Unnecessary injections
Injections are very popular in developing countries. It is very difficult to persuade adults that injections are seldom necessary and that other treatment would be better and less dangerous. Injections can carry disease or cause abscesses if needles and syringes are not properly sterilised for each injection.
Recent studies have also shown that injections increase the paralysis caused by polio. With an Indian colleague I have recently studied the effects of injections on children with polio in a hospital in South India. We looked at 262 children with polio. Of these, 174 had received unnecessary injections less than two days before the beginning of paralysis. We found that an injection in an arm or leg increased the likelihood of paralysis in that limb by 20%. We also found that injections increased the damage to muscles in that arm or leg. Injections were more likely to be linked with death or lack of recovery of muscle strength. Nearly a third of the children would not have had paralysis without the unnecessary injections.
Many injections – especially those for fevers and diarrhoea in children and babies – are unnecessary. If other medicines were given by mouth, then the effects of polio would also be reduced. We must persuade mothers that unnecessary injections for their sick children should be avoided.
Dr H V Wyatt, Dept of Clinical Medicine, Leeds University, 1 Hollyshaw Terrace, Leeds, LS15 7BG
EDITOR: Dr Wyatt would like to hear from anyone concerned about this issue. Fuller details of these research results are available. Any details of children with polio and injection practices would be gratefully received.
Request for teaching materials
The organisation, CONSEDE, in Honduras are asking readers for information. Together with five other groups, they are putting together a manual for teaching agriculture. Their idea is to simplify both the teaching and learning of agricultural techniques in their projects. They would be grateful if readers who know of other helpful publications that they could adapt, would write to them. They find Paso a Paso very helpful and are looking for similar materials. Spanish material would be particularly useful.
CONSEDE, Apartado Postal 996, Tegucigalpa, AMDG, Honduras, C America
Wartime communication
The sharing of ideas and experiences among farmers and between farmers and technicians is not an easy process. It becomes even harder during a civil war.
Communication becomes very difficult and few people remain dedicated to agricultural extension work. On the other hand, these same difficulties make the need to share information even more important. During the recent civil war we worked with the agricultural programme of the dioceses of Chalatenango (in the north of El Salvador where the effects of the civil war were serious). In the busy agricultural seasons we planned a series of visits to different parishes. Each parish priest would announce our visit with plenty of warning, so that all interested farmers could come. We held the meetings immediately after the church services on Sundays – the day when most people don’t work. Sometimes we had farmers from 15 different communities – all belonging to the same diocese. Many farmers brought samples of damaged or diseased crops or of insect pests that were destroying their crops. The next step was to find a solution to these problems. Ulises asked everyone to tell us which were their most serious problems, while I made a list. Then we would ask how many people had the same problems so that we could deal first with those affecting most people.
In order to find a solution to these problems, we first asked the farmers to share how they had tried to solve them. Sometimes the solutions came from the farmers themselves. For example, we all clapped when Juan shared with us how he controlled rats using the tree, Madre de Cacao (Gliricidia sepium) – seeds or powdered bark were mixed with rice or maize and used as a poison. We would offer our advice only when nobody present had a solution.
In this way we all learnt from each other and together found solutions to almost all their problems. After the meeting the farmers returned to their communities and shared what they had learnt with their neighbours and relatives.
The understanding that nobody knows everything and that we can all learn from each other is essential for agricultural extension work.
Wilfredo Morán, 3a CP No 9, Chalatenango, El Salvador, C America
Alphabetical records
Your issue on literacy (September 1993) reminded me of an incident at the hospital where we work. We needed to organise a system of record-keeping after the first attempt to keep records alphabetically failed.
Finding patient notes was often difficult. People here use a limited number of names. This means that many people in the same area may have the same name and surname. Many do not know their date of birth so we could not use this either. We decided to arrange things first in village order and then by name. Mudimbi was one of the clerks responsible for organising the new system. We organised the files first by village, then by name, and we began using the system in the hospital. Two days later we found that the system was not working.
We spent some time with the two clerks responsible. We realised that the problems began when the second letter was needed – does Debbe come before or after Dobbe? ‘My alphabet seems to have gone – I can’t remember it,’ explained Kitengie. In his culture there are very few books and no need for alphabetical skills. We wrote out the alphabet and explained step by step how the system worked. We put a large alphabet on the wall opposite the desk where Kitengie and Mudimbi work. Then they could absorb the letters and their order without realising it. Later, a colleague in the office overheard Kitengie explaining with great enthusiasm to someone else how the system worked. ‘Now our patient records are in good order!’
We learnt a lesson too. We must not assume that the people we work with will have the same literacy skills we may take for granted.
Mrs C Ostins, Kipushya, Hospital, Zaire