The Human Right to Health: Reflections of a Community Educator

Rusasa, Rwanda, March 2008. Azalia Mitchell and participants in a week-long workshop on basic health education and the roles and responsibilities of health workers. Photo: James Haganza

I joined the Peace Corps and started doing community health work, volunteering in communities in C™te d'Ivoire. I did community education with women about their bodies - their reproductive organs and prenatal and postnatal care - and about caring for newborns. And I worked with high school girls, teaching them about their bodies, sexual health, hygiene, sanitation, and nutrition.

That's where I first learned about the prevalence of disease. I encountered people with diseases we don't have in the United States anymore and some that we've never had. We don't have malarial mosquitoes anymore; you don't see cholera outbreaks or people dying of typhoid.

In rural West African communities, people I met had been taught very little about their physical health. People knew they weren't healthy - they would say they were tired. But even with malaria, many didn't know how it was transmitted; some people thought they got it from eating oily foods. This was crazy to me. People had a name for the disease, and could identify signs and symptoms, but they didn't know how it was transmitted and therefore didn't know how to prevent it.

It was the same with nutrition: Many of the women and kids were malnourished only because people had not been taught how to combine foods to create a nutritious meal. While there were many families who, literally, did not have food to eat, a lack of education was also a huge part of the equation, and there wasn't a place for them to get that information. No one should have to suffer and get sick because of a lack of information.

So I walked around and talked to people all day. I was either going to someone's house or people were stopping by mine to get information. Women would ask me about vaginal discharge or other things about their reproductive and sexual health, wanting to know whether it was normal. It was surprising how little information I could have and still have people turned to me as a major resource.

I talked about nutrition, sexually transmitted infections, HIV. I encouraged women to go to the local clinic - for the pregnant women to go for prenatal consultations and for mothers to have their kids vaccinated.

I stuck with community health work because you could see actual results: a year later you could see a big difference, with cases of infection decreasing. It was interesting and exciting. I saw women coming to the clinic and saw the difference it made: Mothers were delivering live babies, and getting through the birthing process alive.

But I kept thinking, People are dying. And it was hard to grasp why. People?had a tendency to say, "He died so stupidly." It's true - these were all the stupidest diseases, ones that were easily preventable. Most children who die before they are five years of age are killed by easily preventable diseases. We have come so far in modern medicine. We can treat complicated diseases and perform heart surgery, but we can't prevent children from dying of diarrhea?

What gains have you seen in disease eradication?

For three years I worked for the Carter Center in areas where there was a disease called Guinea worm, a waterborne, parasitic disease. People get it by drinking contaminated water. The worm essentially stays in the system for nine months to a year. My responsibility was to go to villages where Guinea worm was endemic, both to do community education and to figure out what was preventing Guinea worm from being eradicated.

You can distribute water filters, and if used correctly, they can break the transmission cycle of this debilitating, painful disease - so that even if there is no potable water source in the community, residents don't have to get Guinea worm. They don't have to be out of work for weeks or months, waiting to recuperate.

The fun part for me was figuring out creative ways to teach people about Guinea worm. We were able to experiment, using radio messages, theater troupes, puppet shows, and comic books.

And when it's done, it will be done forever. Guinea worm is close to being eradicated globally (soon to join smallpox, the only other disease that has been eradicated).

What differences do you see in impact between public health work carried out in the US and work done internationally?

For me, public health is all fundamentally about human rights and social justice. In the US, social and economic rights don't get much attention; we focus more on civil and political rights. The human right to health falls under social and economic rights, which people don't like to talk about here. In the US it's hard to say people have a right to food and water.

Yet when we talk about human development internationally, it is considered normal to talk about education, health care, food, water, and economic opportunities. It is generally agreed that we need to give resources in order to help developing countries develop their capacity - but when we talk about universal health care here in the US, it's like a scandal.

My family was poor when I was growing up, ten kids with a single mom, but it wasn't this kind of poverty. I'm thinking about all those women coming and asking about their bodies, things that they never had a chance to talk about. I'd gotten a lot of my information from a book, a library, or a women's center. Folks in rural West Africa didn't have access to these sources.

What dilemmas do you see in getting public health work done?

People shouldn't be filtering mud as a source of drinking water. With so many things, we know what the solution is, but it's not yet happening. I often think, What's the number of people who died this hour because they didn't have a source of drinking water? I wish we could keep a sense of urgency.

Some groups have been able to harness the tools of the business sector to market products that are for the social good, like condoms and oral rehydration kits, at reduced prices. These programs have been painted as a success. Except health is not a commodity. This is life or death.

Programs should be giving condoms out everywhere, or mosquito nets free of charge. When people say something can't be done, they mean that it's too expensive. That kind of economic "sustainability" argument is causing people to die.

What ideas can you offer people who want to get involved?

There are plenty of good projects and organizations, and many ways to get involved. At the most basic level, I encourage people in the US to take a closer look at our own health care system. Understand your own health insurance benefits, and inform yourself about the policies that have been legislated to prevent people from having access to health care.

Once you're aware, you move toward some sort of action, whether it's volunteering at Planned Parenthood or talking to community groups that you're involved in. Do anything, as long as you're doing something!