Hesperian Health Guides

Working for change

In this chapter:


Ruk's story

When Ruk was born in a village in Nepal, his mother struggled a long time to give birth. At first she thought her baby would not breathe. As a baby, Ruk would cry at night and he always seemed to have a cold or fever.

Ruk played on the mud floor and outside the house where his family spread the millet and corn to dry and separated the rice grain from the chaff and dust. Chickens, goats, and their dog lived in the same small area. Ruk loved to sit and watch his mother cook at the open stove, even though the wood smoke stung his eyes and made his nose run.

A boy swimming.

As Ruk grew older, he always seemed to have a runny nose. Sometimes he had very painful earaches in both ears, which often drained pus. He loved to swim in the small river below the village, but this made the pus drain even more.

When Ruk started going to school, he was slow to learn and not very good at reading. The teacher got angry because he thought Ruk was ignoring what he said. But it was hard for Ruk to hear the teacher. So, to avoid getting into trouble, Ruk sat at the back of the class. Children teased him. He spoke in a funny way and was difficult to understand.

Finally Ruk's parents decided it was not worth spending money to pay for his school uniform, books, and pens if he was not going to learn. So Ruk stopped going to school. Instead, he carried wood for the fire, fed the animals, and scrubbed the cooking pots for his mother.

A man holding a small child in distress.

One day, Ruk got a terrible earache that lasted for several days. His ear filled with pus and he developed a swelling behind the ear. Finally his father took him to the village herbal healer, but the medicines did not take away the swelling. His father had to carry Ruk to the health post in another village. The health worker there drained an abscess behind Ruk's ear and gave him an injection and some antibiotic syrup to take for a week.

After some time, Ruk had severe pain again. Both his ears always smelled bad and lots of pus came out of them. His neck got swollen and he had very high fever. The health worker told them to take Ruk to the hospital in the city. Ruk's parents had little money and did not know where they would stay, but they followed the health worker's advice.

Ruk almost died because the infection got into his brain and bloodstream. At the hospital, they gave him a lot of medicines but he was still very ill. Luckily, a visiting ear doctor drained the pus from the abscess, removed a lot of infected bone, and repaired his ear drum. The doctor explained how to take care of Ruk's ears and said Ruk should use a hearing aid. Ruk's parents just looked at the doctor and nodded.


A group of men and women sitting together and talking to each other.
Sandra, why do you think Ruk lost his hearing?
Maybe he lost some hearing during his difficult birth.
He had many fevers and colds. And his family didn't know that ear infections could
damage his hearing.
There was no health worker nearby to tell them what to do.
I'll bet the smoke and the dust made his nose run and made his ear worse!

Why did Ruk stop going to school?

Ruk had really wanted to go to school and learn like the other children. Children who lose their hearing become disabled when teachers, family, and friends do not know how to communicate with them. If the school and the teacher knew that Ruk could not hear well they might have tried to communicate differently with him. They might even have helped other children understand that ear infections can cause children to lose their hearing. If the school had accepted Ruk and helped him to learn, he would have made friends and had a better future.

People can change the conditions that make children lose their hearing

A group of men and women sitting together and talking to each other.
Ruk's parents should have visited the health worker before he lost his hearing.
Yes, but if the health worker had come to the village and taught everyone the causes of deafness, they would have known what to do.
And if the medicines were cheaper, they might have gotten them sooner.
If we could grow more vegetables to eat, the children might not get sick so much.
Maybe the village could organize a way to get sick children to the hospital easily when they need it.


There is power in communities working for change. Here are some examples:

  • People can organize local or national immunization campaigns against common childhood illnesses. Health workers can use simple health education materials with parents, children, teachers, and others.
  • Health workers, teachers, and child care workers can be trained to recognize, treat, and prevent chronic ear infections and other causes of hearing loss in children.
  • People can demand that the government make affordable medicines available to treat childhood illnesses, including ear infections, and that pharmacies and clinics in their communities keep them in stock.
  • People can also work together to remove the communication barriers that make deafness a disability. They can learn sign language themselves, and they can work to provide educational opportunities for children who cannot hear well.

Improving the well-being of the whole community will help prevent and heal many of the problems that cause hearing loss. When a country's wealth is shared for the good of all its people, everyone — men and women, mothers and children — can have adequate health care, good roads and communication to receive medical attention when needed, and enough good food and clean water to help them grow strong and stay healthy.