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Hesperian Health Guides

Chapter 2: Treating health problems

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HealthWiki > A Book for Midwives > Chapter 2: Treating health problems


Most of the daily work of a midwife is treating health problems. When a woman you are caring for has a problem, like exhaustion, pain in the belly, or even heavy bleeding, you will need to take these steps to solve it:

  1. Find the immediate cause of the problem.
  2. Choose the best treatment.
  3. Look for the root (underlying) causes of the problem — to fully address the problem or prevent problems from happening again.


Finding the causes of health problems

In this section, we tell how Celeste, a midwife, solves a health problem. The details of this story apply only to Celeste, but the way she thinks about the problem and works to solve it can be used by any midwife for any health problem. We list each step that Celeste uses so that you can use these steps too.

  1. Start with a doubt. This means start by admitting what you do not know.
  2. Think of all the possible causes. Most ways of feeling sick can be caused by many different problems.
  3. Look for signs to find the likely cause. Health problems have signs. You can see these signs in how someone feels, how their body looks and acts, and by taking medical tests.
  4. Decide the most likely cause.
  5. Make a plan for what to do. This could be a plan to change a person's habits, change something in their home or environment, or give a medicine.
  6. Look for results. Find out if your treatment is working. If it is not, start these steps again.
Celeste's steps for finding causes
  1. Start with a doubt.
    A young pregnant woman named Elena came to her midwife, Celeste, for care. During the checkup, Elena said that she felt tired all the time. First, Celeste acknowledged that she did not know what was making Elena tired.

  2. Think of all the possible causes.
    Celeste knew that being tired can be caused by many things. Sickness, hard work, not enough sleep, stress, and anemia are some of the most common causes.

  3. Look for signs to find the likely cause.
    Celeste asked Elena questions to find out more about the tired feeling.
    Celeste asking questions and Elena answering them.
    Are you working more than usual?
    I work hard, but no harder than usual.
    Are you sleeping less? Do you feel ill?
    I'm sleeping enough, and do not feel ill.

    Celeste also asked Elena what she usually ate. Elena said that she mostly ate maize and beans every day. Actually, mostly just maize. Elena complained of the high cost of buying meat.

    Celeste checked Elena's physical signs. Elena had pale eyelids and gums and a fast, weak pulse — all signs of anemia.


  4. Decide the most likely cause.
    Celeste could not do a blood test to be sure, because there was no laboratory nearby, but all the other signs showed that Elena probably had anemia.

  5. Make a plan for what to do.
    Celeste explained to Elena that anemia can cause tiredness and make it hard for a woman to recover after a birth — especially if the woman bleeds heavily. She told Elena that anemia means not enough iron in the blood and that it can usually be cured by eating foods rich in iron and protein or by taking iron pills.
    Celeste speaking to Elena.
    If you cannot afford to buy red meat, there are cheaper foods that are rich in iron. Try liver, eggs, yams, and leafy green vegetables.

  6. Look for results.
    When Elena came back for her next check up, Celeste checked for signs of anemia. After improving her diet, Elena seemed be getting better. If Elena had not gotten better, Celeste would have recommended that Elena take iron and folate pills.

These 6 steps will help you solve most health problems.

Note: To "start with a doubt" is very difficult for most health workers. Many health workers are afraid to admit when they do not know an answer. But to accurately assess a problem, and to treat it appropriately, we must admit what we do not know.


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