Need of rural communities to be engaged and empowered for global health and wellness

INTRODUCTION

Rural communities do many things with whatever they have for health and wellness of their ownselves and their families. They use various modalities for prevention and therapy of disorders, maintenance and promotion of health. For their everyday needs also, they use various itoms and do activities which affect their health and wellness.¹ They do a lot for vulnerable members of family also. Whatever modes are used probably do a lot of good to the users. Such activities need to be shared with global communities. Also, practitioners of modern medicine need to know and need to support the right actions for global health. Under the banner of WHO, Levin, years back defined self-care as ‘the ability of individuals, families and communities to promote health, prevent diseases, maintain health, and cope with illnesses and disabilities with or without the support of health workers, extending far beyond the common perceptions of individual acts of self-interest, to a set of behaviours and practices determined by a person's cultural, environmental, and socioeconomic circumstances’.²

Objectives

Objective of current study was to get information in context of modes of therapies and other activities by the rural communities for their health and wellness.

METHODS

Study design, location, duration and population

An observational study was performed at Rural communities of villages and around the village with the health facility, study centre. Activities were observed over the years. Communities of villages and around village with health facility was taken as study population.

Procedure

Self-observations and experiences were added after discussions with rural communities, health workers, and others who work for health and development of communities in the villages from where information was collected. Since the article is based on observations of activities of rural women, not a planned study, no tool was used. Observations spread over a decade are in the article. For the same reason no tables are possible, however pictures are added.

RESULTS

It was observed that rural people use various modes which impact their own and their family’s health, wellness as well as development. Actions may be at birth for the new born or elderly of the family. Many women do not disclose about their pregnancy, do not go out, do not mix with many people and take special precautions during first few weeks of pregnancy, others even continue field work, no change. It is really good not to get exposed to environmental pollution and any infection during first few weeks of pregnancy for the mother and best of growth and development of the baby. Though it is also essential to ensure that all is well. Although pregnancy, birth are physiological processes, abnormalities are possible during pregnancy, birth and post birth. Awareness of availability and essentiality of modern medical care for abnormality, is also essential. Few weeks prior to birth time, ‘Baby shower’ of pregnant woman is done, a way of giving best wishes to pregnant woman and birth preparedness (Figure 1).

The same event can be utilized for readiness for complications with science added for safe birth and post birth. During delivery as the baby comes out of birth canal, sandbag is kept on pelvic area of mother’s abdomen, in pelvic area over the uterus which helps in uterine contractions and retraction and blood does not get collected inside the uterus, even if excessive bleeding occurs, modern day ‘aortic compression’ being advocated for prevention and management of post-partum hemorrhage.³ Blood comes out of the birth canal and becomes visible fast (Figure 2).

For some days after birth, mother and baby are kept in a isolated place of the house. Mother is given high calorie diet, depending on what the family has, not allowing anyone to go near or touch the mother and the baby, good for infection prevention for mother as well as baby and best of breastfeeding. Families need to know, essentialities of cleanliness and illumination. Post birth, some kitchen items, boiled with water, ‘kada’ is consumed with or without jaggery, for good involution of uterus and increasing breast secretions. With this mother as well as the baby get iron too. Rural women breastfeed beyond infancy, good for the baby and spacing between two pregnancies. But proper and timely weaning is essential, knowing weaning time and weaning items, as per the availability for the best of growth of the baby. Scientific advocacy helps. Many other activities are performed by members of the family. It may be cereals grinded at home by women, good exercise for shoulders, back and also food with lots of fiber real nutritious and good for bowel function, is consumedly by the family (Figure 3).

Cleanliness is essential. Ginger and Basil leaves juice with powdered black pepper and honey are made into paste and consumed for upper respiratory symptoms, (Figure 4) good practice of avoiding antibiotics which are very commonly used, but may not be necessary and may even do harm to the user. Another type of ‘Kada’, made from other kitchen items, boiled with water is consumed hot for acute as well as chronic illnesses, muscle and joint disorders and other disorders. Some tree leaves and /or tree barks are grinded with turmeric and made into paste applied on swellings, wounds and for muscle pains (Figure 5).

Such therapies are reported to be doing a lot of good as anti-inflammatory medication. Milk with turmeric power added is consumed after any injury as pain killer (Figure 6). In addition various herbs are used for therapy well as promotion of health. All this needs sharing for the best of global health. In addition to such actions for prevention of sicknesses or therapies of sicknesses, rural communities do various other activities which also affect their health and wellness. They make their huts with mud with lots of tree leaves, easily available in villages. Such huts have safety from heat and cold, sort of inbuilt air conditioning by villagers, using worldly wisdom within their limited resources. Without understanding inherent advantages of rural modes, as per their resources, governments and civil societies try to help villagers with all good intentions by providing huts made of cement and iron which become very cold in winter and very hot in summer, adding to miseries of the lives of rural communities in winter as well as summer. For meals, Banana leaves and other leaves are used as plates, bowls of different sizes and used for various purposes (Figure 7). Big leaves are just washed and used, no plastic, or no thermocal. It is available easily to rural people. It protects environment and prevents water pollution and is resource saving too. Cleanliness is essential. There are many other things which need sharing.

DISCUSSION

Communities, groups of people that may or may not be spatially connected, but share common interests, concerns, identities, like rural communities, need to feel empowered and enabled to gain control over necessary decisions for the health and development, their own, their families’ and communities. In modern day practice, it is essential to priorities modes for best therapy and best outcome without harmful effects. A lot of research is needed, including reverse pharmacology to understand more about modalities of actions for health and wellness to have evidence-based therapies so that such modalities can be used for global health with scientific evidence.⁵ Reverse pharmacology will let the world know about the scientific ways such modalities act and will also guide for future research. Also, communities need to be made aware that they may be doing some activities or using modalities which are not safe, like applying mud on open wound or do massage of abdomen of pregnant woman or some other similar activities. They also need to be aware of modern medicine as there is a definite place for modern technology and modern medicine for the best of global health, rural inclusive. Also, it is essential that communities know what more they can do on their own, with existing material and skills and for what all needs, they need support from the government, health systems as well as civil society and also for what all requirements, changes in governments’ policies and/or programs are required so that rural communities also have the best of health and also their development gets expedited. Communities need to know their strengths, weaknesses, barriers, actions needed and challenges in seeking government’s as well as others support. It has become more important with rising cost of health care and global evidence of medical errors killing many around the world.⁶ Communities need to be involved, engaged, empowered and enabled for the best of global health and wellness and development too.

Altobelli from Lima, Peru reported that one of the keys to improving health globally is promoting adoption of healthy home practices for better nutrition and illness prevention.⁷ Sharing and advocacy to improve performance of female community health workers (CHWs) in promoting mothers’ behavior for maternal, neonatal child health (MNCH), build on guided sharing of their own memories of childbearing, build self-confidence and empowerment of CHWs in learning sessions and help in child care also. CHWs can share histories with women to build their trust and empowerment. Thompson et al opined that community-based participatory research is promising approach in reducing health disparities around the world.⁸ This becomes a step in engaging and enabling communities. The study by Suharmiati revealed that socio-economic status affected the Traditional Health Services (THS) utilization in rural Indonesia.⁹ The results showed that those with lower SES were 1.111 times more likely to utilize THS than those with the lowest SES. Finlayson et al reported that development bodies of states were increasingly stimulating social enterprise activities in communities as empowering social as well as economic development interventions and ownership.¹⁰ Maton reported about the pathways and processes through which empowering community settings influence their members, the surrounding communities and the larger society empowering communities, individual development, community betterment, and positive social change.¹¹ A set of organizational characteristics and associated processes leading to member empowerment across domains were identified. Another research revealed that exploration of the ways of community psychology and allied disciplines, can help increase the number and range of empowering settings, and enhance the community and societal impact of existing modes.¹¹ The community empowerment necessarily addresses social, cultural, political and economic factors that underpin health and wellness, seek to build partnerships with other sectors in finding modalities of actions for better health of communities as was found in the observations in the rural communities. For going ahead community engagement is essential, working collaboratively with communities, understand their activities, encourage and enable them and learn from them. It is a powerful vehicle for bringing changes for improving health of communities supporting, helping and reforming, and having policies, programs and practices, best for community health, keeping their wellbeing in mind. Worldly wisdom can improve quality of life and development gets enhanced with safe community practices as was found to be happening in the rural communities. Community engagement approaches can be used in the variety of ways to facilitate participation. Community partnership impacts the engagement practices, providing insight into the importance of communication and practices grounded in the culture of communities. Each community effort begins by building strong, compassionate relationship. Once these relationships are developed, interpersonal connections are set for successful outcomes. Relationship is necessary foundation for care, trust and change. Foundation leads to shared learning from each other’s’ experiences. So, communities are able to make decisions with information that impact their everyday lives. Once communities come to understand that they can make differences in their own lives their communities also, they move confidently towards social, ecological awareness, behavior change. With this, transformation starts and sustainable change becomes a reality for further development. This is achieved by strengthening rural people's, individual as well as collective efforts with strong emphasis on inclusion of vulnerable members. This is what rural communities are doing with whatever resources they have. Engagement with communities’ readiness to learn reveals, people know to help themselves what they don’t know and also, they know what more they need to know for participation with successful and sustainable involvement, widely believed to be beneficial for implementation and evaluation of health services inspite of the challenges. Haldane et al opined that there was evidence that community involvement had positive impact on health and wellness as well as community development, particularly when substantiated by strong organizational and community processes.¹² However participatory approaches and community empowerment which led to health improvement and positive outcomes are complex processes, influenced by an array of social and cultural factors. There are many challenges in successful and sustainable community involvement. A community development approach to engagement can empower communities so that they take responsibility for their own health. Community participation is a fundamental element of an equitable and rights-based approach to health and wellness that has been proven effective in optimizing health interventions for positive public health impact. Community participation needs to be the central aspect of public health policies and practices This is possible by knowing what communities do. This will lead to awareness of policy and program makers as well as practitioners. However, one of the most enduring problems for global health in scientific community is how to readily transfer knowledge generated from findings. So, sharing of observations is essential. Reverse pharmacology research can also do a lot. Certain roles require community-led activities that attempt to facilitate social enterprise and benefit from community participation from planning stage. This happens in communities globally and needs sharing and brain storming for the best of global health. While rural communities need some support, they do have a right to ask for their say in their health with rural eye as well as mind for rural issues after real mapping and knowing ground realties, nothing about rural health, without rural communities. It has become obvious that traditional ivory tower models in health are failing to meet health and social needs of society, especially rural people around the world. In addition there are rising cost issues with modern medicine.¹³ And also many medical errors continue to kill many people around the world.⁶ So search for alternatives continues. Suharmiati also opined that the use of traditional health services is increasing and it seems that they are even expected to fill the gap in health coverage caused by a lack of modern health facilities in rural areas.⁹

CONCLUSION

Rural communities need to feel empowered and enabled to gain control over necessary decisions for health and wellness of themselves, their families and people around. Need is of robust evaluation of community initiatives activities, for health and development that affect long term outcomes, cost-effectiveness. Over all community involvement is the key in priority settings to drive healthcare interventions after having known what they do. The need is of more robust evaluation of community and modes of activities which affect health and wellness in settings globally for global health.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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