Hesperian Weblog

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.  

New Contraceptives Are Not Enough

Late last month, Nicholas Kristof wrote a column for the New York Times on contraception, “Birth Control Over Baldness” as well as a blog post called “An Aside on Contraception.” 

In these two pieces, Kristof bemoans the lack of funding for new contraceptive technology, saying, “Yet after three millennia, although we can now intercept a missile in outer space, we’re often still outwitted by wandering sperm. Largely, that’s because research on contraception is pitifully underfunded; if only family planning were treated as seriously as baldness! Contraception research just hasn’t received the resources it deserves, so we have state-of-the-art digital cameras and decades-old family planning methods.” He argues that cheap contraceptives could make a huge difference in the developing world.

We agree! Helping families plan and space their children is an essential part of empowering women, especially in developing countries – and investing in new technologies that make contraception more accessible, easier to use, or with less side effects, is to be championed. However, the problem of promoting contraception use in developing countries (and here in the U.S.) is not as easy as just creating new methods.

Hesperian friend and partner Melissa Smith, medical editor of Where Women Have No Doctor, summarized these challenges in her response to Kristof, published in the comments section of the NY Times blog:

While researching low-cost effective contraceptives is critical to improving global health, let us not forget to support grassroots action to deal with barriers to family planning.

As a physician in poor Guatemalan communities, I witnessed high maternal and infant mortality rates. Data show that simply spacing pregnancies by two years can dramatically reduce these deaths.

Contraceptives, however, often sit unused on clinic shelves. Family planning myths, religious barriers, and resistance from male partners mean many women cannot access contraceptives.

Effective strategies to address these barriers do exist, though they are not widely known. Grass-roots activists are working throughout the world to change this by publicizing ways communities can overcome these challenges.

If we focus on research but neglect grassroots strategies, we run the risk that these new methods will gather dust on clinic shelves along with existing contraceptives – affordable or not.

Melissa Smith, M.D

For more information about grass-roots efforts see: Community Action for Women’s Health and Empowerment, a work in progress at the Hesperian Foundation.

Thanks, Melissa, for bringing to light many of the complexities and nuances of this issue!

World Cup of Health: The Netherlands vs. Spain

At Hesperian, as with much of the world, football fever is in the air as the final of the World Cup approaches. Isolated whoops of victory and cries of defeat can be heard around the office, as staff members surreptitiously (or not-so-surreptitiously) keep an eye on their favorite teams. Comparisons and discussions are inevitable, and it didn’t take long to connect the game with the subject that is constantly on our minds here: health. What if the fates of the two competitors in Sunday’s final were to be decided through their approach to health and social justice, as opposed to a lucky kick of a ball?

Given the similar nature of the two countries, comparing their health systems would at first appear to be a yawn-inducing draw. Both the Netherlands and Spain have universal health care for their citizens; both are in Western Europe; and both are members of the European Union. Here in the US, where universal access to quality care is still a frustratingly distant goal, we wish we had anything like our finalists. But even with such enlightened rivals, quality health and especially health care equality is not assured.

The Netherlands uses a dual-insurance system of national health care, with long-term treatment and high-cost items such as wheelchairs covered by the state, and shorter-term procedures covered by mandatory private insurance, which is paid for by the individual and her or his employer. Spain, on the other hand, has a national health service that is all-inclusive and can be used by all residents. It is important to note that neither nation covers the important fields of dentistry and eye care. In both countries, citizens must buy private insurance for these.

Perhaps the biggest distinction between the health care in these two countries is how they treat undocumented immigrants. This is one of the many gaping holes in the recent US health reform, with the nation’s 7 million undocumented immigrants living in third-world conditions because of a lack of basic care. It seems that the Netherlands is not much different. Although they possess a wide social safety net, the Dutch do not extend it all the way down the social ladder. Undocumented immigrants do have opportunities to get care, but are often discouraged by doctors, the medical system, and other factors. Spain, in contrast, passed a law in 2002 extending full medical coverage to undocumented immigrants and there is little detectable difference between their access to care and that of the average Spanish citizen.

When the teams line up for the final this Sunday, there’s no telling who will come out the victor. In terms of equality in health care, however, the answer is clear: ¡VIVA ESPAÑA!

David Morley, June 15, 1923 – July 2, 2009

When David Morley died on July 2nd, Hesperian lost a long-standing friend and a loyal but critical supporter. Although he was 86 when he died unexpectedly from a heart attack, David had an unparalleled enthusiasm for his work that belied his age and affected everyone he met.

At the beginning of his medical career, and after working for a short while in general practice, David left England for Imesi-Ile, a village in rural Nigeria and began the pioneering work that would eventually help transform primary health care—especially for children. After arriving in Nigeria he quickly realized that the conventional Western hospital model for delivering health care would neither reduce infant mortality nor cure other serious childhood health problems. Health improvement would only be achieved by providing information and training people locally in health-care skills. By 1965, Imesi-Ile became the first community in the world to record the elimination of measles, achieved by training local women to immunize the children.

After 5 years in Nigeria, David returned to London and founded the Tropical Child Health Unit at the Institute of Child Health in London, but continued to travel internationally working with community-based groups helping them train local health workers. And somewhere along the way, David and Hesperian discovered each other and realized how complementary our people-oriented, low-tech approaches to health care for the world’s poorest people were. Bill Bower, co-author of Hesperian’s Helping Health Workers Learn, remembers David as an “out-of-the-box thinker,” who was consistently supportive of Hesperian’s work and who made the long journey to visit Project Piaxtla—the village-based health project in Ajoya, Mexico where the book Where There Is No Doctor was developed.

David was also a co-founder of Child-to-Child, which teaches children about various health and development issues. Children then pass on what they learn to other children, their families, and their wider communities through participatory activities, such as telling stories and playing games. Hesperian was one of the early “testers” of the Child-to-Child activities at Project Piaxtla, and you will find several of them in Helping Health Workers Learn and Disabled Village Children.

TALC (Teaching-aids At Low Cost), also founded by David, develops and distributes low-cost health education materials (including Hesperian’s books) to community health workers all over the global south.. TALC has been especially instrumental for getting wider distribution of Where There Is No Doctor, particularly in Africa. And unlike most octogenarians, David jumped whole hog into modern technology by pioneering the use of CD-ROMs as a way to provide access to health and medical education information in areas beyond the reach of the internet.

Over the 30-plus years we have been colleagues, we have been champions of each other’s work. It will be difficult to continue extending the reach of primary health care without David, and certainly we will not do it as creatively, as sensitively, or as successfully in his absence. David Morley will remain an inspiration to all of us involved in making health a reality for all people.