I’ve been engaged in a “healthcare debate” in my head for years.  It focuses particularly on that monster known as Big Pharma.  I have my own special Moment of Hate whenever an ad comes on TV for a miracle suppressant for a symptom, an ad geared to convince you that you have the symptom and need the suppressant.  I’m convinced that medical researchers are too lazy to seek real long-term cures for our major killers such as heart disease and cancer, instead rushing through trials and patents on symptom-suppressants—because that’s where the big money is.

Some of my personal aversion to Big Pharma grew out of my work in the Third World, where people have long been victimized by pill dumps—foisting out-of-date or dangerous meds that have been rejected or even banned in the US on the poor—a form of medical maltreatment that could appear to be a policy of slow genocide.

And some of my zeal was fired by a book that I first read thirty years ago…

…It was the strangest book I’d ever seen, and yet it became an essential part of my working life.  I carried it with me to three continents despite the restrictions on luggage size and weight.  I had to leave it in London, and was overjoyed when I rediscovered it back in the U.S.  Its cartoon illustrations, childlike and graphic, were both homely and horrifying, covering everything from baby puke to making a simple splint; from putrefying skin diseases to the instructive but repulsive life cycle of intestinal parasites; from the proper use of a corncob for the obvious purpose to the universal symbols of the world’s most evil junk foods:  a bag of “Chips”, a few pieces of wrapped candy, and a sculpted old-fashioned bottle of Coca Cola, its message of nutritional doom all too clear, covered over with a big penciled X.  It was a practical medical manual that combined clinical terminology, lists and charts, with school-child art and plain talk.  A manual for real people in real life situations—people who have to live and function and help others do the same—where there is no doctor.

Where There Is No Doctor was there when I had dengue fever: “Person feels very ill, weak, miserable.”  That was me.  Sadly, “no medicine cures it,” and prevention was practically impossible: “avoid mosquito bites.”  Frank, practical, logical.

When a villager in Rio Limpio asked me what to do for a child with diarrhea, we consulted WTIND.  Diarrhea is always a hot topic in the Third World because babies can die quickly from even the simplest forms.  Rehydration drink is the first line of defense, restoring the balance of salt and sugar and addressing the loss of fluids (these days cereal is substituted for sugar).  WTIND assured us comfortingly that “most diarrhea can be treated successfully in the home.”  Fortunately for my friend, rehydration drink did the trick for her little girl, mixed precisely as prescribed in WTIND.  Fortunately for most of us, our children will be well nourished and easily cured, will not be like the skeletal little boy in the illustration in WTIND whose shriveled hand points eerily to a child-sized coffin and one drooping flower in a vase next to it.

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.

The book shows you (with text and pictures) how to catheterize yourself, beginning with an iron pot and a hot fire for sterilization of the tube.  Ouch!  WTIND pulls no punches.  Since a baby can die if its umbilical cord, by folk tradition,  is “left long, kept tightly covered, and not kept dry,” the book provides another unforgettable illustration—a frail child’s corpse with its head thrown back and its body bent like a bow from tetanus.  Perhaps because the drawings are so stark, they tell the story as well as, maybe better than, a gory film or color photo.

Though authored by native English speakers, the book started life in Spanish, as Donde Hay No Doctor, then became a perennial guidebook in English, and later made the transition to other cultures and languages.  The brain-child of biologist and educator David Werner, who also did the original illustrations, its purpose was to assist expatriate development workers, local “barefoot doctors,” volunteers and ordinary people to improve health at all levels from prevention to healing.  Werner himself had toiled in Mexico in a project in the Sierra Madre.  The project has a lengthy history that began in the mid 1960s, but undoubtedly the most positive and enduring product of the on-going activities there is WTIND.  Today, the book—glossier, slightly more transportable in width and breath but heavier, at about 450 pages, than the one I bought in 1980—can be obtained in100 languages.

This startling, intense, fact-filled tome with its winsomely grotesque illustrations gets an overhaul every few years.  The copy I carried around the world had a mono-color cover; the most recent edition features a full-color photo on the front.  And what an evocative photo: a group of men, waist-deep in a river, carrying an ailing man (his straw hat lies at his feet) on a crude but effective stretcher made from logs and wire.

The Hesperian Foundation, located in Berkeley, California, arose out of Werner’s initiatives to set the world right, health-wise.  Hesperian prints the regularly revised Werner books and sends them on request to anyone, but especially wherever there is no doctor, no nurse, even no vet.  The book’s title spawned others written by other experts: Where There Is No Dentist, Where There Is No Animal Doctor, Where There Is No Women’s Doctor.  A recent addition, A Community Guide to Environmental Health, focuses on global issues “from toilets to toxics.”  My sister, by one of those coincidences that makes life round and cozy, works as a volunteer for Hesperian.  So WTIND, the book that I left behind (for other Quaker volunteers to read) when I left my overseas work in 1994 to return to the US—where, after all, there is a doctor—boomeranged back into my life recently.  My new copy is more colorful on the outside, but inside are the same charmingly bizarre line drawings of people engaged in the most basic practices, and a text that combines best first aid, prevention and medical practice with simple street talk.

Earlier versions of WTIND were so geared to putting medical knowledge in the hands of the local people that they did not automatically steer the reader /health worker toward or provide extensive information about any but the most needed allopathic meds.  Nowadays, however, Western medicines are far more prevalent in poor villages on far-flung continents, and in order to survive, people need to know what they are, and when and how to take them.  When I first encountered WTIND, AIDS was as yet unheard of.  Now, as it plagues much of the African subcontinent, knowing how to combat and survive it is essential.  So it too, and the treatment for its symptoms, is included in WTIND.

But the advice about high tech Western medicines also includes important explanations and warnings about their use.  The book states that not everything that can be injected is good for you and not everything that is good for you should be injected.  For example, the chapter on “Right and Wrong Uses of Modern Medicines,” warns about the use of chloramphenicol, an anti-typhoid drug once commonly (and wrongfully) handed out in the Third World for mild diarrhea: “Never give it to newborn babies.”

WTIND touts some folk remedies and pooh-poohs others, and includes a list of acceptable herbal medicines.  I found this piece of advice about traditional beliefs particularly memorable:

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.

Frank, practical, logical.  But let’s make one thing clear: Werner’s book, and the assiduous updates by his collaborators and later by experts designated by Hesperian, was not meant to replace adequate, professional medical care.  It was designed exactly as it said: for the times and places when no such care is available.  In Rio Limpio, for example, the “clinic” was a cinderblock building with no windows and a padlock on the metal door, obviously meant to keep people out, not invite them in.  Supposedly, a nurse visited once a month.  But sometimes she didn’t.  I never saw that door open in the year I lived in the village.  That’s WTIND territory.  And it’s far from rare in the developing world.

As the introduction states, “guidelines are included not only for what to do, but for when to seek help…The book points out those cases when it is important to see or get advice from a health worker or doctor.  But because doctors or health workers are not always nearby, the book also suggests what to do in the meantime—even for very serious problems.”  WTIND doesn’t mess around when the case is grave, as with infected wounds: “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.”

WTIND was written for “the villager, the village storekeeper or pharmacist, the teacher, the village health worker, mothers and midwives.”  Birthing babies is explained with copious drawings, and there is a rather disturbing picture of how to perform your son’s circumcision, should you wish to do so.  Such “urban” ills as obesity are not ignored, but the bulk of the book is given over to immediate, necessary treatment of everything from bullet wounds to snake bite, and to common, sometimes deadly illnesses most likely to attack the poor: diarrhea—from dysentery to cholera—skin disorders, leprosy, anemia, tuberculosis, brucellosis, rickets and diseases spread by flies, pigs, and feces.  There are illustrations of how to build latrines, from a complicated stall to a basic pole and pit.  The Green Pages section in the back is a pharmacopoeia subtitled “The uses, dosage, and precautions for the medicines referred to in this book.”

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.  The praise for the book ranges from testimonials like my own to solid backing from the medical profession:

“Home health care manuals are a dime a dozen, but this one is in a league by itself…  This amazing manual…successfully brings together modern concepts of public health and personal health care into a usable and understandable format for the Third World villager.  If you are a physician, dentist or nurse planning to volunteer on a medical mercy mission, review this book ahead of time and take it with you.” — Annals of Internal Medicine, Vol. 125, No.12.

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.

Lots of us sensibly purchase AAA or other insurance for an emergency we hope will never occur—the breakdown of our car on a lonely highway, on a Sunday perhaps, where there is no mechanic.  You could think of WTIND that way, and get a copy for the next snow-bound week or lost-in-the-wilderness ankle sprain or mysterious child ailment while on vacation.  You could even consider getting copies of WTIND for your grown children or your friends.  You don’t want them to suffer in case of a black-out or winter storm event, right? You can order the most recently revised version (and others titles mentioned above) from www.hesperian.org.  At around twenty bucks, it’s a bargain.

I think of it as a weapon in my personal battle against Big Pharma.  And the pictures alone are worth the price.

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