USING MODULE 14 IN A TRAINING PROGRAM
THE RIGHT TO HEALTH
GO TO SECTION I - MODULE 14
The purpose of Module 14 is to provide an overview of the guarantees related to the right to health.
This module should help trainees understand/clarify for themselves:
- the development of the concept of the right to health;
- international, regional and national standards and the state’s obligations; and
- international and other mechanisms to protect the right.
Suggested Methods
¨ Brainstorming on the meaning of health: A facilitator could begin the session with a brainstorming exercise on the meaning of health. In this exercise, participants would be asked to give, in a few words, the meanings they attribute to health. These should be recorded on a board or chart paper. The statements should be written without discussing or clarifying them.
In the second step, based on the statements made by the participants, the facilitator defines the meaning of the right to health. Next, s/he elaborates on various standards related to the right to health and explains the scope of the right and the obligations arising from the right.
The brainstorming exercise would help the participants define the right to health without being restricted by existing definitions.
¨ Case study: The following case study and the questions raised could be used for initiating discussion on the right to health. The case study could also be used for generating a general discussion on economic, social and cultural rights.
The Story of Luis
Consider Luis, a 7-year-old boy who died of tetanus. Luis lived with his family in the small village of Platanar, 11 Km. by dirt road from the town of San Ignacio. In San Ignacio there is a health center staffed by a doctor and several nurses. The health center conducts a vaccination programme and has a jeep. But the vaccination programme only occasionally reaches nearby villages. One year the health team began to vaccinate in Platanar, but after giving the first vaccination of the series, they never returned. Perhaps, they grew discouraged because many parents and children refused to cooperate. Also the road to Platanar is very dusty and hot.
When the staff of the health center failed to return to Platanar, a midwife from the village went to San Ignacio and offered to take the vaccine to the villages and complete the vaccination series. She explained that she knew how to inject. But the doctor said no. He said that unless the vaccines were given by persons with formal training, it would be putting the children’s lives in danger.
Three years later, the boy Luis took a bucket of food scraps to the pen where his family kept a pig and piglets. On the way, he stepped on a long thorn with his bare foot. Normally Luis wore sandals, but his sandals had broken 3 days before and were too worn out to repair. Luis’ father was a sharecropper who had to pay his maize harvest as rent for the land he farmed. He was too poor to buy new sandals for his son. So Luis went barefoot. The boy pulled the thorn from his foot and limped back to the house.
Nine days later, the muscles in Luis’ leg grew stiff and he had trouble opening his mouth. The following day, he began to have spasms in which all the muscles in his body suddenly tightened and his back and neck bent backwards.
The village midwife at first called his illness congestion and recommended an herbal tea. But when the spasms got worse, she suggested that Luis’ parents take him to the health center in San Ignacio.
The family paid one of the big landholders in Platanar to drive to San Ignacio in his truck. They had managed to borrow 500 pesos, but the landholder charged them 300 for the trip. This was much higher than the usual price.
In San Ignacio, the family waited for 2 hours in the waiting room of the health center. When it was finally their turn to see the doctor, he at once diagnosed the illness as tetanus. He explained that Luis was in grave danger and needed injections of tetanus antitoxin. He said these were very expensive and, in any case, he did not have them. They would need to take Luis to the city of Mazatlan, 100 Km. away.
The parents despaired. They had barely enough money left to pay the bus fare to Mazatlan. If their son died, how would they get his body back to the family graveyard in Platanar?
So they thanked the doctor, paid his modest fee, and took the afternoon bus back to Platanar. Two days later, after great suffering, Luis died. 1
What caused Luis’s death? This is a key question to start discussion after reading or telling the story.
The question game: "But why?”
To help the group recognize the complex chain of causes that led to Luis’ death, play the game, "But why?” Everyone tries to point out different causes. Each time an answer is given, ask the question "But why?” This way everyone keeps looking for still other causes. If the group examines only one area of causes, but others exist, the discussion leader may need to go back to earlier questions, and rephrase them so that the group explores in new directions.
The question game might develop like this:
Q: What caused Luis’s illness?
A: Tetanus-the tetanus bacteria
Q: But why did the tetanus bacteria attack Luis and not someone else?
A: Because he got a thorn in his foot
Q: But why did that happen?
A: Because he was barefoot.
Q: But why was he barefoot?
A: Because he was not wearing sandals
Q: But why not?
A: Because they broke, and his father was too poor to buy him new ones.
Q: But why was his father so poor?
A: Because he is a sharecropper.
Q: But why does that make him poor?
A: Because he has to give half his harvest to the landholder.
Q: But why?
A: (A long discussion could follow depending on the local condition.)
Q: Let us go back for a minute. What is another reason why the tetanus bacteria attacked Luis and not someone else?
A: Because he was not vaccinated.
Q: But why was he not vaccinated?
A: Because his village was not covered by the vaccination team from the larger town.
Q: But why was the village not covered?
A: Because the villagers did not cooperate with the team when it did come to vaccinate.
Q: What is another reason?
A: The doctor refused to let the midwife give vaccinations.
Q: But why did he refuse?
A: Because he did not trust her. Because he thought it would be dangerous for the children.
Q: But why did he think that way? Was he right?
A: (Again a whole discussion)
Q: But not all children who get tetanus die. Why did Luis die while others live?
A: Perhaps it was God’s will
Q: But why Luis?
A: Because he was not treated adequately
Q: Why not?
A: Because the midwife tried to treat him with tea.
Q: Why else?
A: Because the doctor in San Ignacio could not treat him. He wanted to send Luis to Mazatlan for treatment.
Q: But why?
A: Because he didn’t have the right medicine.
Q: Why not?
A: Because it is too expensive.
Q: But why is this life-saving medicine so expensive?
A: (A whole discussion can follow. Depending on the group, this might include comments on the power and high profits of international drug companies, etc.)
Q: But why did Luis’s parents not take him to Mazatlan?
A: They did not have enough money.
Q: Why not?
A: Because the landholder charged them so much to drive them to San Ignacio.
Q: Why did he do that? (A whole discussion on exploitation and greed can follow)
A: Because they were poor.
Q: But why are they poor? (This question will keep coming up.)
1. Taken from David Werner and Bill Bower, Helping Health Workers Learn (Palo Alto: The Hesperian Foundation, 1982), 26-30
