Eva Salber on Community Medicine and Health Facilitators

South African physician Eva Salber discusses the unacknowledged role of health facilitators — people who provide advice, counsel, and support to others — in community medicine and how the existing health care infrastructure can make use of their skills.

| May/June 1983

  • community medicine, health facilitator - hand holding apple out to many reaching hands
    The role of health facilitators in supporting community medicine has been largely undervalued.
    Photo by Fotolia/Diverser
  • Dr Tom Ferguson
    Dr. Tom Ferguson

  • community medicine, health facilitator - hand holding apple out to many reaching hands
  • Dr Tom Ferguson

Eva Salber is Professor of Family and Community Medicine at the Duke University School of Medicine in Durham, North Carolina. Last year I had the privilege of visiting Dr. Salber at her home in nearby Chapel Hill and discussing her important work promoting the role of lay health care volunteers in community medicine. The following report is drawn from my conversation with this truly remarkable woman. 

"The great majority of illnesses," Dr. Salber observed as we sat in the comfortable downstairs family room of her home, "are never seen by a physician. The real primary care is provided by one's family, close neighbors, and friends. Furthermore, in every community there are certain people to whom others turn for advice, counsel, and support. I call such individuals health facilitators. And one of the most important things any doctor or other health professional can do is to find these people and offer them recognition, information, and support."

Eva Salber, you see, is a champion of the lay health facilitator. She has taught medical professionals from many countries how to help and benefit from these unsung heroes and heroines who, in fact, have always provided a great deal (if not the majority) of the world's health care. Dr. Salber is quick to say, however, that she isn't the force behind the "barefoot doctors." Rather, she has simply pointed out their existence, and suggested ways they might be given the recognition and support they deserve.

Witch Doctors and "Ill Wishers"

Eva's interest in lay health care was kindled by her experiences as a staff physician at one of South Africa's first Institutes of Family and Community Health (the forerunners of the neighborhood health centers in the U.S.). "We learned very quickly," she recalled, "that the local medicine men could deal with certain kinds of troubles better than we could. They were much more effective in handling family and personal problems because they were part of the local culture. And, of course, they knew just what to do with afflictions that involved the client's belief system. If a woman felt that she was being poisoned by an ill-wisher, for instance, we might be able to name her symptoms, be we wouldn't be able to cure her. We learned to refer such cases to the witch doctors. They in turn sent us any patients with the sort of ailments — they called them 'town diseases' — for which our tools were more effective, including VD and other infections that could be cleared up with antibiotics. My great triumph came when the local witch doctor sent one of his wives to me for treatment."

After her introduction to the health facilitator concept, Eva began to notice the same phenomenon wherever she went — including Boston, where she served as director for a health program in a low-income, inner-city housing project. "In spite of the hardships such as poverty, broken families, crime, unemployment, and poor education that housing project residents had to contend with, the neighborhood could boast of an active, effective network of health facilitators who spent a good deal of their time helping others," said Eva. So she put together an advisory committee for her program and appointed the community's health facilitators as members, placing these people in positions of responsibility and power for the first time in many cases. The move was a success. "I've seen it time and time again," observed Dr. Salber. "People want to give, and to be given, the opportunity to help. When provided with that chance, they'll blossom before your eyes."

The Health Advisor Project

"By the time I came to Duke," said Eva, "I was convinced that there are natural health facilitators in every community. So I decided to see whether I could develop a program to help others identify these individuals, to supply them with any information they needed, and to link them with useful groups and agencies in the community."

Her project took place in two villages in rural Durham County, and in an adjoining urban fringe area. A questionnaire had already been designed for a health survey of the region, so Eva simply tacked on an additional question: "Other than doctors, who do you know around here to whom people go for advice on health matters?" As soon as the results came in, Eva began knocking on the doors of the people mentioned, asking if they'd be interested in participating in a program that would give them the opportunity to meet other amateur helpers and to learn methods of aiding their neighbors more effectively. Nearly all the people Eva contacted accepted her invitation.


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