2-12
Many kinds of professionals have served as trainers of health workers:
• doctors
• senior medical students
• nurses
• paramedics
• intermediate-level health workers
• public health graduates (often
foreigners)
• social workers
• school teachers
• teaching teams made up of doctors,
nurses, anthropologists, social
workers, agricultural extension
officers, and foreign experts
Little study has been done to compare the strengths and weaknesses of these
different professionals as health worker trainers. But here are some common
impressions:
Doctors. As a general rule, doctors make poor instructors of
health workers. Their curative, hospital-based training does
not prepare them to look at the needs of a whole community.
Attitudes are also a problem. Doctors have a tendency to take
charge, to regard themselves as decision-makers even in areas
they know little about. Feeling that even simple diagnosis and
treatment are ‘risky’ without years of medical school, they often
limit teaching of curative medicine to a few minor chores. This
severely weakens the role of health workers in the community.
Yet the courses doctors teach usually include a deadly overdose of anatomy, with
countless Latin names. This gives the health worker a magic vocabulary with which to
confuse and impress the people in his community.
Nurses. Some nurses make excellent instructors of health
workers. But such nurses are exceptional. The nurses’ job
has traditionally been to take orders without question, and
to clean up after the doctors. They are given little decision
making responsibility. So it is not surprising that, when nurses
instruct village health workers, they place strong emphasis on
unquestioning obedience, filling out forms, and functioning
as errand boys or girls. As they have been dominated and
undervalued, they tend to do the same with health workers.
For a nurse to effectively prepare health workers as leaders of social change, she
must be a true rebel. Fortunately, many such nurses exist! Unfortunately, they are
rarely chosen as instructors.
School teachers. In Honduras, some young school teachers
have proved to be surprisingly good instructors of village health
workers. These teachers are given 2 or 3 months of special
training in community development and primary care activities.
Then they are sent to teach and work with village health
workers. The young teachers are far more willing to go to
remote villages than are nurses or doctors. They also are able
to relate well to the health workers and local people. Having a
limited background in health, they do not set themselves up as
‘authorities’. Rather, they explore and learn with others about approaches to solving
different health problems. This puts them on a more equal footing with students and
villagers. It seems that, in some circumstances at least, teaching skills may be
more important than an extensive background in medicine and health care.