Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.) Chapter 3: The Medical System (introduction...) The Medical System Community health workers Health posts Health centers Hospitals How to Get Better Care (introduction...) Know what to expect Bring a friend or family member If You Need to Go to the Hospital Working for Change

Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 3: The Medical System

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Most people use some combination of modern medicine and traditional remedies to treat their health problems themselves. In many cases, this is all that they need to do. But for some health problems, a woman may need to seek medical advice.

¨ There are times when you cannot treat a health problem yourself. You may need to seek help from the medical system.

In most areas of the world, there are 4 different levels of health care: community health workers or traditional healers, health posts, health centers, and hospitals. Together, they are called the medical system. A medical system can include health workers, nurses, doctors, and others. They may be in private practice (charge money for their services), or they may be supported by the community, the government, a church, or another organization. Sometimes they are well trained and equipped - and sometimes they are not,

This chapter describes the medical system and how a woman can use it to get help for her health problems. Not every community has each of these 4 levels, and there can be many different combinations of health services that make up the medical system. But no matter what combination of health services is available, women - and all sick people - will get better care if there are good connections between the different levels of health care.

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The Medical System

Community health workers

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Some communities have well-trained, skilled health workers. These health workers often work out of health posts or centers, but not all do. Community health workers may or may not have formal training. But by working closely with the people in their communities, they can help prevent many common health problems, and help people treat their problems before they become more serious. A health worker can be trained to provide the same services as a health post.

¨ When health care is provided by trained health workers within the community, everyone can get better care, for less money.

Health posts

Many communities have health posts. In some places, this level of care is called a clinic or an MCH (Maternal Child Health). A health post should be able to provide:

· health information so that everyone can make better decisions about their health.

· immunizations or vaccinations that can prevent many diseases, including tetanus, measles, diphtheria, whooping cough, polio, tuberculosis, rubella, and hepatitis.

· care during pregnancy (prenatal care) that can help a woman find and treat problems affecting her or her unborn baby before they become serious.

· family planning services and supplies. Family planning can save lives by helping women control how many children they have, and the amount of time between births.

· health exams to help find and treat problems such as weak blood (anemia), high blood pressure, and sometimes sexually transmitted diseases (STDs).

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Health centers

Health centers provide a middle level of care. They are usually in larger towns, so people from nearby communities as well as from the town use them. Health centers usually offer all the services a health post offers, and they may also have a few beds where sick people can stay while being cared for.

Health centers are more likely than health posts to have trained nurses and doctors. They are also more likely to be crowded, and the doctors and nurses may know less about the people they see.

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Some health centers have laboratories with special equipment. This means they can do tests that give more information about the cause of a health problem. Often, however, a person must go to a hospital to have tests done.

Hospitals

Hospitals are usually in large towns or cities, and can be expensive. They usually have many doctors and nurses, and special equipment for treating serious illnesses. A person with a serious illness may need to go to a special hospital that can treat certain problems. A woman might need to go to a hospital for:

· problems that cannot be treated elsewhere.
· complications of childbirth or abortion.
· emergencies such as a pregnancy in the tube.
· health problems that require an operation.

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No matter where you go for health care, you should be treated with respect. All people who care for your health should do their best to provide you with: 1. Access. Everyone who needs medical care should be able to have it. It should not matter where you live, how much money you have, what your religion is, how much status you have in the community, the color of your skin, your political beliefs, or what health problem you have. 2. Information. You should be told about your problem and about what the different possible treatments mean for you. The person caring for you should make sure you understand what you need to do to get better, and how to prevent the problem from happening again. 3. Choice. You should be able to choose whether or not you are treated, and how. Also, you should be able to choose where to go for treatment. 4. Safety. You should be given the information you need to avoid harmful side effects or results of treatment. You should also be told how to prevent dangerous health problems in the future. 5. Respect. You should always be treated with respect and courtesy. 6. Privacy. Things that you say to a doctor, nurse or other health care worker should not be overheard by others or repeated to anyone else. Exams should be given in a way that other people cannot see your body. If there are other people who need to be in the room, you should be told who they are and why they are there. You have the right to tell them to leave if you do not want them there. 7. Comfort. You should be made as comfortable as possible during an exam. You should also have a good place to wait and not have to wait too long. 8. Follow-up care. If you need more care, you should be able to go back to the same person, or be given a written record of the care you have received to take to a new doctor, nurse, or health worker. Figure

How to Get Better Care

There are many decisions to make when you have a health problem. One decision is whether to see a health worker, and what kind of health worker you think you need. If there is more than one way to treat a problem, you will need to consider the risks and benefits of each kind of treatment before you make a decision. You will be able to make the best decisions - and get the best care - if you can take an active role in working with your doctor, nurse, or health worker to solve your health problem.

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Know what to expect

You will be best able to take an active role in your health if you are prepared and know what to expect when you seek medical care.

Questions about your health

It is best to learn as much as you can about your health problem before you use the medical system. Reading this book may help you understand your health problem and the possible causes. For help thinking about health problems, see “Solving Health Problems.”

The doctor, nurse, or health worker who sees you should ask about the problem you are having now and about your past health. Try to give complete information, even if you feel uncomfortable, so that the person asking the questions can learn as much as possible about your health. Always tell about any medication you are taking, including aspirin or family planning methods.

¨ It often helps to think of the questions you want to ask before you go for medical care.

You should also have a chance to ask any questions you may have. It is very important to ask as many questions as you need to make a good decision about how to solve your health problem. If these questions have not already been answered, you may want to ask:

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Many doctors and nurses may not be used to giving good information, or they may be busy and not take the time to answer your questions. Be respectful, but firm! They should answer your questions until you understand. If you do not understand, it is not because you are stupid, but because they are not explaining well.

The exam

In order to know what is wrong with you and how serious your problem is, you may need an examination. Most exams include looking at, listening to, and feeling the part of your body where the problem is. For most problems you need to undress only that part of your body. If you would feel more comfortable, ask a friend or female health care worker to be in the room with you during the exam.

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Tests

Tests can give more information about a health problem. Many tests are done by taking a small amount of urine, stool, or coughed-up mucus and sending it to a laboratory. Or. a needle is used to take a small amount of blood from your finger or arm. Other common tests include:

· taking some fluid from your vagina to test for sexually transmitted diseases (STDs).

· scraping cells from the opening of your womb (cervix) to test for cancer. (This is called a Pap test.)

· taking tissue from a growth to test for cancer (biopsy).

· using X-rays or ultrasound to see inside your body. X-rays may be used to find broken bones, severe lung infections, and some cancers. Try not to be X-rayed during pregnancy. Ultrasound can be used during pregnancy to see the baby inside your womb. Neither of these tests causes any pain.

ultrasound machine

¨ X-rays ore safe if they are used properly. A lead apron should be used to protect your reproductive organs.

Before you have any test, discuss the cost. Ask the doctor, nurse, or health worker to explain what he or she will learn from the test, and what would happen if the test was not done.

Bring a friend or family member

Many people feel worried about seeking medical care - even for illnesses that are not serious. And when a person is sick, it can be even harder for them to demand the care they need. If another person can go along, it can help.

If a woman is very sick, someone who can give information should go with her.

A friend can:

· watch the woman’s children.

· help think of questions to ask, remind the woman to ask them, and make sure they are answered.

· answer questions if the woman is too sick to talk.

· keep the woman company while she waits.

· stay with the woman while she is being examined, to support her and make sure the doctor acts in a respectful way.

If You Need to Go to the Hospital

If you need to have an operation or you have a serious illness, first find out if it is possible to be treated without having to stay in a hospital. If a hospital is the only place you can get the care you need, this advice may help:

· Bring someone with you who can help you get the attention you need and help you make decisions.

· Different people may examine you. Each one should write down what he or she did on a card that stays with you. This way the next person who cares for you will know what has already been done.

· Before anyone begins a test or treatment, it is very important to ask what they are going to do and why. This way you can decide if you want them to do it and help prevent mistakes.

· Try to make friends with the staff at a hospital. They can help you get better care.

· If you need to have some kind of operation, ask if it is possible to have an injection to stop pain only in the area being operated on (local anesthetic). It is safer and you will get better more quickly than if you are given medicine to make you sleep during the surgery (general anesthetic).

· Ask what medicines you are being given and why.

· Ask for a copy of your records when you leave.

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Common operations for women An operation is sometimes the only answer to a serious health problem. During many operations, a doctor makes a cut in the skin in order to fix problems inside the body or to change the way the body functions. Here are some of the operations women commonly have: · Emptying the womb by either scraping or suctioning (D and C, or MVA.). Sometimes the lining of the womb must be removed - either during or after an abortion or miscarriage, or to find the cause of abnormal bleeding from the vagina. · Birth by operation (cesarean section or c-section). When complications make it dangerous for a woman or her baby to go through normal labor and birth, a cut is made in a woman’s belly so her baby can be born. C-sections can be necessary, but too often they are done for the benefit of the doctor, not the woman. See the chapter on “Pregnancy.” · Sterilization. During this operation, a woman’s fallopian tubes are cut and the ends tied. This prevents her eggs from reaching the womb, so a man’s sperm will not be able to make her pregnant. · Removing the womb (hysterectomy). A hysterectomy is a serious operation, so it should be done only when there is no better way to solve your health problem. Ask if you can have your ovaries left in.

Blood transfusions A blood transfusion may be given in an emergency, when you have lost a lot of blood. It can save your life. But if the blood has not been tested properly, it can carry diseases, such as hepatitis or HIV/AIDS, that are passed through the blood. Avoid blood transfusions except in cases of life or death emergencies. If you must have an operation that you know about ahead of time, see if it is possible to have some of your own blood taken in advance and stored at the hospital. Then if you need it, you will get your own blood back. If you cannot have your own blood stored, ask a friend or relative to come with you to the hospital. Be sure she has been tested for hepatitis and HIV, and that neither she nor her partner has had a new sex partner in the last 6 months. Her blood must also be tested to make sure that it will work in your body. Figure If you must receive blood from an unknown person and the hospital does not test its blood for HIV, there is a risk that you might become infected. After the transfusion, protect your partner by practicing safer sex for 6 months and then try to get tested for HIV/AIDS. For more information, see the chapters on “AIDS” and “Sexual Health.”

After you have an operation

Before you leave the hospital, ask:

· What should I do to keep the cut clean?

· What should I do about pain?

· How long should I rest?

· When can have sex again? (If you feel too shy to ask this, perhaps the doctor or health worker can talk to your partner.)

· Do I need to see a doctor again? If so, when?

To keep your lungs healthy and prevent pneumonia, move around if you can. While in bed, take deep breaths and try ti sit up often

Eat soft, mild foods that are easy to digest.

Rest as much as you can. If you are at home, ask your family to take care of your daily chores. A few days spent taking care of yourself can help you get better faster

Watch for signs of infection: yellow discharge (pus), a bad smell, fever, hot skin near where you were cut, or more pain. See a health worker if you have any of these signs.

If your operation was in the abdomen, try not to strain the area that was cut. Press against it gently with a folded cloth, blanket, or pillow whenever you move or cough.

Working for Change

Millions of people throughout the world suffer and die from illnesses that could have been prevented or treated if they had access to good medical care. And even where health services do exist, there are many barriers that keep women, especially poor women, from using them.

But together, health workers and groups of women can change the medical system. They can make it a resource - rather than a barrier - for women as they try to solve their health problems. The medical system will not change on its own, though. It will change only when people demand it, and when they offer creative ways to bring the health care that people need within the reach of all.

A good place to begin changing the medical system is by discussing the health care problems that affect people in your community - including lack of access to good care - with other women and men.

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Women can also work together to:

· help every member of the community to learn about women’s health problems. For example, you can organize a campaign to explain how important it is that women get good prenatal care. If women and their families know about women’s health needs, women will be more likely to use the health services that already exist. They will also be more likely to demand that new ones - such as better treatment and screening for cervical and breast cancer - be made available.

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· see how existing health resources can be improved. For example, if there is already a community midwife, how can she get training in new skills?

· find new ways to make health care available. It is important to think about what health services you want to have, and not just what you have now. So, if there is no health worker now, how can one be trained and supported? If there is already a clinic, could it offer new services like workshops or counseling?

· share the knowledge each woman has about health care. Women already do much of the ‘health work’ in the community. For example, it is usually women who care for the sick, teach children to stay healthy prepare food, keep the home and community clean and safe, and help other women have babies. Through this work, they have learned many skills that they can use to care for each other and every member of the community.