NURSING
. CARE
, W tf)RLD
THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION
HEALTH
Cover WHO/Interfoto
In this issue
More than ever, we need nurses 3
Hiroshi Nokoji mo
Heahng a sick society 4
Blonko Misconiovo
The traditional birth attendant 6
lmtioz Toj Komol
Chile's rural nurses 8
lsobel Ringeling 8. Gerordo Herrero
"Miss, we cannot read or write" 10
Moureen Minden
Helping famffies to cope 12
Tomor Krulik8. Shiro Kotz
page 10
Home care in Denmark 14
Slim Allogui
Ufe for its own sake 16
Normandy helps Senegal 18
Brigitte Giroult 8. Bodoro Somb
When special care is needed 20
Ellen B. Rudy 8. Borboro J. Doly
Fresh hopes for Paraguayan mothers 22
Moggie Jones
Vacdnations: mothers require
motivation 24
Dominique Tuko-Mbiosi
Quahty care in the South Pacific 25 page 12
Ruth Stork8. N. NgopokoShort
Ideas for action: Bohvia' s promotores 26
Joseph W.Bostien
WHO inaction 28
WHO on ... 30
page 25
World Health • September-october 1992 World Health is the official illustrated mogozine of the World Hoolth Articles and photographs that ore not copyrighted moy be reproduced provided
IXISSN 0043-8502 Orgonizonon. lt oppoors six nmes oyoor in English, French, Portuguese, credit is given to the WorldHoolth Organizonon. Signed articles do not
Russian ond Spanish, ond four nmes oyear in Arabicand For~ . The Arabic necessorily reflect WHO's views. The designonons employed ond the
Correspondence should be addressed to the Editor, World Health Magazine, edinon is available from WHO's Regional Office for the Eastern Mediterranean, presentonon of material published in World Health do not imply the expression
WorldHoolth Organizonon, CH·121 1Geneva 27, Switzerland, or dire<:~y to P.O. Box 1517, Alexandria 21511 , Egypt. The Forsi edinon is obtainable of any opinion what5oever on the port of·the Orgonizonon concerning the
authors, whose addresses ore given ot the end of eoch article. For from the Public Hoolth Comminee, Iron University Press, 85 Pork Avenue, legal status of ony country, territory, city or oroo or of it5 outhorines, or
subscriptions see order formon poge 31. Teheran 15875·4748, Iron. The Russian edinon con be obtained from concerningthedelimitanon of it5 fronners or boundaries.
"Medit5ino· Publishing House, Petroverigski per., 6/8, 101000 Moscow.
Russian Federonon.
,World Health • September-october 1992 3
Editorial
More than ever, we need·nurses
M
ost people's image of the
nurse is that of a unifonned
lady caring for patients in a
Nurses increasingly see
hospital ward. This stereotype gives a themselves not iust as active
very false impression. In fact, many
nurses work, and always have worked, providers of care, meeting the
outside hospital- in people's homes, professionally defined needs
in health centres and dispensaries,
schools, factories and elsewhere. Most of passive patients, but more
people are also unaware that many
nurses work as senior managers and as
as facilitators who help people
educators and researchers. In many to take charge of their own
countries there are also male nurses.
Thus, the number and diversity of health. Or Hiroshi Nakajima,
persons working under the title 'nurse' Oirector·Generol of the World Health Organization.
makes generalization dangerous and,
more practically, poses enonnous
problems of definition and passive patients, but more as developed countries alike we need
categorization, as well as legislation facilitators who help people to take excellent nursing and midwifery
and professional preparation. While a charge of their own health. She- or he services.
nurse in one country may be a highly - infonns, educates, and supports the More than ever it is essential to
educated practitioner with several work carried out in families and clarify and agree on fundamental
qualifications and responsibility for communities. The work of nursing issues: the who, what, why, and how
her own actions, her counterpart staff and their training must therefore of nursing. Nurses, other health
elsewhere or even in her own country be geared to these situations and workers, and the communities they
-sometimes called auxiliaries or provide responses to local - and serve must move beyond the
nurse-aides- may have had only changing - needs. It must also be seen traditional stereotype and be flexible
minimal training and have no in relation to the other caring and forward-looking. This may
autonomy. The answer to the question professions that have proliferated sometimes be painful and difficult, but
"what is a nurse?" is therefore not during recent decades. it will enable us to create nursing and
self-evident. In many countries, the nursing midwifery services that are
Promoting health, preventing profession is in a state of crisis, appropriate for the third
illness, and caring for the sick are age- resulting in lack of interest among the millennium. •
old human concerns, and certainly not young to take up nursing. Until society
the prerogative of any occupation. In · values caring work and women's work
fact, the bulk of nursing and healing is more highly, and rewards them
carried out not by professional nurses accordingly, measures taken to attract
and their support staff, but by families new recruits will not succeed; well-
and friends. Traditionally, caring and educated, motivated women will
nursing in families and communities continue to seek careers in occupations
have been carried out by mothers, that have a higher social standing and
grandmothers, young girls or female higher remuneration. The social
neighbours. This is unlikely to change, consequences of this for the health and
and is now fully recognized by health well-being of populations will be
workers everywhere. Nurses disastrous. In developing and
increasingly see themselves not just as
active providers of care, meeting the
professionally defined needs of Hiroshi Nakajima, M. D., Ph. D.
, 4 World Health • September-october 1992
Healing a sick society
Blanka Misconiova
We had to change the system
... Nurses and physicians
were among the first to play
an active part in changes
which occupied everybody's
minds.
F
or the past 40 years, the role of
nursing and the status of nurses
in Czechoslovakia were closely
connected with the relationship of
society to health and the acceptance of
human rights, and showed insufficient
reverence for the human being.
Society was controlled by decisions of
a single party which claimed to speak
for the "people". All that was
imperfect, diseased, or handicapped
was kept out of public view as the
"perfect" society strode forward to
"the better tomorrow".
When in 1989 our country started
on the difficult road to democracy, Nurses and physicians played key roles in changing the attitude of society to health.
health and medical workers had a
particularly challenging task -to
change the attitude of society to major changes in the education of since November 1989, which already
health. We had to change the system nurses, defining the new role of the had 14 000 members. What we have
but at the same time undergo a nurse in the health care system, paving · in common is the desire to help our
metamorphosis of our own the way for private practice, revising country, to help the weak, the sick and
consciousness. Nurses and physicians legislation, altering the wages the depressed. Our sick society was
were among the first to play an active structure, and so forth. grateful for this assistance as people
part in the changes which were began to realize how big is the debt
occupying the minds of our entire owed to those who care for the old,
society. To help the weak diseased and handicapped fellow
Short-term and long-term reform citizens who used to be kept away
plans were developed within the At the time of our "velvet revolution" from public gaze.
Ministry of Health, involving a the department of childhood allergies In November 1991 I was appointed
multidisciplinary team of workers consisted of one physician and myself Director of Nursing and, within the
from several specialized branches. - a nurse - with 3500 young patients. framework of the Ministry, I became a
Part of these plans included creating In the evenings and at weekends I met member of the team responsible for
the post of Director of Nursing at the with my colleagues in the Nurse setting new priorities and radically
Ministry of Health, as well as making Clubs, an organization established changing the existing health care
. CARE
, W tf)RLD
THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION
HEALTH
Cover WHO/Interfoto
In this issue
More than ever, we need nurses 3
Hiroshi Nokoji mo
Heahng a sick society 4
Blonko Misconiovo
The traditional birth attendant 6
lmtioz Toj Komol
Chile's rural nurses 8
lsobel Ringeling 8. Gerordo Herrero
"Miss, we cannot read or write" 10
Moureen Minden
Helping famffies to cope 12
Tomor Krulik8. Shiro Kotz
page 10
Home care in Denmark 14
Slim Allogui
Ufe for its own sake 16
Normandy helps Senegal 18
Brigitte Giroult 8. Bodoro Somb
When special care is needed 20
Ellen B. Rudy 8. Borboro J. Doly
Fresh hopes for Paraguayan mothers 22
Moggie Jones
Vacdnations: mothers require
motivation 24
Dominique Tuko-Mbiosi
Quahty care in the South Pacific 25 page 12
Ruth Stork8. N. NgopokoShort
Ideas for action: Bohvia' s promotores 26
Joseph W.Bostien
WHO inaction 28
WHO on ... 30
page 25
World Health • September-october 1992 World Health is the official illustrated mogozine of the World Hoolth Articles and photographs that ore not copyrighted moy be reproduced provided
IXISSN 0043-8502 Orgonizonon. lt oppoors six nmes oyoor in English, French, Portuguese, credit is given to the WorldHoolth Organizonon. Signed articles do not
Russian ond Spanish, ond four nmes oyear in Arabicand For~ . The Arabic necessorily reflect WHO's views. The designonons employed ond the
Correspondence should be addressed to the Editor, World Health Magazine, edinon is available from WHO's Regional Office for the Eastern Mediterranean, presentonon of material published in World Health do not imply the expression
WorldHoolth Organizonon, CH·121 1Geneva 27, Switzerland, or dire<:~y to P.O. Box 1517, Alexandria 21511 , Egypt. The Forsi edinon is obtainable of any opinion what5oever on the port of·the Orgonizonon concerning the
authors, whose addresses ore given ot the end of eoch article. For from the Public Hoolth Comminee, Iron University Press, 85 Pork Avenue, legal status of ony country, territory, city or oroo or of it5 outhorines, or
subscriptions see order formon poge 31. Teheran 15875·4748, Iron. The Russian edinon con be obtained from concerningthedelimitanon of it5 fronners or boundaries.
"Medit5ino· Publishing House, Petroverigski per., 6/8, 101000 Moscow.
Russian Federonon.
,World Health • September-october 1992 3
Editorial
More than ever, we need·nurses
M
ost people's image of the
nurse is that of a unifonned
lady caring for patients in a
Nurses increasingly see
hospital ward. This stereotype gives a themselves not iust as active
very false impression. In fact, many
nurses work, and always have worked, providers of care, meeting the
outside hospital- in people's homes, professionally defined needs
in health centres and dispensaries,
schools, factories and elsewhere. Most of passive patients, but more
people are also unaware that many
nurses work as senior managers and as
as facilitators who help people
educators and researchers. In many to take charge of their own
countries there are also male nurses.
Thus, the number and diversity of health. Or Hiroshi Nakajima,
persons working under the title 'nurse' Oirector·Generol of the World Health Organization.
makes generalization dangerous and,
more practically, poses enonnous
problems of definition and passive patients, but more as developed countries alike we need
categorization, as well as legislation facilitators who help people to take excellent nursing and midwifery
and professional preparation. While a charge of their own health. She- or he services.
nurse in one country may be a highly - infonns, educates, and supports the More than ever it is essential to
educated practitioner with several work carried out in families and clarify and agree on fundamental
qualifications and responsibility for communities. The work of nursing issues: the who, what, why, and how
her own actions, her counterpart staff and their training must therefore of nursing. Nurses, other health
elsewhere or even in her own country be geared to these situations and workers, and the communities they
-sometimes called auxiliaries or provide responses to local - and serve must move beyond the
nurse-aides- may have had only changing - needs. It must also be seen traditional stereotype and be flexible
minimal training and have no in relation to the other caring and forward-looking. This may
autonomy. The answer to the question professions that have proliferated sometimes be painful and difficult, but
"what is a nurse?" is therefore not during recent decades. it will enable us to create nursing and
self-evident. In many countries, the nursing midwifery services that are
Promoting health, preventing profession is in a state of crisis, appropriate for the third
illness, and caring for the sick are age- resulting in lack of interest among the millennium. •
old human concerns, and certainly not young to take up nursing. Until society
the prerogative of any occupation. In · values caring work and women's work
fact, the bulk of nursing and healing is more highly, and rewards them
carried out not by professional nurses accordingly, measures taken to attract
and their support staff, but by families new recruits will not succeed; well-
and friends. Traditionally, caring and educated, motivated women will
nursing in families and communities continue to seek careers in occupations
have been carried out by mothers, that have a higher social standing and
grandmothers, young girls or female higher remuneration. The social
neighbours. This is unlikely to change, consequences of this for the health and
and is now fully recognized by health well-being of populations will be
workers everywhere. Nurses disastrous. In developing and
increasingly see themselves not just as
active providers of care, meeting the
professionally defined needs of Hiroshi Nakajima, M. D., Ph. D.
, 4 World Health • September-october 1992
Healing a sick society
Blanka Misconiova
We had to change the system
... Nurses and physicians
were among the first to play
an active part in changes
which occupied everybody's
minds.
F
or the past 40 years, the role of
nursing and the status of nurses
in Czechoslovakia were closely
connected with the relationship of
society to health and the acceptance of
human rights, and showed insufficient
reverence for the human being.
Society was controlled by decisions of
a single party which claimed to speak
for the "people". All that was
imperfect, diseased, or handicapped
was kept out of public view as the
"perfect" society strode forward to
"the better tomorrow".
When in 1989 our country started
on the difficult road to democracy, Nurses and physicians played key roles in changing the attitude of society to health.
health and medical workers had a
particularly challenging task -to
change the attitude of society to major changes in the education of since November 1989, which already
health. We had to change the system nurses, defining the new role of the had 14 000 members. What we have
but at the same time undergo a nurse in the health care system, paving · in common is the desire to help our
metamorphosis of our own the way for private practice, revising country, to help the weak, the sick and
consciousness. Nurses and physicians legislation, altering the wages the depressed. Our sick society was
were among the first to play an active structure, and so forth. grateful for this assistance as people
part in the changes which were began to realize how big is the debt
occupying the minds of our entire owed to those who care for the old,
society. To help the weak diseased and handicapped fellow
Short-term and long-term reform citizens who used to be kept away
plans were developed within the At the time of our "velvet revolution" from public gaze.
Ministry of Health, involving a the department of childhood allergies In November 1991 I was appointed
multidisciplinary team of workers consisted of one physician and myself Director of Nursing and, within the
from several specialized branches. - a nurse - with 3500 young patients. framework of the Ministry, I became a
Part of these plans included creating In the evenings and at weekends I met member of the team responsible for
the post of Director of Nursing at the with my colleagues in the Nurse setting new priorities and radically
Ministry of Health, as well as making Clubs, an organization established changing the existing health care
