Hesperian Health Guides
Finding root causes of health problems
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 â 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 Elenaâs problem, it is a community problem.
After you have asked everyone âwhyâ 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.
Finding the many root causes of health problems means looking hard at the different parts of peopleâs lives that contribute to the problem.
For example: A fistula is a terrible complication of some births. When a labor goes on much too long, the tissue inside a womanâs vagina can become crushed and break open, leaving a hole to her bladder. This causes serious health problems and constant leaking of urine. To prevent a fistula, simply prevent a long labor. If a woman is in labor for more than a day, bring her to a medical center or hospital.
But by looking more deeply at the many causes of a long labor, we can do more to prevent fistula and other related problems.
- Young girls who do not eat well often grow up to have small bones (including small pelvises). An abnormally small pelvis can cause a long labor. Some young girls do not eat enough because their families cannot afford food. Some are not fed enough because they are not considered as important as boys.
- Some girls have children too young. Young girls have long, complicated labors because their bodies have not fully grown. Girls might marry and have children early because it is the custom of their communities or because their parents are poor and cannot care for them. Or both.
- Women in bad health are more likely to have long, complicated labors. Anyone can have health problems, but those who do not have access to basic health care are in the greatest danger.
- Rural and poor women cannot easily get medical help in an emergency.
To prevent fistulas, must we simply get women to hospitals faster, or can we also work to change the conditions that cause long labors, like poor nutrition of young girls and too-early marriage and childbirth? How can we work to stop the root causes of these problems â poverty and unfair treatment of women and girls?
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 womenâs 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.
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First, name the problems you are facing.
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.
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.
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.