PIP: A traditional birth attendant, also known as an indigenous midwife, is the main provider in many developing countries of obstetric services. Due to this unique position, the traditional birth attendant has been considered as possibly the ideal person to deliver family planning services in her local community. This consideration has influenced program policy in many countries and consequently there is information available to aid in the determination of whether to involve traditional birth attendants and, if so, how to best use them. There have been 2 opposing views in response to the involvement of traditional birth attendants. 1 view regards them as potential innovators. She is seen as ideally placed both physically and socially to act as a representative of the family planning program to her patients. The traditional birth attendant is the acknowledged and often prestigous expert on obstetrics matters, including at times traditional methods of birth control. The alternative view is less hopeful for rather than identifying the traditional birth attendant as an innovator it regards her as a firm opponent of innovation, a determined conventionalist. Pro gram experience in India, Pakistan, Indonesia and East Java and experime ntal studies in the Philippines, Malaysia, and Thailand along with anthr opological inquiries generally support the skeptical view but none of the findings imply that the traditional birth attendant should be ignored by the family planning programs. In the intermediate positions of many actual programs, the wisest plan seems to be to ensure that the potential contribution of the traditional birth attendant is neither overlooked nor exaggerated
PIP: Traditional midwives are active in most villages and many urban areas of Asia, Africa, and Latin America. They deliver babies, provide prenatal and postpartum care, teach folk methods of birth control, treat infertility, and enjoy the confidence of many women. Most official family planning programs make little or no use of these traditional midwives. Research should be conducted into the most effective ways of recruiting and rewarding midwives in family planning programs. They seem to function best when provided with adequate training, supervision, and incentives. Traditional midwives are participating in the national family planning programs in Pakistan, Indonesia, Malaysia, and the Philippines. Only in Iran do they participate in the medical aspects of family planning. Midwives in Iran do IUD insertions and their performance compares favorably with that of medical personnel.
Matched MeSH terms: Allied Health Personnel; Health Personnel
PIP: A great deal of attention is being devoted to the use of nonphysicians to provide such fertility control services as contraception, sterilization, and abortion. Legal obstacles exist, however, which must be overcome before the role of nonphysicians can be expanded. Such obstacles include medical practice statutes, nursing and midwifery legislation, and laws and regulations directly related to such fertility control measures as the provision of contraceptions and the performance of sterilizations. On the other hand, the following 3 main approaches have been used to permit increased participation of nonphysicians: delegation of tasks by physicians, liberal interpretation of existing laws, and authorization. Thus, the important elements in expanding the roles of nonphysicians are 1) authorization; 2) training; 3) qualification; 4) supervision; and 5) opportunities for referrals to physicians. The ultimate role of paramedicals will depend upon the continued simplification of technology, the results of research on the quality of care which they can provide, the attitudes of the medical profession, and the elimination of the legal ambiguities and obstacles which exist.
Matched MeSH terms: Allied Health Personnel*; Health Personnel
PIP: On August 15, 1978, the integrated parasite control/family planning program was launched by the National Family Planning Board in the Tanjong Malim Estate in Kuala Lumpur (the estate is a rubber oil palm plantation) to enhance the health status of the estate workers and their families. Personal hygiene, good toilet habits, and washing fruits and vegetables before eating were emphasized. Pre- and post-surveys of worm infestation of the estate population revealed that treatment with drugs dramatically reduced the rate of intestinal helminthiasis infection among the population. To sustain the prevention or total eradication of the disease, an ongoing educational program was initiated and included the following features: 1) increasing knowledge of the community as to how intestinal helminthiasis is transmitted, and ways of limiting transmission; 2) providing safe and sanitary toilet facilities for young children, and; 3) periodic deworming of susceptible population every 3 months. The estate members are also encouraged to plant vegetables in their backyard. The National Family Planning Board also helped the estate members organize different functional groups, such as Mothers' Group. This multifaceted approach to family planning appears to have an encouraging future, particularly in family development.
Malaria is still a very real threat to health in S.E. Asia including Malaysia. While there has been a dramatic fall in the number of cases and also the number of deaths from the disease in Malaysia cases are still occurring and there has actually been a rise in the number of deaths in the past year. Parts of Perak and the East Coast states are still high risk areas in Peninsular Malaysia. While 95 percent of the population of Peninsular Malaysia is now malaria-free there has also been a concomitant loss of herd immunity which means that if a non-immune person contracts falciparum malaria he stands a greater chance of a fatal outcome. Doctors and other health personnel should be more malaria conscious and make a practice of making blood films of all cases of fever. This is especially important in the rural areas and Estate Hospital Assistants must be encouraged to look for malaria parasites in their fever patients. The younger generation of EHAs have little experience of malaria and a definite policy of education to bring them up to date in antimalarial work and microscopic detection of the parasite should be under taken by the industry. Some problems of chemotherapy and drug resistance are discussed.
This preliminary report details our experience and also serves to evaluate the risk benefits of office laparoscopy for female fertility assessment in 183 subjects. The patients were admitted at about 8.00 in the morning and discharged at 3.00 to 4.00 in the afternoon after laparoscopy has been performed. Only 7. 7 percent of the subjects required inhalational anesthetic gases along with a combination of intravenous sedation and local anesthetic infiltration. The pick-up rate for pelvic abnormality is fairly high, approximately 22.4 percent. Difficulties and complications encountered during laparoscopy were minimal and easily overcome. The benefits of laparoscopy overrules the risk of complications. It is suggested that all family planning clinics involved in fertility assessment and sterilization feature laparoscopy on an but patient basis as one of its main activities.
This paper attempts to explain both the persistence of traditional misconceptions about leprosy as well as the relative ineffectiveness of the Leprosy Control Programme. It has been pointed out that leprosy is a disease with tremendous social significance. To improve the Programme therefore, the human element which is of paramount importance must be identified and rectified. It is felt however, that we the providers should set our own house in order first. We need to find out the knowledge, attitudes and practices of the medical personnel and auxiliaries relating to leprosy, and identify the factors that contribute to their lack of motivation and undesirable attitudes which in turn deter patients from seeking and continuing treatment. Interventions based on the findings of such studies will contribute considerably towards the successful implementation of the Programme.
The study reported served 2 purposes: 1) to assess the amount of sexual information posessed by a sample of staff nurses working for the National Family Planning Board and the Public Health Dept., and 2) to gather local normative data on the Information Subtest of the Derogatis Sexual Functioning Inventory (DSFI). The subjects for the this study were 2 groups of staff nurses. 10 were employees of the National Family Planning Board currently working in 1 of its clinics and 25 were public health nurses who were at a 1 week training at the clinic. The research was a questionnaire type study. Each subject was given the DSFI. On the Information Subtest of the DSFI the subjects obtained a mean score of 12.7 with a standard deviation of 4.2. This score is much lower than the normative mean (American population) and the sexually dysfunctional women mean. The nurses had inadequate and inaccurate knowledge about anatomy, physiology and psychology of sexual relations. Error analysis revealed that as a group they had poor understanding about male sexuality, the effect of aging on sexuality fertility and menopause, and difficulty in accepting oral-genital sex and sexual fantasies. This study recommends that these nurses, in order to more effective in their work, should be trained in the area of human sexuality. This training must include not only the physiology of sex but also the human aspects of sexual union.
The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.
Matched MeSH terms: Allied Health Personnel/statistics & numerical data*
The infectiousness with regard to HBV Infection of staff and patients in various units of the General Hospital, Kuala Lumpur
was assessed. It was found that all units, with the exception of the obstetric unit, were equally high risk areas. At least 50% of the patients in all these units had one or more of the markers. Among the medical staff, the anaesthetists had the highest
incidence of HBV markers (100%) while medical officers who had worked for three years or more were more likely to have to
have the HBV markers. The degree of infectiousness of the nurses In HDU and ICU/OT was found to be similar.
PIP: Resolutions adopted by the 12th Annual Asian Parasite Control/Family Planning (APCO/FP) Conference held in Colombo, Sri Lanka urge the incorporation of quality of life issues of all dimensions in projects of all participating countries. 1 study discussed during the conference concerned health volunteers of the integrated project in Sri Lanka, which analyzes motivating factors which make community young people work on a voluntary basis. Another topic covered was the role of women in the achievement of primary health care. Video reports were presented by Bangladesh on family planning and parasite control activities, Brazil on utilization of existing organizations to improve successful integrated projects, China on making twin concerns of family planning and primary health care, Indonesia on strengthening urban FP/MCH clinics, Korea on health promotion through the integrated project, Malaysia on the NADI program, the Philippines on the Cebu model of integrated health care, and Thailand on fee charging urban programs.
Ultimately, the majority of our medical graduates ends up in primary health care either in private practice or in the government service. It would be appropriate that their education and training should meet not only the requirements of their eventual vocation, but just as importantly, the expectations of a more discerning community at large. Rising pressures on the profession to provide more cost-effective and affordable health services of good quality would put an increasing emphasis on the development and promotionof primary health care to higher standards. Primary health care workers would be hard-pressed to provide more health information and to actively participate in disease prevention and control as part of their professional duties. As medical specialisation and technology contibute towards more fragmented, complex and dehumanising forms of practice, the greater will be the need for the integrative skills of the primary physician providing personal and continuing care. The future nature of medical care will have to respond to this community demand.