Hesperian Weblog

Do you know where your water comes from?

No matter where you are, in a rural or urban area, you are in a watershed. Often, we know which city, county and state we live in, but not which watershed! A watershed is an area of land where all the water from rain and snow drains downward to a single body of water, such as a stream, river, lake, or wetland. A healthy watershed has the right combination of plants, water and soil to protect groundwater and can provide us with water for drinking, washing, agriculture, industry, and recreation. If a watershed is damaged—for example by deforestation, dumping of industrial and agricultural waste, or building large dams—everyone’s health is affected.

Chapter 9 of A Community Guide to Environmental Health – published by Hesperian in 2008 and now available in Spanish – provides a wealth of information about why it is important to protect our watersheds and how this can be done. It includes clear explanations and illustrations, activities, and stories about people who have organized to protect their watersheds and their health in the Aguan river valley of Honduras, among the Yaqui people in Northern Mexico, and in the Yukon territory in Alaska. Take a look at this unique resource that is being used by health workers, teachers, activists, development professionals and others around the world working to improve the health of people and the environment.

Curious about your watershed? If you live in the US, you can find your watershed at the website of the Environmental Protection Agency by entering your zip code.

What’s changed? New software plug-in aids publishing work and Hesperian’s updates

Usually when a publisher reprints a book, they just send an order to the printing plant that they need another several thousand books, and the printer simply reuses the same files (or plates) to produce the additional copies. But not Hesperian.

Since thousands of people in over 200 countries rely on Where There Is No Doctor and other Hesperian publications to diagnose, treat, and prevent common illnesses, it is crucial to keep the information in our materials as up-to-date as possible. Every printing reflects evolving medical knowledge, changes in availability and effectiveness of medicines, World Health Organization recommendations, and more. Dozens of changes are made with every printing, and now, also between “printings” on the internet.

  While researching and implementing those changes is a lot of work, the challenge becomes even greater when you consider the need to communicate these medical changes to the thousands of users of the books and the partner organizations that translate, publish, and distribute them in 88 languages – organizations that also need to keep their editions up-to-date.

Like many publishers, Hesperian uses Adobe InDesign to create our books, but the program has no useful way to track and record changes. For years, we have tried to work around this shortcoming, manually marking up changed pages to photocopy or PDF and share with translation partners and others – a time consuming process with less than optimal results.

At last an efficient technological solution has appeared – from a small company called CtrlPublishing based in Sweden. CtrlPublishing has developed a “plug-in” (add-on) for Adobe InDesign and InCopy that allows for tracking of changes from multiple editors and designers. The plug-in, called CtrlChanges, clearly tracks and marks additions and deletions to text, is user-friendly and intuitive, and enables the creation of annotated PDFs with complete records of changes. This will enable our colleagues in Cambodia, for instance, to easily see what was added and deleted in our new edition so they can evaluate whether they want to translate and incorporate those same changes into their new Khmer printing.

  We visited CtrlPublishing’s website and tested a free trial of the plug-in, then wrote to the company to learn more. We were incredibly grateful when CtrlPublishing offered to donate the software to our always financially struggling non-profit!

We have now been experimenting with and using the CtrlChanges Pro plug-in for 4 months, while updating materials on midwifery, community dentistry, and environmental health. During this short time, we have been able to simplify and streamline our internal editorial processes and improve our ability to communicate critical medical updates to partners.

This summer, Hesperian’s flagship resource, Where There Is No Doctor, will be updated for the 26th time since its original publication in Spanish in the 1970s. HIV treatment recommendations, medicines for tuberculosis, and many other topics will be reviewed by Hesperian staff and trusted medical advisors working all over the world. But this time, we know that the process will be smoother and we will be able to share these lifesaving updates more quickly and efficiently in 88 languages with the people who need them most.

A Manual for All Reasons

Hesperian depends on our volunteers and supporters around the world to get our books to those who need them most.  Judy Tart has been packing books as a volunteer with Hesperian since 2007 – and her sister, Barbara Bamberger Scott, has been using Hesperian books since the 1980s.  Judy recently sent Barbara the most updated version of Where There Is No Doctor, and Barbara was so excited to see the book again that she published an article on her experiences using it in on Homestead.org. 

Some excerpts are below, and you can read the full article, "A Manual for All Reasons," here. 

I purchased my first copy of Where There Is No Doctor in 1980 in a radical bookshop in London at the advice of Quaker mentors who were preparing me to work in Botswana. I carried it from Botswana to England to the Dominican Republic back to England, to Spain and Kenya and back. I found it as useful in Europe (and now the US) as it was in the remote pueblo where I worked in the DR or the trackless desert homeland of the Masaai at the foot of the sacred Mount Kenya. I still read and still garner medical knowledge from WTIND. I am almost certain that in case of national emergency or natural disaster I could deliver a baby with nothing but a copy of WTIND, some clean towels and a very sharp knife. 

It is said that all over the world, in every Peace Corps training center, church guest house, and little ex-pat library for volunteers on furlough, you will find at least one copy of Where There Is No Doctor.

WTIND, once denounced by the World Health Organization, is now praised by that same organization, and is regularly issued to all Peace Corps volunteers. Undeniably, Werner and his cohort harnessed a variety of essential dynamics that, in their time, were both scientifically radical and socially prophetic: the preservation of and reverence for local medical practices when they could be shown to have any sound basis; the conviction  that poverty-ridden, barely literate people could be empowered  to understand their health and  heal others; and the dissemination of human-scale modern medical knowledge that has been said to have saved tens of thousands of lives.

Thanks to Judy, Barbara, and everyone else who works hard to get our books to the community health workers and villagers bringing health to all.  

Khmer edition of A Community Guide to Environmental Health released in Cambodia

In April 2006 Dr. David Narita, working with OMF in Cambodia, emailed Hesperian and asked for permission to translate and update the Khmer edition of Where There Is No Doctor. The only copies available in Khmer, he wrote, were printed in an old font that many people could no longer decipher, had been photocopied and re-bound so many times that even new copies were mostly illegible, and contained out of date medical information. In 2009, he printed a full translation of the 9th edition of Doctor.

Around the same time, Hesperian was looking for groups to begin translations of our newest book, A Community Guide to Environmental Health – Dr. Narita didn’t feel he could take the project on directly, but recommended one of his partners from the work on Where There is No Doctor, Mao Boran. Mr. Boran recruited two partners, a medical translator and an illustrator, and together with support from Dr. Narita they worked tirelessly to translate Environmental Health into Khmer, and to adapt 179 illustrations for a Cambodian setting. Throughout the process, they ensured that the page layout and numbers matched the English edition, so that Khmer and English speakers can work together using the two books.

Both books are now available in Khmer at three bookstores in Cambodia – Angkor Thom Bookstore, International Bookstore, and Peace Book Center – and can be purchased together for a reduced price. In addition, OMF is using both books as a part of their community health education and health evangelism work. Cambodia faces an array of obstacles to achieving health for all; 34% of the population lives on less than one dollar per day, and just under half of all Cambodia children under five are malnourished.

Mao writes, ‘I'm really proud to be part of the project, and always feel good when I got home and see the book. I expect to have more opportunity to expand my knowledge from translation, as well as to bring benefit to Cambodian people. What is most important is that I am really grateful for Hesperian to have brought books to Cambodia.’ Mao completed the translation just in time for his recent marriage, and we wish him the best in both ventures!

You can see a full list of Khmer translations of Hesperian titles here. 

Women Helping Women in Rural Madagascar

In the 15 years since Hesperian first published A Book for Midwives in 1995, the book has been used all around the world by traditional midwives, as well as by women concerned about their health and the health of their newborn children.

One such group of women lives in the commune of Mahatsinjo in rural Madagascar. They are a small group of traditional midwives, mothers, and young women who have banded together to promote women and children’s health in their remote region.

Their organization, Taratra Reny sy Zaza, faces considerable challenges: many of the women in the area have not finished primary school, and their families rely on small, unofficial landholdings to grow enough food. Many of the women have their first child when they are still in their mid teens, sometimes as young as 14. Caring for large families on few resources takes a great toll on the health of the women in the community, and the nearest hospital is fifteen kilometers away.

In order to promote women and young children’s health in these communities, Taratra joined forces with a handful of Canadian doctors to create health workshops that help local women better protect their health and the health of their families. One of these workshops, held September 6-9th, 2010, was designed to give midwives crucial training and skills to support women’s health, as well as provide basic health information about prenatal care, breastfeeding, and nutrition to other women in the community.

Using Hesperian’s book A Book for Midwives, and models of a pelvis, placenta, baby, and a uterus that were knitted from yarn, workshop facilitators demonstrated basic prenatal, birth and neonatal care, what to do in emergency situations, and gave participants the chance to have a hands-on learning experience.

Inspired by how this information can truly empower them to improve the health of women and children in the community, Taratra is working to organize a community health center that would serve the communities around Mahatsinjo while helping to improve the existing hospital at Tsinjoarivo, 15 km away. Based on this workshop, Taratra leaders are also planning to hold community conversations about women’s needs and are looking forward to conducting similar workshops in the coming months.

Taratra Reny sy Zaza first received Hesperian materials through the Gratis Books Program, which provides books free of charge to grassroots and community groups around the world who cannot afford to buy them, even at discounted prices. A Book for Midwives can be purchased through Hesperian’s online store and downloaded for free from our website.

Filling Without Drilling: Supplies for Community Dentistry

We are excited to announce the release of the new update of Where There Is No Dentist, a resource that community health workers, educators, and individuals from around the world have used to help people care for their teeth and gums since 1983! This new 2010 update includes expanded medicines information, an updated resources section with information on Atraumatic Restorative Treatment (ART), and the most current general information about HIV and care of the teeth and gums. In honor of the release of this updated edition, we’d like to share a story about how this book is used in the field – and how non-profits can help to support community dentistry.

For years, Lee Gallery, a longtime volunteer, has overseen Hesperian's Gratis (free book) program , combing through hundreds of letters from people who need our books but cannot afford them.

Recently, Lee received a letter from a dental assistant at Mzambazi Rural Hospital in Malawi, expressing his appreciation for the books he had received, including Where There Is No Doctor and Where There Is No Dentist.

“These health books have really helped me because now my work could go forward really properly,’’ said the dental assistant, Stanley Hoyi Chidimba, in a hand-written, one-page letter. “Sir, for this reason, I am really thanking you very, very much indeed.”

However, he realized that he could do only so much to help his patients: he had no filling material for Atraumatic Restorative Treatment (ART), a procedure in which dentists or dental workers remove tooth decay with hand tools, then fill the cavities with an adhesive material called glass ionomer. Since ART allows dental workers to fill cavities without drilling, it is especially useful in communities where expensive dental drills and the electricity needed to operate them are not available.

Mr. Chidimba even attached a copy of the certificate he had received for his training in the dental technique.

Mr. Chidimba eventually did receive help in the form of Lee’s dentist, whom she mentioned the predicament to in passing. The dentist sent an assortment of used but fully functional dental tools and supplies to Mr. Chidimba in Malawi, many of them unused product samples given away by pharmaceutical and dental corporations. A reviewer helping with the new 2010 update of Where There Is No Dentist later remarked to us that much of the equipment in US dental offices and clinics is simply thrown away after its pre-determined “life” due to governmental regulation, even though it can be reused if sharpened and refitted.

Many of the supplies needed for ART and other dental procedures are common tools such as tweezers, mirrors, explorers, and excavators, but they are often prohibitively expensive for community health workers. Where There Is No Dentist details how to build a variety of your own dental instruments, and we hope that more organizations that donate medicine and equipment to support health projects around the world will add dental tools and ART materials to the list of what they provide. As many health workers and advocates for community-based primary care have long understood, caring for the teeth and gums is part of caring for the person as a whole.

Hesperian is a non-profit publisher of health materials – we are not a grant-making organization, and we do not distribute dental supplies. However, we encourage you to explore the resources below, taken from Where There Is No Dentist, which may provide free or reduced-cost dental equipment:

FDI-The World Dental Federation 

Durbin PLC may sell instruments at lower prices—contact them! 

World Dental Relief

Project HOPE

Direct Relief International

MAP International

Dentaid

Working for young women’s health and empowerment in Sudan

A guest blog by Kim Wolf, Valentino Achak Deng Foundation and Program Associate for Sub-Saharan Africa at the Global Fund for Women

In July 2010, I spent two weeks traveling as a volunteer with the Valentino Achak Deng Foundation in Marial Bai, Southern Sudan, along with two friends, Sarah, a freelance journalist with the UK Guardian and Danielle, a domestic violence counselor in Seattle. The three of us initiated a twice-a-week girls club at a secondary school established by Valentino’s Foundation to provide a safe space for girls to discuss reproductive health issues and offer peer support, and conducted meetings with women entrepreneurs in the market to increase their access to resources.

Our conversation with 20 bright girls from the secondary school exposed a stark reality of limited choice. Four of the young women were already married with children and yet these were some of luckiest girls in Southern Sudan; only 2.5 percent of women aged 15-24 are literate and girls are more likely to die in childbirth than they are to finish primary school. It took a while for the students to feel comfortable speaking, but once questions started there was no stopping them. The girls expressed concern for early pregnancies, forced marriages, and a lack of understanding and access to contraceptives

It was obvious from these conversations that in Marial Bai and the surrounding region there is a serious lack of reproductive and sexual health and women’s rights education compounded by a very traditional and gendered post-conflict context. According to the UNFPA the estimated maternal mortality rate is 1,700 deaths per 100,000 live births, the fifth highest in the world, and contraceptive prevalence rates are a mere 1%. This is a normal part of life for these young women. But they feel that the more they learn, the more they will be able to stand up to these types of injustices.

I donated Hesperian's book Where Women Have No Doctor* to a group of girls that are boarding at the school in an effort to answer many of the questions they began to ask. They were thrilled to receive the book, so much that I found them reading it over a truck’s headlight one night. The energy I felt after talking with these young women was both powerful and confusing. Looking beyond that moment it was clear that for things to shift in favor of women and girls, reproductive health education, including for boys and men, is crucial to helping women realize their right to health in Southern Sudan and around the world.

For many Southern Sudanese the first step to a decent and peaceful life lies in the upcoming referendum. Everyone I spoke with plans to vote for secession from the North come January 2011, despite the North’s efforts to “make unity attractive” by building roads and infrastructure. At this pivotal time in the history of Sudan all hands are needed to bring peace to a land that has known so much turmoil and pain.

* The Arab Resource Collective (ARC) has translated six Hesperian titles into Arabic, including Where Women Have No Doctor. The ARC is a regional non-profit organization based in Lebanon and working in a number of countries, including Sudan.

Mongolian Edition of A Community Guide to Environmental Health

The Mongolian edition of A Community Guide to Environmental Health was among the top 20 bookstore bestsellers in April and May! This thrilling news is due to the work of Hesperian translation partner Oyungerel Tsedevdamba, director of the Mongolia NGO Local Solutions which produced their edition of A Community Guide to Environmental Health in April of 2010.

The book has been a huge success outside of bookstores as well. Three government ministries (Health, Environment and Education) are distributing 400-450 books each from through their offices in the local soums (counties) of Mongolia. Journalists have published at least 5 interesting and engaging articles directly related to the book in newspapers and magazines. Mongolian National Television have produced and broadcasted "environmental health" spots to coincide with the book release and Oyungerel has been hard at work encouraging other media to publicize the book and its contents. Recently, a Mongolian health blogger offered to publish the book chapter by chapter on his blog! Also, some journalists are initiating a series of articles calling upon Mongolians to utilize the information in our book to transform local communities.

During the development of this edition, Local Solutions discussed with Hesperian the necessity to add a chapter on geothermal heating to their edition. Poor air quality during the long and hard Mongolian winters is a huge health issue there. As they were compiling the information for the chapter, the test building with the first geothermal heating system was not providing the hoped-for results, and the engineers were worried that geothermal might not prove sufficient to overcome the cold Mongolian winter. As it turned out, by the time the book was sent to the printer, they learned that geothermal heating worked in a completely unexpected place – an old kindergarten building which contained more insulation than the test building. While timing did not permit Local Solutions to include that story in their edition, they recently wrote us:

”After publishing the Community Guide for Environmental Health, we were so encouraged to see that Mongolian public is VERY enthusiastic about learning everything to make their lifestyle greener. Unfortunately, our winter is the biggest enemy of our environment – just imagine – one village burns 18,000 tons of wood in one winter. So, we are starting to work on the second book with your style of simple language and drawings.”

Local Solutions fundraised enough to bring 4 consultants from JUCCCE (Joint US-China Collaboration on Clean Energy), an environmental NGO and a network of eco-friendly specialists and engineers, to Huvsgul province. Combined with work they were already carrying out in the capitol Ulaanbaatar and Selenge province, Oyuna reports “I am expecting extensive recommendations from JUCCCE team on how to green Mongolia's harsh winter. They will advise on how to improve building codes, insulation, heating systems, sealing practices, alternative fuels etc. Following their advice, Local Solutions is planning to compile a book "How to Make Winters Green" that will be for the general public. We are visualizing that it is going to be at least 500 pages explaining engineering stuff with simple illustrations and simple language.”

Misereor, the agency that helped fund the printing of the book, will be meeting with Local Solutions to discuss how to undertake some of the projects described in the book. It should be a fascinating and productive discussion.

We are looking forward to a Bay area visit from Local Solutions in August to hear more about their work and how they use the Community Guide as an organizing tool. If you are in the Bay Area and would like to be notified about (invited to!) a brown bag lunch talk at our office, let us know by writing to tawnia@hesperian.org.  

May Day: Remember the Dead, Fight for the Living

Labor activists in the US have traditionally celebrated May 1, International Workers Day or May Day, with actions and rallies to raise awareness and support for all workers, and in particular to recognize the advances of trade unions. We love Peter Linebaugh’s “The Incomplete, True, Authentic and Wonderful History of May Day” which dates the beginning of May Day to 1886.

In the United Sates, May 1 has also become an important day for immigration activists since 2006 when a broad coalition of groups mobilized millions of people in the U.S. for a “Day without Immigrants” to call attention to the role of immigrants in the U.S. economy. With the passing of a new, tough immigration law in Arizona last week, this year’s May Day is particularly important for the movement. The law, known as SB 1070, gives police officers unprecedented authority to stop and detain anyone who is suspected of being in the country without legal papers.

But despite the increase in worker occupational health and safety programs that labor organizing has won, each year thousands of workers are killed and millions become ill or are injured from unsafe conditions in their workplaces. Each year, workers and unions around the world, including AFL-CIO member unions in the US, recognize April 28 as an International Day of Mourning, or Workers Memorial Day.

This year’s Memorial Day is particularly significant for Hesperian because the Korean organization Supporters for the Health and Right of People in Semiconductor Industry (SHARPS) led by Dr. Jeong-ok Kong, one of our partners in the development of our book-in-progress A Worker’s Guide to Health and Safety, is remembering the workers who have died of occupational cancers in Korea. The most recent case, the death of Ji-yeon Park — a young worker from Samsung’s Onyang semiconductor factory — who died of leukemia at age 23, came less than one month after Samsung workers, their families, and community supporters participated in the 1st Memorial Week of occupational deaths of semiconductor workers to honor the memory of the many other workers who gave their lives working at Samsung. There are now 23 documented cases of Samsung workers who have suffered from blood cancers like leukemia or lymphoma, and 9 workers among them have already died.

Please take a moment to visit the recently unveiled Stop Samsung website, watch the workers and their families tell their story, and sign the petition to demand that Samsung acknowledge its responsibility for the cancer deaths of its workers; and the Korean government enforce its laws to protect workers.

Naomy Ruth Esiaba Works for Change in Kenya

By Jane Maxwell, Hesperian Editor

On page 210 of A Health Handbook for Women with Disabilities, there’s a story told by Naomy Ruth Esiaba, a polio survivor and woman of great determination from Kisumu, Kenya. In her story, Naomy recalls how, despite strong beliefs in her community that women with disabilities could not (and should not) become pregnant, Naomy did just that. She very much wanted to be a mother, loved children, and was delighted to be pregnant. But when she went for a check-up, the doctor told her to have an abortion right away because her disability would damage the developing baby. Women with disabilities are often encouraged to have abortions, even in countries where abortions are illegal.

Though she was scared, Naomy decided to go through with the pregnancy. But she was afraid to go for any more medical check-ups and didn’t do so until she was quite far along. Fortunately, when she did go for her check-up, she saw a helpful doctor who assured her she was going to carry the pregnancy to term, and advised her to give birth in a hospital. Naomy carried her baby the full 9 months, and delivered a healthy, non-disabled girl. During a recent trip to Kenya, I was lucky enough not only to visit my long-time friend Naomy, but to be there when “baby” Ann was home from college to celebrate her 21st birthday!

Naomy was a key reviewer of A Health Handbook for Women with Disabilities, and brought the same determined spirit to that endeavor. She gathered 7 friends—all women with disabilities—who camped at Naomy’s house for several days, sleeping on mattresses on the floor while they did a thorough review of the early manuscript. During that meeting they decided to start an organization, Disability and Women Development Strategies (DWDS), with the mission of empowering women with disabilities by providing education and building collaborative networks.

When A Health Handbook for Women with Disabilities was published in 2007, Hesperian received a grant to give copies of the book to disabled women’s groups in Africa. We sent Naomy 30 copies (later, she obtained and distributed 28 copies more). When the books arrived, she and her 7 colleagues at DWDS brought 30 women with disabilities to Kisumu and held the first workshop of its kind in that region of Kenya, discussing information from the book and giving each woman a copy. Naomy told me that this gathering gave the women and girls who attended an opportunity to get to know each other and establish relationships. Out of that workshop, 10 more community-based organizations for women with disabilities formed.

Representatives from each of these organizations continue to gather once a month to discuss various disability-related issues. While in Kenya, I was fortunate enough to attend one of the monthly meetings where about 50 women with disabilities, many of them with Hesperian’s book in hand, participated in discussions about disability and human rights. Naomy stressed to the group that many policies giving certain rights to people with disabilities are already in place in Kenya, such as physical access to public buildings, and free health care. However, few disabled people are aware of these policies, so they do not demand the services they are entitled to.

There are now 102 women with disabilities registered with DWDS, and there’s no doubt that with Naomy Ruth Esiaba at the helm, they will be making their voices heard.