy objects.

♦ Make a truss to hold the hernia in.

PLAN FOR A SIMPLE TRUSS:

Put a little cushion here so it presses against the groin.

CAUTION:

If a hernia suddenly becomes large or painful, try to make it go back in by lying with the feet higher than the head and pressing gently on the bulge. If it will not go back, seek medical help.

If the hernia becomes very painful and causes vomiting, and the person cannot have a bowel movement, this can be very dangerous.

Surgery may be necessary. Seek medical help fast. In the meantime, treat as for Appendicitis (page 95).

178

SEIZURES (FITS, CONVULSIONS)

We say a person has a seizure when he suddenly loses consciousness and makes strange, jerking movements (convulsions). Seizures come from a problem in the brain. In small children, common causes of seizures are high fever and severe dehydration. In very ill persons, the cause may be meningitis, malaria of the brain (cerebral malaria), or poisoning. In pregnant women, it may be eclampsia (see page 249). A person who often has seizures may have epilepsy.

♦ Try to figure out the cause of a seizure and treat it, if possible.

♦ If the child has a high fever, lower it with cool water (see page 76).

♦ If the child is dehydrated, give an enema of Rehydration Drink slowly. Send for medical help. Give nothing by mouth during a seizure.

♦ If there are signs of meningitis (page 185), begin treatment at once. Seek medical help.

♦ If you suspect cerebral malaria, inject quinine or artesunate (see page 366).

♦ If you suspect eclampsia, give medicine (see page 390).

EPILEPSY

Epilepsy causes seizures (fits) in people who otherwise seem fairly healthy. Seizures may come hours, days, weeks, or months apart. In some persons they cause loss of consciousness and violent movements. The eyes often roll back.

In mild types of epilepsy the person may suddenly ‘blank out’ a moment, make strange movements, or behave oddly. Epilepsy is more common in some families (inherited).

Or it may come from brain damage at birth, high fever in infancy, or tapeworm cysts in the brain (page 143). Epilepsy is not an infection and cannot be ‘caught’. It is often a life-long problem. However, babies sometimes get over it.

Medicines to prevent epileptic seizures:

Note: These do not ‘cure’ epilepsy; they help prevent seizures. Often the medicine must be taken for life.

♦ Phenobarbital often controls epilepsy. It costs little (see page 389).

♦ Phenytoin may work when phenobarbital does not. Use the lowest possible dose that prevents seizures (see page 389).

When a person is having a seizure:

♦ Try to keep the person from hurting himself: move away all hard or sharp objects.

♦ Put nothing in the person’s mouth while he is having a seizure. No food, drink, medicine, nor any object to prevent biting the tongue.

♦ After the seizure the person may be dull and sleepy. Let him sleep.

♦ If a seizure lasts more than 15 minutes, put liquid diazepam in the rectum using a plastic syringe without a needle. For dosage see page 389. Do not inject phenytoin, phenobarbital, or diazepam into the muscles. These medicines can be injected in the vein, but it is very dangerous if you have little experience. Only a person with experience giving injections into a vein should give injections of these medicines.

For more information on seizures, see Disabled Village Children, Chapter 29.

• TUBERCULOSIS (TB, consumption)
• RABIES
• TETANUS (Lockjaw)
• MENINGITIS
• MALARIA
  • Signs of malaria
  • Analysis and treatment
  • How to avoid MALARIA and DENGUE
• DENGUE (breakbone fever, dandy fever)
• BRUCELLOSIS, UNDULANT FEVER, MALTA FEVER
• TYPHOID FEVER
• TYPHUS
• LEPROSY (Hansen’s disease)

The diseases covered in this chapter are often difficult or impossible to cure without medical help. Many need special medicines that are difficult to get in rural areas. Home remedies will not cure them. If a person has one of these illnesses,

THE SOONER HE GETS MEDICAL HELP, THE BETTER HIS CHANCE OF GETTING WELL.

CAUTION: Many of the illnesses covered in other chapters may also be serious and require medical assistance. See the Signs of Dangerous Illness, page 42.

TUBERCULOSIS (TB, consumption)

Tuberculosis of the lungs is a chronic (long-lasting), contagious (easily spread) disease that anyone can get. But it often strikes persons between 15 and 35 years of age, especially those who are weak, poorly nourished, have HIV, or live with someone who has TB.

Because so many people with HIV (page 399) get very sick with TB, all people with HIV should get a TB test.

People with HIV can take isoniazid (see page 360) to prevent TB from developing. Encourage people with TB to also be tested for HIV and find help with a treatment program if they are positive.

Tuberculosis is curable. Yet thousands die needlessly from this disease every year. Both for prevention and cure, it is very important to treat tuberculosis early. Be on the lookout for the signs of tuberculosis. A person may have one or many of them.

180

Most frequent signs of TB:

• A cough that lasts longer than 3 weeks, often worse just after waking up.

• Slight fever in the evening and sweating at night.

• There may be pain in the chest or upper back.

• Chronic loss of weight and increasing weakness.

In serious or advanced cases:

• Coughing up blood (usually a little, but in some cases a lot).

• Pale, waxy skin. The skin of a dark skinned person tends to get lighter, especially the face.

• Voice grows hoarse (very serious). In young children: The cough may come late. Instead, look for:

• Steady weight loss.

• Frequent fever.

• Lighter skin color.

• Swellings in the neck (lymph nodes), or the belly (page 20)

TB is usually only in the lungs. But it can affect any part of the body. In young children it may cause meningitis (see page 185). For skin problems from TB, see page 212.

If you think you might have tuberculosis:

Seek medical help. At the first sign of tuberculosis, go to a health center where the workers can examine you, and test the stuff you cough up (phlegm or sputum) to see if you have TB or not. Many governments give TB medicines free. Ask at the nearest health center. You will probably be given some of the following medicines:

• Isoniazid (INH) pills (page 360)

• Ethambutol pills (page 361)

• Rifampin pills (page 360).

• Streptomycin injections (page 361)

• Pyrazinamide pills (page 361)

It is very important to take the medicines as directed. Treatments may be different in different countries, but usually the treatment has 2 parts. You will take 4 medicines for 2 months and then test your sputum. If you are getting better, you will take 2 or 3 medicines for another 4 months. Then you will be tested again to make sure you are cured. Do not stop taking the medicines, even if you feel better. This can lead to the illness coming back and infecting you and other people, with a form of TB that is much harder to cure, multi-drug resistant tuberculosis (see page 359). To cure TB completely can take from 6 months to more than a year.

Eat as well as possible: plenty of energy foods and also foods rich in proteins and vitamins (pages page 110 to page 111). Rest is important. If possible, stop working and take it easy until you begin to get better. From then on, try not to work so hard that you become tired or breathe with difficulty. Try to always get enough rest and sleep.

Tuberculosis in any other part of the body is treated the same as TB of the lungs, but the treatment may be longer. This includes TB in the glands of the neck, TB of the abdomen (see picture on page 20), TB of the skin (see page 212), and TB of a joint (like the knee). A child with severe TB of the backbone may also need surgery to prevent paralysis (see Disabled Village Children, Chapter 21).

Tuberculosis is very contagious. It spreads when someone with TB coughs germs into the air. Anyone, especially a child, who lives with someone who has TB runs a great risk of catching the disease.

If someone in the house has TB:

• If possible, see that the whole family is tested for TB (Tuberculin test).

• Have the children vaccinated against TB with B.C.G. vaccine.

• Everyone, especially the children, should eat plenty of nutritious food.

• The person with TB should eat and sleep separately from the children, if possible in a different room, as long as he has any cough at all.

• Ask the person with TB to cover his mouth when coughing and not spit on the floor.

• Watch for weight loss and other signs of TB in members of the family. Weigh each person, especially the children, once a month, until you are sure no one in the household is sick with TB.

TB in family members often starts very slowly and quietly. If anyone in the family shows signs of TB, have tests done and begin treatment at once.

Early and full treatment is a key part of prevention.

181

RABIES

Rabies comes from the bite of a rabid or ‘mad’ animal, usually a rabid dog, cat, fox, wolf, skunk, or jackal. Bats and other animals may also spread rabies.

Signs of rabies in the animal:

• Acts strangely, sometimes sad, restless, or irritable.

• Foaming at the mouth, cannot eat or drink.

• Sometimes the animal goes wild (mad) and may bite anyone or anything nearby.

• The animal dies within 5 to 7 days.

Signs in people:

• Pain and tingling in the area of the bite.

• Irregular breathing, as if the person has just been crying.

• Pain and difficulty swallowing, and fear of liquids. A lot of thick, sticky saliva.

• The person is alert, but very nervous or excitable. Fits of anger can occur.

• As death nears, seizures (convulsions) and paralysis.

If you have any reason to believe an animal that has bitten someone has rabies:

• Tie or cage the animal for a week.

• Clean the bite well with soap, water, and hydrogen peroxide. Do not close the wound; leave it open.

• If the animal dies before the week is up (or if it was killed or cannot be caught), take the bitten person at once to a health center where he can be given a series of anti-rabies injections.

The first symptoms of rabies appear from 10 days up to 2 years after the bite (usually within 3 to 7 weeks). Treatment must begin before the first signs of the sickness appear. Once the sickness begins, no treatment known to medical science can save the person’s life.

Prevention:

• Kill and bury or cage for one week any animal suspected of having rabies.

• Cooperate with programs to vaccinate dogs.

• Keep children far away from any animal that seems sick or acts strangely.

Take great care in handling any animal that seems sick or acts strangely. Even if it does not bite anyone, its saliva can cause rabies if it gets into a cut or scratch.

182

TETANUS (Lockjaw)

Tetanus results when a germ that lives in the feces of animals or people enters the body through a wound. Deep or dirty wounds are especially dangerous.

wounds very likely to cause tetanus

• animal bites, especially those of dogs and pigs

• gunshot and holes made with knife wounds dirty needles

• injuries caused by barbed wire

• puncture wounds from thorns, splinters, or nails

causes of tetanus in the newborn child

Tetanus germs enter through the umbilical cord of a newborn baby because of lack of cleanliness or failure to take other simple precautions. The chance of tetanus is greater

• when the cord has been cut with an instrument that has not been boiled and kept completely clean, or

• when the cord has not been cut close to the body (see page 262), or

• when the newly cut cord is tightly covered or is not kept dry.

183

Signs of tetanus:

• An infected wound (sometimes no wound can be found).

• Discomfort and difficulty in swallowing.

• The jaw gets stiff (lockjaw), then the muscles of the neck and other parts of the body get stiff. The person has difficulty walking normally.

• Painful convulsions (sudden tightening) of the jaw and finally of the whole body. Moving or touching the person may trigger sudden spasms like this:

Sudden noise or bright light may also bring on these spasms.

In the newborn, the first signs of tetanus generally appear 3 to 10 days after birth. The child begins to cry continuously and is unable to suck. Often the umbilical area is dirty or infected. After several hours or days, lockjaw and the other signs of tetanus begin.

It is very important to start treating tetanus at the first sign. If you suspect tetanus (or if a newborn child cries continuously or stops nursing), make this test:

test of knee reflexes

With the leg hanging freely, tap the knee with a knuckle just below the kneecap.

If the leg jumps just a little bit, the reaction is normal.

If the leg jumps high, this indicates a serious illness like tetanus (or perhaps meningitis or poisoning with certain medicines or rat poison).

This test is especially useful when you suspect tetanus in a newborn baby.

184

What to do when there are signs of tetanus:

Tetanus is a deadly disease. Seek medical help at the first sign. If there is any delay in getting help, do the following things:

• Examine the whole body for infected wounds or sores. Often the wound will contain pus. Open the wound and wash it with soap and cool, boiled water; completely remove all dirt, pus, thorns, splinters, etc.; flood the wound with hydrogen peroxide if you have any.

• Inject 1 million units of procaine penicillin at once and repeat every 12 hours for 7 to 10 days (page 352). (For newborn babies crystalline penicillin is better.) After using injected penicillin for 2 days, you can switch to penicillin by mouth (penicillin V, page 351). If there is no penicillin, use another antibiotic, like tetracycline.

• If you can get it, inject 5000 units of Antitetanus Immunoglobulin (human tetanus immune globulin, HTIG), 1 time only. Be sure to follow all the precautions (See page 70 and page 388).

• As long as the person can swallow, give nutritious liquids in frequent small sips.

• To control convulsions, give diazepam (Valium) by mouth or in the rectum (for dosages See page 388 to page 390).

• Touch and move the person as little as possible. Avoid noise and bright light.

• If necessary, use a catheter (rubber tube) connected to a syringe to suck the mucus from the nose and throat. This helps clear the airway.

• For the newborn with tetanus, if possible, have a health worker or doctor put in a nose-to-stomach tube and feed the baby the mother’s breast milk. This provides needed nutrition and fights infection.

How to prevent tetanus:

Even in the best hospitals, half the people with tetanus die. It is much easier to prevent tetanus than to treat it.

• Vaccination: This is the surest protection against tetanus. Both children and adults should be vaccinated. Vaccinate your whole family at the nearest health center (see page 147). For complete protection, the vaccination should be repeated once every 10 years. Vaccinating women against tetanus each time they are pregnant will prevent tetanus in newborn infants (see page 250).

• When you have a wound, especially a dirty or deep wound, clean and take care of it in the manner described on page 89.

• If the wound is very big, deep, or dirty, seek medical help. If you have not been vaccinated against tetanus, get the vaccination and also get an injection of antitetanus immunoglobulin (see page 388).

• In newborn babies, cleanliness is very important to prevent tetanus. The instrument used to cut the umbilical cord should be sterilized (page 262); the cord should be cut short, and the umbilical area kept clean and dry.

185

MENINGITIS

This is a very serious infection of the brain, more common in children. It may begin as a complication of another illness, such as measles, mumps, whooping cough, malaria, or an ear infection. Children of mothers who have tuberculosis sometimes get tubercular meningitis in the first few months of life.

Signs:

• Fever

• Severe headache.

• Stiff neck. The child looks very ill, and lies with his head and neck bent back, like this:

• The back is too stiff to put the head between the knees.

• In babies under a year old: the fontanel (soft spot on top of the head) bulges out.

• Vomiting is common.

• In babies and young children, early meningitis may be hard to recognize. The child may cry in a strange way (the ‘meningitis cry’), even when the mother puts the child on her breast. Or the child may become very sleepy.

• Sometimes there are seizures (fits, convulsions) or strange movements.

• The child often gets worse and worse and only becomes quiet when he loses consciousness completely.

• Tubercular meningitis develops slowly, over days or weeks. Other forms of meningitis come on more quickly, in hours or days.

Treatment:

Get medical help fast, every minute counts! If possible take the person to a hospital. Meanwhile:

• Inject ampicillin every 6 hours, 500 mg for children or 1 g for adults (see page 353). Also give ceftriaxone or gentamicin (see page 358).

• If there is high fever (more than 40°), lower it with wet cloths and acetaminophen or aspirin (See page 378 to page 379).

• If the mother has tuberculosis or if you have any other reason to suspect that the child has tubercular meningitis, inject him with 20 mg of streptomycin for each kg. he weighs and get medical help at once. Also, use ampicillin in case the meningitis is not from TB.

• If you know the meningitis came from malaria, give an injection of artesunate or quinine at once (see page 366).

Prevention:

For prevention of tubercular meningitis, newborn babies of mothers with tuberculosis should be vaccinated with B.C.G. at birth. Dose for the newborn is 0.05 ml (half the normal dose of 0.1 ml).

For other suggestions on prevention of TB, see pages page $1 to 180.

186

MALARIA

Malaria is an infection of the blood that causes chills and high fever. Malaria is spread by mosquitos. The mosquito sucks up the malaria parasites in the blood of an infected person and injects them into the next person it bites. People with HIV are twice as likely to catch malaria.

Signs of malaria

The typical attack has 3 stages:

1. It begins with chills, and often headache. The person shivers or shakes for 15 minutes to an hour.

2. Chills are followed by fever, often 40° or more. The person is weak, rushed (red skin), and at times delirious (not in his right mind). The fever lasts several hours or days.

3. Finally the person begins to sweat, and his temperature goes down. After an attack, the person feels weak, but may feel more or less OK.

• Usually malaria causes fevers every 2 or 3 days (depending on the kind of malaria), but in the beginning it may cause fever daily. Also, the fever pattern may not be regular or typical. For this reason anyone who suffers from unexplained fevers should have his blood tested for malaria.

• Chronic malaria often causes a large spleen and anemia (see page 124). For people with HIV (page 399) it can cause them to get sick faster.

• In young children, anemia and paleness can begin within a day or two. In children with malaria affecting the brain (cerebral malaria), seizures (fits) may be followed by periods of unconsciousness.

Also, the palms may show a blue gray color, and breathing may be rapid and deep. (Note: Children who have not been breastfed are more likely to get malaria.)

Analysis and treatment

• If you suspect malaria or have repeated fevers, if possible go to a health center for a blood test. In areas where an especially dangerous type of malaria called falciparum occurs, seek treatment immediately.

• In areas where malaria is common and blood tests are not available, treat any unexplained high fever as malaria. Take the malaria medicine known to work best in your area. (See page 363 to page 367for dosages and information on malaria medicines.)

• If you get better with the medicine, but after several days the fevers start again, you may need another medicine. Get advice from the nearest health center.

• If a person who possibly has malaria begins to have seizures or other signs of meningitis (page 185) he may have cerebral malaria. If possible, inject quinine or artesunate at once (see page 366).

187

How to avoid MALARIA and DENGUE

Malaria occurs more often during hot, rainy seasons. If everyone cooperates, it can be controlled. All these control measures should be practiced at once.

1. Avoid mosquitos. Sleep where there are no mosquitos or underneath a bed net treated with insecticide or under a sheet. Cover the baby’s cradle with treated mosquito netting or a thin cloth.

2. Cooperate with the malaria control workers when they come to your village. Tell them if anyone in the family has had fevers and let them take blood for testing.

3. If you suspect malaria, get treatment quickly. After you have been treated, mosquitos that bite you will not pass malaria on to others.

4. Destroy mosquitos and their young. Mosquitos breed in water that is not flowing. Clear ponds, pits, old cans, or broken pots that collect water. Raise mosquito-eating fish in ponds or lakes. Fill the tops of bamboo posts with sand and keep water containers covered.

5. Malaria can also be prevented, or its effects greatly reduced, by taking anti-malaria medicines on a regular schedule. See page 363 to page 367.

DENGUE (breakbone fever, dandy fever)

This illness is sometimes confused with malaria. It is caused by a virus that is spread by mosquitos. In recent years it has become much more common in many countries.

It often occurs in epidemics (many persons get it at the same time), usually during the hot, rainy season. A person can get dengue more than once. Repeat illnesses are often worse.

To prevent dengue, control mosquitos and protect against their bites, as described above.

Signs:

• Sudden high fever with chills.

• Severe body aches, headache, sore throat.

• Person feels very ill, weak, miserable.

• After 3 to 4 days person feels better for a few hours to 2 days.

• Then illness returns for 1 or 2 days, often with a rash that begins on hands and feet.

• The rash then spreads to arms, legs, and finally the body (usually not the face).

A severe form of dengue may cause bleeding into the skin (small dark spots), or dangerous bleeding inside the body. Go to a hospital immediately.

Treatment:

• No medicine cures it, but the illness goes away by itself in a few days.

• Rest, lots of liquids such as rehydration drink, fruit juice, or milk, acetaminophen (but not aspirin or ibuprofen) for fever and pain.

• In case of severe bleeding, treat for shock, if necessary (see page 77).

188

BRUCELLOSIS, UNDULANT FEVER, MALTA FEVER

This is a disease that comes from drinking fresh milk from infected cows or goats. It may also enter the body through scrapes or wounds in the skin of persons who work with sick cattle, goats, or pigs, or by breathing it into the lungs.

Signs:

• Brucellosis may start with fever and chills, but it often begins very gradually with increasing tiredness, weakness, loss of appetite, headache, stomach ache, and sometimes joint pains.

• The fevers may be mild or severe. Typically, these begin with afternoon chills and end with sweating in the early morning. In chronic brucellosis, the fevers may stop for several days and then return. Without treatment, brucellosis may last for years.

• There may be swollen lymph nodes in the neck, armpits, and groin (page 88).

Treatment:

♦ If you suspect brucellosis, get medical advice, because it is easy to confuse this disease with others, and the treatment is long and expensive.

♦ Treat with tetracycline, adults: two 250 mg. capsules 4 times a day for 3 weeks. For precautions, see page 357. Or use cotrimoxazole. (For dosage and precautions, see page 357.)

Prevention:

♦ Drink only cow’s or goat’s milk that has been boiled or pasteurized. In areas where brucellosis is a problem, it is safer not to eat cheese made from unboiled milk.

♦ Be careful when handling cattle, goats, and pigs, especially if you have any cuts or scrapes.

♦ Cooperate with livestock inspectors who check to be sure your animals are healthy.

PREVENT BRUCELLOSIS: never drink unboiled milk

189

TYPHOID FEVER

Typhoid is an infection of the gut that affects the whole body. It is spread from feces‐to‐mouth in contaminated food and water and often comes in epidemics (many people sick at once). Of the different infections sometimes called ‘the fever’ (see page 26), typhoid is one of the most dangerous.

Signs of typhoid:

First week:

• It begins like a cold or flu.

• Headache, sore throat, and often a dry cough.

• The fever goes up and down, but rises a little more each day until it reaches 40° or more.

• Pulse is often relatively slow for the amount of fever present. Take the pulse and temperature every half hour. If the pulse gets slower when the fever goes up, the person probably has typhoid (see page 26).

• Sometimes there is vomiting, diarrhea, or constipation.

Fever goes like this:

• 1st day: 37.5°C

• 2nd day: 38°

• 3rd day: 38.5°

• 4th day: 39°

• 5th day: 39.5°

• 6th day: 40°

Second week:

• High fever, pulse relatively slow.

• A few pink spots may appear on the body.

• Trembling.

• Delirium (person does not think clearly or make sense).

• Weakness, weight loss, dehydration.

Third week:

• If there are no complications, the fever and other symptoms slowly go away.

Treatment:

♦ Seek medical help.

♦ Give ciprofloxacin (page 356), chloramphenicol (page 356), ampicillin (page 352), or cotrimoxazole (page 357). Ask a health worker which medicine works best where you live.

♦ Lower the fever with cool wet cloths (see page 76).

♦ Give plenty of liquids: soups, juices, and Rehydration Drink to avoid dehydration (see page 152).

♦ Give nutritious foods, in liquid form if necessary.

♦ The person should stay in bed until the fever is completely gone.

♦ If the person shits blood or develops signs of peritonitis (page 94) or pneumonia (page 171), take her to a hospital at once.

Prevention:

♦ To prevent typhoid, care must be taken to avoid contamination of water and food by human feces. Follow the guidelines of personal and public hygiene in Chapter 12. Make and use latrines. Be sure latrines are a safe distance from where people get drinking water.

♦ Cases of typhoid often appear after a flood or other disaster, and special care must be taken with cleanliness at these times. Be sure drinking water is clean. If there are cases of typhoid in your village, all drinking water should be boiled. Look for the cause of contaminated water or food.

♦ To avoid the spread of typhoid, a person who has the disease should stay in a separate room. No one else should eat or drink from the dishes he uses. His stools should be burned or buried in deep holes. Persons who care for him should wash their hands right afterwards.

♦ After recovering from typhoid some persons still carry the disease and can spread it to others. So anyone who has had typhoid should be extra careful with personal cleanliness and should not work in restaurants or where food is handled. Sometimes ampicillin is effective in treating typhoid carriers.

190

TYPHUS

Typhus is an illness similar to but different from typhoid. The infection is transmitted by bites of lice ticks rat fleas

Signs:

• Typhus begins like a bad cold. After a week or more fever begins, with chills, headache, and pain in the muscles and chest.

• After a few days of fever a typical rash appears, first in the armpits and then on the body, then the arms and legs (but not on the face, palms of the hands, or soles of the feet). The rash looks like many tiny bruises.

• The fever lasts 2 weeks or more. Typhus is usually mild in children and very severe in old people. An epidemic form of typhus is especially dangerous.

• In typhus spread by ticks, there is often a large painful sore at the point of the bite, and the lymph nodes near the bite are swollen and painful.

Treatment:

♦ If you think someone may have typhus, get medical advice. Special tests are often needed.

♦ Give tetracycline, adults: 2 capsules of 250 mg. 4 times a day for 7 days (see page 355). Chloramphenicol also works, but is riskier (page 356).

Prevention:

♦ Keep clean. De-louse the whole family regularly.

♦ Remove ticks from your dogs and do not allow dogs in your house.

♦ Kill rats. Use cats or traps (not poison, which can be dangerous to other animals and children).

♦ Kill rat fleas. Do not handle dead rats. The fleas may jump off onto you. Drown and burn the rats and their fleas. Put insecticide into rat holes and nests.

191

LEPROSY (Hansen’s disease)

This mildly infectious disease develops slowly, often over many years. It can only spread from persons who have untreated leprosy, to persons who have low resistance to the disease.

In areas where leprosy is common, children should be checked every 6 to 12 months especially children living with persons who have leprosy.

Signs:

Leprosy can cause a variety of skin problems, loss of feeling, and paralysis of the hands and feet.

The first sign of leprosy is often a slowly growing patch on the skin that does not itch or hurt. At first, feeling inside the patch may be normal. Keep watching it.

If feeling in the patch becomes reduced or absent (see page 38) it is probably leprosy.

Examine the whole body for skin patches, especially the face, arms, back, butt, and legs:

• Pale patch without clear border.

• Patches are a different color from surrounding skin, but never completely white or scaly.

• Ringworm‐like patch with or without raised border.

Later signs differ according to the person’s natural resistance to the disease. Watch out for:

• Tingling, numbness or loss of feeling in hands or feet. Or deformities or loss of feeling in skin patches.

• Slight weakness or toes deformities in the hands and feet. Clawed toes. Drop foot.

• Swollen nerves that form thick cords under the skin. Nerves may or may not be painful when you press them. Check for thick nerves in wrist ankle, elbow, neck, near armpits, behind knees :

Advanced sign may include:

• burns and scars where feeling has been lost

• ear lobe thick and lumpy

• loss of eyebrows

• blindness

• nose sometimes deformed

• painless sores on hands or feet

• paralysis and deformity of the hands and feet

Treatment of leprosy:

Leprosy is usually curable, but medicine must usually be taken for years. The best medicine is dapsone, combined with 1 or 2 other medicines (See page 362 to page 363).

If a ‘lepra reaction’ (fever, a rash, pain and perhaps swelling of hands and feet, or eye damage) occurs or gets worse while taking the medicine, keep taking it but get medical help.

192

Prevention of damage to hands, feet, and eyes:

The large open sores often seen on the hands and feet of persons with leprosy are not caused by the disease itself and can be prevented. They result because, when feeling has been lost, a person no longer protects himself against injury.

For example, if a person with normal feeling walks a long way and gets a blister, it hurts, so he stops walking or limps.

But when a person with leprosy gets a blister, it does not hurt.

So he keeps walking until the blister bursts and becomes infected. Still without pain, the infection gets deeper and attacks the bone.

In time the bone is destroyed and the foot becomes more and more deformed.

1. Protect hands and feet from things that can cut, bruise, blister, or burn them:

Do not go barefoot, especially not where there are sharp stones or thorns. Wear shoes or sandals. Put soft padding inside shoes and under straps that may rub.

When working or cooking meals, wear gloves. Never pick up an object that might be hot without first protecting your hand with a thick glove or folded cloth. If possible, avoid work that involves handling sharp or hot objects. Do not smoke.

1. At the end of each day (or more often if you work hard or walk far) examine your hands and feet very carefully or have someone else examine them. Look for cuts, bruises, or thorns.

Also look for spots or areas on the hands and feet that are red, hot, swollen or show the beginnings of blisters. If you find any of these, rest the hands or feet until the skin is completely normal again. This will help callous and strengthen the skin. Sores can be prevented.

1. If you have an open sore, keep the part with the sore very clean and at rest until it has completely healed. Take great care not to injure the area again.

2. Protect your eyes. Much eye damage comes from not blinking enough, because of weakness or loss of feeling. Blink your eyes often to keep them wet and clean.

If you cannot blink well, close your eyes tightly often during the day, especially when dust blows. Wear sun glasses with side shades, and maybe a sun hat. Keep eyes clean and flies away.

If you do these things and begin treatment early, most deformities with leprosy can be prevented.

For more information about Hansen’s disease, see Disabled Village Children, Chapter 26.

• GENERAL RULES FOR TREATING SKIN PROBLEMS
• Instructions for Using Hot Compresses (Hot Soaks)
• SKIN PROBLEMS: A Guide to Identification
  • If the skin has small or pimple-like sores
  • If the skin has a large, open sore or skin ulcer
  • If the skin lumps under the skin
  • If the skin has swollen lymph nodes
  • If the skin has large spots or dark patches
  • If the skin has large spots or white patches
  • If the skin has large spots or red patches
  • If the skin has raised reddish or gray patches
  • If the skin has warts
  • If the skin has rings
  • If the skin has welts or hives
  • If the skin has blisters
  • If the skin has blisters
• SCABIES (SEVEN YEAR ITCH)
• LICE
• BEDBUGS
• TICKS AND CHIGGERS
• SMALL SORES WITH PUS
• IMPETIGO
• YAWS
• BOILS AND ABSCESSES
• ITCHING RASH, WELTS, OR HIVES (ALLERGIC REACTIONS IN THE SKIN)
• PLANTS AND OTHER THINGS THAT CAUSE ITCHING OR BURNING OF THE SKIN
• SHINGLES (HERPES ZOSTER)
• FUNGUS INFECTIONS (RINGWORM, TINEA)
  • How to prevent fungal infections:
• WHITE SPOTS ON THE FACE AND BODY
• Vitiligo (White Areas of the Skin)
• MASK OF PREGNANCY
• PELLAGRA AND OTHER SKIN PROBLEMS DUE TO MALNUTRITION
• WARTS (VERRUCAE)
• CORNS
• PIMPLES AND BLACKHEADS (ACNE)
• CANCER OF THE SKIN
• TUBERCULOSIS OF THE SKIN OR LYMPH NODES
• ERYSIPELAS AND CELLULITIS
• GANGRENE (GAS GANGRENE)
• ULCERS OF THE SKIN CAUSED BY POOR CIRCULATION
• BED SORES (PRESSURE SORES)
• SKIN PROBLEMS OF BABIES
• DANDRUFF (Cradle Cap, Seborrhea)
• ECZEMA (RED PATCHES WITH LITTLE BLISTERS)
• PSORIASIS

Some skin problems are caused by diseases or irritations that affect the skin only, such as ringworm, diaper rash, or warts.

Other skin problems are signs of diseases that affect the whole body, such as the rash of measles or the sore, dry patches of pellagra (malnutrition).

Certain kinds of sores or skin conditions may be signs of serious diseases, like tuberculosis, syphilis, leprosy, or HIV infection.

This chapter deals only with the more common skin problems in rural areas. However, there are hundreds of diseases of the skin.

Some look so much alike that they are hard to tell apart, yet their causes and the specific treatments they require may be quite different.

If a skin problem is serious or gets worse in spite of treatment, seek medical help

Many skin problems can be helped by keeping the body clean. Try to wash once a day with mild soap and clean water.

If the skin becomes too dry, wash less often and do not use soap every time. Try rubbing petroleum gel (Vaseline), glycerin, or vegetable oils into the skin after bathing. Wear loose cotton clothing.

194

GENERAL RULES FOR TREATING SKIN PROBLEMS

Although many skin problems need specific treatment, there are a few general measures that often help:

RULE 1

If the affected area is hot and painful, or oozes pus, treat it with heat. Put hot, moist cloths on it (hot compresses).

If the skin shows signs of serious infection such as:

• inflammation (redness or darkening of skin around the affected areas)

• swelling

• pain

• heat (it feels hot)

• pus

Do the following:

♦ Keep the affected part still and elevate it (put it higher than the rest of the body).

♦ Apply hot, moist cloths.

♦ If the infection is severe or the person has a fever, give antibiotics (penicillin, a sulfonamide, or erythromycin).

Danger signs include: swollen lymph nodes, a red or dark line above the infected area, or a bad smell. If these do not get better with treatment use an antibiotic and seek medical help quickly.

RULE 2

If the affected area itches, stings, or oozes clear fluid, treat it with cold. Put cool, wet cloths on it (cold compresses).

If the affected skin forms blisters or a crust, oozes, itches, stings, or burns, do the following:

♦ Apply cloths soaked in cool water with white vinegar (2 tablespoons of vinegar in 1 quart of pure boiled water).

♦ When the affected area feels better, no longer oozes, and has formed tender new skin, lightly spread on a mixture of talc and water (1 part talc to 1 part water).

♦ When healing has taken place, and the new skin begins to thicken or flake, rub on a little vegetable lard or body oil to soften it.

RULE 3

If the skin areas affected are on parts of the body often exposed to sunlight, protect them from the sun.

RULE 4

If the skin areas most affected are usually covered by clothing, expose them to direct sunlight for 10 to 20 minutes, 2 or 3 times a day.

195

Instructions for Using Hot Compresses (Hot Soaks)

1. Boil water and allow it to cool until you can just hold your hand in it.

2. Fold a clean cloth so it is slightly larger than the area you want to treat, wet the cloth in the hot water, and squeeze out the extra water.

3. Put the cloth over the affected skin.

4. Cover the cloth with a sheet of thin plastic or cellophane.

5. Wrap it with a towel to hold in the heat.

6. Keep the affected part raised.

7. When the cloth starts to cool, put it back in the hot water and repeat.

196

SKIN PROBLEMS: A Guide to Identification

If the skin has small or pimple-like sores

If the skin has a large, open sore or skin ulcer

If the skin lumps under the skin

197

If the skin has swollen lymph nodes

If the skin has large spots or dark patches

If the skin has large spots or white patches

If the skin has large spots or red patches

If the skin has raised reddish or gray patches

198

If the skin has warts