Medical Students as Health and Environmental Promoters

by Salma Galal, M.D.

Health education has to be the responsibility of the whole community

There are a lot of entry points to promotional or developmental activity, once starting anywhere one finds himself a mid of the conglomorate, entangled in the social system; it provokes a 'snowball effect'.

People have to sense that the person trying to change or to improve conditions is honest and is truly concerned.

Change is a natural process of any social system, however, not all subjects or things change at the same time or at the same rate. A community is a social system existing to achieve objectives through collective efforts.

Fig.1. Entities to be considered in working with communities

At least three participating entities have to be considered in entering the community for developmental or promotional activity, or for research work:

• the community,
• the administrators and officials
• the community developers /promoters

Each of the above has different value system and concept, role understanding of themselves vis a vis the others as well as weighing priorities of existing problems. Their understanding of community needs and development is different. The diversity is not only between each entity but also within each.

Even if the medical student is from the same community, going through medical education changes some of his/her value system.

Formal community leaders would try to keep the developer or research team away from the community negotiating the best out of the situation. They perceive themselves as the 'voice' of the community, knowledgable of their needs. However, after having contacted formal leaders the health promoter found that it was important to organize community meetings to present intended actions and to clarify the role of each entity . In order to facilitate the dissemination of information to the community as a whole.

Informal community leaders are as important as the formal leaders. Sometimes they have better credibility in their community than the formal leaders.

Besides, they are very effective if they become engaged in the process from the beginning.

The interaction between the community leaders and the promoters/community developer initiate a mutual learning process. In case of the student being from the same community he/ she is often known to them but he /she have to prove themselves capable in taking over the promoter role. In case she/he is a ‘stranger’ or newcomer, she/ he has to develop trust and acceptance not only with community leaders but also with the community members as a whole.

During the initial phase the encounter between the promoter/team and community can be characterised by

• explaining their concept
• negotating and review in priorities requested by community leaders

However after the performance of the activity, the durability and continuing enthusiasm of the student improves her credibility in the community.

Table 1. Comparison between health promoter/team & community leader

Often initial request of the community is improving hospital conditions or health center or having specialized physicians coming to their village, they just demand the ‘best’ regardless of its cost-effectiveness. Negotiations with the community has to set feasable priorities.

In each community there are always volunteers, who have to be identified and encouraged, these last might be women, men, youth or children.

It is important to have an open meeting for the whole community explaining the intentions of the work because often the information given is not submitted as intended. In some communities where there is segregation, a meeting has to be held for women and for men separately.

-Administrators and officials

Administrators and officials usually fullfil their job within the regulations set up. Usually they are interested after (or during) office hours to find other means of earning in order to confront living demands due to the high inflation rates and the structural adjustment policy adopted.

Paying courtesy visit to local administrators is necessary. Also informing them about the activity of the health educators or promoters is important.

For comments, suggestions, and feedback please email: heea_egypt@yahoo.com.