The essential guide to field health “Where There is No Doctor” celebrates 50 Years
By S.L Backman
When Jodi Hammer trained to serve as a community health worker specializing in child and maternal health in Ecuador in 1994, she learned about nutrition, malnourishment in children, and how to identify and treat common health conditions in the absence of health clinics or medical professionals to staff them. One lesson covered the basics of delivering a baby.
The Peace Corps gave her a copy of “Where There Is No Doctor”, a basic health guide especially for people living far from doctors or medical facilities. Living in Urcuqui, a village in the highlands of the Andes Mountains, Hammer kept her copy of the book in her backpack at all times.
Except one day, when she climbed onto a public bus going into the regional capital. Dodging the chickens in the center aisle, she wedged herself into a seat by the window and settled in for the long ride. Suddenly, she heard a commotion. “I looked up and saw one of my mothers’ group mothers, very pregnant, hoisting herself onto the bus all alone to go to the hospital to have her baby. She was already having regular contractions.”
“I thought, I am going to be delivering a baby here on this bus, overfilled with passengers and their livestock, including this squealing pig on top…”
Hammer hurried over to the woman and persuaded the other passengers to let her lie on the front seat while the bus lumbered from stop to stop, loading on board passengers and their baggage, including live animals going to market.
“I was timing her contractions with my little watch, and I thought, Where’s my “Where There Is No Doctor”? It was the one time I didn’t have it with me! I thought, What are the odds….?”
The bus stopped again and again, loading more passengers and cargo—including a hog-tied, squealing pig. “I’ll never forget looking up and seeing a pig being hoisted up on the roof… I thought, I am going to be delivering a baby here on this bus, overfilled with passengers and their livestock, including this squealing pig on top…”
Hammer called out to the driver. “I said señor, señor! I will pay you all the missed fares, but this woman needs to get to the hospital!” The driver skipped some of his usual stops, and the bus arrived at the hospital before the woman delivered her baby. Hammer, exhausted, vowed to make sure that every day afterwards, when she picked up her backpack and headed out the door, she would first double-check that it contained her copy of “Where There Is No Doctor”.
Bringing health information to people in remote places using easily understood language and illustrations has been the mission of “Where There Is No Doctor” since the early 1970s, when the first Spanish-language edition of the famed health manual was published. That edition, as well as the English edition, have become well known to Peace Corps volunteers worldwide as a resource and guide for their own health care and the health of people in local communities.
Jody Hammer, who served in Ecuador, helps advise he near-delivery of baby on a bus with what she learned in the book.
Through the decades, Peace Corps volunteers have at times formally received the book as a part of their kit before being sent into the field. At other times, volunteers have been informally advised that the book might be useful. Some volunteers have first encountered copies already on the shelves of community health centers far off the beaten track.
The nonprofit publisher behind “Where There Is No Doctor”, Hesperian Health Guides, reports that the book has been used in 221 countries and territories. With full translations in 85 languages, and at least 5 million copies distributed, the World Health Organization regards “Where There Is No Doctor” as the world’s most widely used health manual. And yet, the book’s reach is likely even wider thanks to Hesperian’s open-copyright policy, which has allowed information and illustrations from the book to be photocopied, adapted, and distributed as booklets, pamphlets, posters and the like. Sarah Shannon, Hesperian’s Executive Director since 1996, shares that the organization continues to receive countless letters, emails, and stories about how the book has positively impacted the lives of individuals and their communities around the world.
In addition to “Where There Is No Doctor”, Hesperian has produced other easy-to-read, life-saving manuals and resources related to health and health care. Today, Hesperian’s library includes over a dozen books, covering topics like disability, reproductive health, environmental health, worker safety, and more. Nearly all these titles have also been translated into other languages, and all are available for adaptation to local conditions and further translation. “Where There Is No Doctor” continues to be updated to address changing health care concerns.
The most recent revision of the health manual was completed in 2022 and is available as a bound volume (in English, Spanish, Portuguese, Kreyol, Urdu, and Bambara) or as a PDF, and its chapters can be read and downloaded for free on Hesperian’s online HealthWiki. In 2011, Hesperian began working on “The NEW Where There Is No Doctor”, a project that expands on the previous edition and covers new topics, such as diabetes and heart disease, that were not included in the original. This year, both Hesperian and “Where There Is No Doctor”, the book, are celebrating their 50th birthday. Although the magnitude of the book’s impact may never be fully quantified, my conversations with a few RPCVs suggest some of the many ways that the health information in “Where There Is No Doctor” has supported the health of PCVs and their host communities across place and time. The experiences of these RPCVs hint at what can be learned from this newly updated, but classic, resource.
