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Child Health: A Manual for Medical and Health Workers in Health Centres and Rural Hospitals.
  1. PAUL EUNSON, Consultant paediatrician

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    Child Health: A Manual for Medical and Health Workers in Health Centres and Rural Hospitals.2nd ed. Edited by P Stanfield, B Balldion, Z Versluys. (Pp 525; KSh360.) African Medical and Research Foundation, 1997. ISBN 9-966-87407-0.

    Rural hospitals in Africa sometimes have a small library, often in the senior doctor’s office, where the books are not accessible to the staff who would benefit from reading them. They are usually old editions of standard British or American textbooks, long winded, with drug doses in minims and guidance for making tincture of belladonna. Occasionally, there would be a paperback edition of Clayton’sTen Teachers, Bailey and Love’sTextbook of Emergency Surgery, or one of the other subsidised books of the admirable English Language Book Society, now sadly defunct. Many of the hospitals have no money for books or journals and rely on infrequent donations.

    If one asked rural health workers what educational material they had, they might produce a well thumbed thin pamphlet produced by AMREF (the African Medical and Research Foundation). Those who were very fortunate will have a copy of Child Health. A new edition is now available, 20 years after the first. The contents move easily between primary health care, curative medicine, and social medicine. It is an intensely practical book, although not as rich in diagrams as Where There is No Doctor (David Werner) or Primary Health Care (WHO). However, it is aimed at practitioners who know how to do a lumbar puncture but need advice on when, why, and what to do with the result. The clarity of the English makes the text accessible to health workers whose first language is not English or who have not attended secondary education.

    If your rural medical aides, clinical officers, and nurses know this book inside out, then they will have the knowledge to manage what comes in front of them. It does not tackle the lack of resources, but having this knowledge will help them to prioritise situations.

    Sections of the book acknowledge the great gaps in levels of health care in Africa by accepting that neonatal special care is now practised in larger centres. This still sits well beside advice on how to control the flow of patients through a clinic and safeguard the vaccine cold chain.

    The final chapter is on child abuse and neglect. When I worked in rural Tanzania 15 years ago people told me that child abuse did not exist as “there is no word for it in our language”. It does exist, particularly in the deprived urban sprawls, and in the refugee communities. A short section on the particular problems of refugee children—physical and emotional—would be a welcome addition next time round.

    Sunlight, rain, termites, and frequent use will take their toll on this book. The price is 360 Kenyan Shillings (£3.60). The next time you want to assist colleagues in a developing country, do not send them your former professor’s weighty tome. Send them 10 copies ofChild Health. It will make a difference.