Manual for Health Workers

Manuel pour la Formation des Hygienistes-Secouristes

Manuel pour les Hygienistes-Secouristes

Manuel pour les Accoucheuses Traditionnelles

First published in 1982.

About the Books
In 1981 I agreed to take the job of “education consultant” in Mali, West Africa. Malians speak many languages, but because it was a French colony, the national language is still French. Luckily, my college degree was in French.  I was part of a team of 4 doctors and an economist who were helping set up a system of public health clinics and services in villages throughout the nation. My job was to get the public health messages that the doctors decided upon to a population that was largely illiterate and did not know that infection by bacteria or parasites can cause illness.

Mali is a large country, but most of it is in the Sahel, a desert-like savannah so dry that only nomads can live there with their herds of cattle, constantly moving, grazing, moving and following the summer rains. In the isolated settled villages, people grow millet, chickens and a few vegetables. The population is now 12 million. It was less than half that 25 years ago when I was there.

To figure out the best way to go about my job, I listened to the radio, I asked people to tell me folktales and I looked at the African art in the newly built museum and wherever I could find it. I sat in on the trainings that other members of the project were giving to the village health workers and midwives, and I watched how the midwives helped mothers give birth. 

Eventually I began to make up folk tale-like stories that incorporated health messages in them. One was about how a miser had found a secret way to make underweight babies healthy and strong that turned out to be a simple paste made from peanuts. Another was about how the Malaria Monster could send his poison into children throughout the villages, but that if they ate a chloroquin pill every day, he could not attack them and would fly off to find other victims.

I made two sorts of illustrations: some realistic and some very flat and stylized, similar to some of the African art I had seen. The doctors and I also included facts about the four conditions that caused most deaths in small children: malaria, measles, diarrhea and the sudden shift from breast-feeding to millet porridge. 

For the midwives we emphasized information about good nutrition for pregnant mothers and babies, signs of anemia and eclampsia, and the necessity of using sterile blades to cut the umbilical cord. I put all this information into manuals: teaching manuals for those who taught the health workers and midwives, and smaller manuals for the workers and midwives themselves to keep.

The manuals were printed and tested towards the end of the year during two separate courses of three days each. One course was for the health workers, one for the midwives. The Malian doctors and nurses who taught the courses used the teachers’ manuals I had made. Each village health worker and each midwife was given a manual to carry in their kit containing medicines and sterile gauze, scissors, matches and other utensils they would need for their public health service.

I did love spending that year in Mali, but if I had to do it all over again, I would have done it very differently. First of all, I would not have made manuals but would have worked with people at the radio station so the stories could be transmitted orally. I would have worked so that they made up the stories that incorporated the health messages, and the stories would have been full of songs that also gave the message. Mali is a country full of wonderful music, wonderful musicians. Malians have excellent memories for the spoken word, so they would have remembered the stories they heard on the radio, especially if they had been played several times, and they would have remembered the songs.

And if we had made manuals, I would have worked with local artists and had them make the pictures, rather than myself. I would have had the manuals printed in Mali, no matter how poor the quality of the paper, rather than in the US and sent over by air.

I heard that, after we left, the many manuals we had had printed were piled neatly in the basement of the Ministry of Health, waiting to be distributed or eaten by rats and mold.

copyright 2018 by Molly Bang