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Finding root causes of health problems

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HealthWiki > A Book for Midwives > Chapter 2: Treating health problems > Finding root causes of health problems


As a midwife, you must find and treat the immediate causes of health problems. For example, think again about the story of Celeste and Elena. The immediate cause of Elena being tired was her anemia. If she eats more iron-rich foods or perhaps takes iron pills, her anemia will probably get better. By looking at the immediate causes, we can help people feel better or save their lives, especially in emergencies.

Treating the immediate cause is very important. But if we only treat the immediate cause, the problem may not truly be solved. It may come back, or it may affect others in the community. Sickness usually results from a combination of causes — direct causes, like germs or lack of iron, and less direct root causes that may be social, economic, or political. By finding these root causes, you can prevent problems from happening again.

In the case of Elena, there are many root causes of her problem. Celeste could probably figure out some of those causes herself. Better yet, she and Elena could meet with a group of people from the community to help think about the problem, because anemia is not just Elena’s problem, it is a community problem.

Celeste asking questions and a group of women answering.
Why was Elena tired?
Because she had anemia.
But why did she have anemia?
Because she did not eat enough foods with iron.
But why didn't she eat enough iron-rich foods?
She did not know which foods had iron.
But why else?
She could not afford meat.
But why couldn't she afford meat?
Because she is poor. She and her husband work on a farm and make little money.
But why do farmers make so little money?

After you have asked everyone “why” in this way for some time, you will find that there are many reasons why Elena had anemia. This exercise also shows why anemia is not just a problem for Elena but for most of the women in the village. Indeed, it is a problem for most women in most villages and poor communities around the world.

Make change in your community to prevent health problems

Most deaths and injuries from pregnancy and childbirth can be prevented by looking at and treating root causes. But to do so, a community must look beyond the experiences of individual women. Look at the common dangers that affect all women in pregnancy and birth. And use the skills of every community member to protect women’s health.

Midwives, who are most experienced with birth, can tell others in the community why women are dying and being injured during birth. Families, midwives, and other health workers and community members can work together to make changes, small and large, to improve health for all. When everyone in the community becomes involved with health, we can do much more than one midwife alone.

How to start

Lack of healthy food, dirty drinking water, lack of transportation in emergencies, and alcohol abuse are a few of the problems that contribute to serious health problems for women. These can all be addressed when they are not considered individual problems and when the whole community works together for change. But it can be difficult to know where to start. A good first step is to meet with community members to talk. If you teach birth classes to pregnant women, meet with other midwives, or are a member of a social or church group, you can use that group to solve problems.

a health worker writing a list in front of a group of women; one woman speaks.
CAUSES of ANEMIA
— iron pills are not
given out at the
health center
— meat is
expensive
— people do not
know which other
foods have iron
Iron pills make me constipated.


First, name the problems you are facing.

4 people speaking in a group of 5 men and women.
You have all read how to stay healthy in pregnancy. But not everyone can do these things. Why?
We always have to wait hours to be seen at the clinic.
How can we eat well when there is no money for food?
I hate vegetables.


After you have named some of the problems in the community, choose what to work on first. It might be the problem that is the most common, the problem that causes the most serious harm, or the problem that can be most easily solved. List every idea the group can think of to work on this problem. Then focus on solutions that someone in the group can make happen.

each of the 5 men and women speaking.
We agree that the whole community can help pregnant women eat better. But how?
I could plant some green vegetables in the coffee field.
We should talk to the storekeeper. He should sell more beans and rice and less liquor!
We could start a community garden.
We could raise chickens.


a man in the group speaking.
I can pay for the seeds, but we all must work together to plant and care for them.

Make a plan. You will need to decide who will do each task, what they will need to do it, and when they will do it.

Be sure to meet again to talk about how the plan is going.

4 people in the group speaking.
The seedlings are coming up well. And everyone has been taking turns watering them.
The chickens have started laying.
I talked to the storekeeper, and he said he will not sell beans — they don't make enough money for him.
Let's all go to the storekeeper together. If we tell him we'll stop buying anything from him, he may listen to our demands!


Midwives can make change

Midwives and the women they serve may face any kind of health problem, from simple ones like nausea to serious ones like a bad hemorrhage. But when midwives work carefully to discover causes, and use wise judgment and support from the community, they can solve nearly any problem, even many of the most difficult ones.

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