Trust in the people / Christian Aurenche

World Heolth • May-June 1992 Trust in the people "Poor health in young people does not derive from illness but from lack of hope, which results in a turning inward and isolation." T he mission hospital in Tokombere, a rural and mountainous area in northern Cameroon, had a qualified and dedicated staff. But in spite of an ever- increasing number of patients seen, greater use of medicines, progress in the quality of health care and higher health expenditure, the health status of the population had not been improving. In 1976 Dr Christian Aurenche started to work in Tokombere. He launched a new approach. Instead of the traditional situation where the hospital is the centre of the health care system, he made the village the centre and the villager the first health actor, while the health professionals offered technical support for the villagers. To achieve this, the attitudes and ways of work of the health workers had to change. Instead of spending their time in only looking after the sick, the health workers became actively involved with the community in studying and solving its own health problems. Village health committees took shape. Mobile health staff provided practical information on health and what could be done to improve it. The training of health workers had to change. Instead of receiving lectures on how to work with communities, they had to go to the villages and learn. They also had to learn to accept that initiatives taken by the community had to be taken seriously and supported. But trusting the people implies that government officials and administrative councils, as well as health workers, should never undertake a project without having first consulted the people, nor should they change it without having at least informed the community. "What humility that requires!" exclaims Dr Aurenche. "I have never before seen it in the field, and that explains why it is so difficult to make a local primary health programme last." Eager to learn According to Dr Aurenche, educating people does not present any problems: they are so eager to learn and so greatly desire to have better health. He never ceases to be amazed by the creative dynamism of a population stimulated in turn by a dynamic health committee. He comments, "Here I must mention a group of women responsible for nutrition in one village, who came with a request for help in opening a 'good nutrition' restaurant in the market at Tokombere, both as a source of funding, and because they wanted those who came to the market to learn how to feed themselves better". He also recalls the opening of a peasants' centre, which is now the heart of a self-run rural development project. There, young people who have finished school receive further 9 training. The programme includes self-run boarding schools, and a youth club in Tokombere with video, a library and a lecture hall. This is important, says Dr Aurenche, because "poor health in young people does not derive from illness but from lack of hope, which results in a turning inward and isolation". Activists for health To create a real partnership between the population and the health workers, even the ways in which future health workers were selected had to be changed: candidates had to agree to work in the villages. But the real difficulty lay in the lack of reform of their basic training. Another problem was that political leaders have hesitated to agree to the training of activists who can take responsibility for health in their own community. Much has been done to improve health in Tokombere. And yet, says Dr Aurenche, it still needs to be demonstrated that "health is not simply the end result of technique, and that human beings do not require merely to be repaired or even protected. People want to he- that is, they want to be free, responsible, creative and in control of their environment". • Or Christian Aurenche is a French physician who was awarded the Sosokawa Health Prize by WHO in 1988 for his dedicated efforts in supporting the health development of the people in Tokombere . His address is Centre de Promotion de la San te de Tokombere, B P74, Maroua, Cameroon.