Taking Care Of Each Other: The Work of Eva Salber

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Eva Salber is Professor of Family and Community Medicine at the Duke University School of Medicine in Durham, North Carolina. Last year I had the privilege of visiting Dr. Salber at her home in nearby Chapel Hill and—while there—of discussing her important work promoting lay health care. The following report is drawn from my conversation with this truly remarkable woman. 

"The great majority of illnesses," Dr. Salber observed as we sat in the comfortable downstairs family room of her home, "are never seen by a physician. The real primary care is provided by one's family, close neighbors, and friends. Furthermore, in every community there are certain people to whom others turn for advice, counsel, and support. I call such individuals health facilitators. And one of the most important things any doctor, or other health professional, can do is to find these people and offer them recognition, information, and support."

Eva Salber, you see, is a champion of the lay health facilitator. She has taught medical professionals from many countries how to help—and benefit from—these unsung heroes and heroines who, in fact, have always provided a great deal (if not the majority) of the world's health care. Dr. Salber is quick to say, however, that she isn't the force behind the "barefoot doctors" . . . rather, she has simply pointed out their existence, and suggested ways they might be given the recognition and support they deserve.

WITCH DOCTORS AND "ILL WISHERS"

Eva's interest in lay health care was kindled by her experiences as a staff physician at one of South Africa's first Institutes of Family and Community Health (the forerunners of the neighborhood health centers in the U.S.). "We learned very quickly," she recalled, "that the local medicine men could deal with certain kinds of troubles better than we could. They were much more effective in handling family and personal problems ... because they were part of the local culture. And, of course, they knew just what to do with afflictions that involved the client's belief system. If a woman felt that she was being poisoned by an ill-wisher, for instance, we might be able to name her symptoms, be we wouldn't be able to cure her. We learned to refer such cases to the witch doctors ... and they, in turn, sent us any patients with the sort of ailments-they called them 'town diseases'—for which our tools were more effective,

including VD and other infections that could be cleared up with antibiotics. My great triumph came when the local witch doctor sent one of his wives to me for treatment."

After her introduction to the health facilitator concept, Eva began to notice the same phenomenon wherever she went ... including Boston, where she served as director for a health program in a low-income, inner-city housing project. "In spite of the hardships that the project residents had to contend with poverty, broken families, crime, unemployment, and poor education—the neighborhood could boast of an active, effective network of health facilitators who spent a good deal of their time helping others," said Eva. So she put together an advisory committee for her program, and appointed the community's health facilitators as members ... placing these people in positions of responsibility and power for (in many cases) the first time. The move was a success. "I've seen it time and time again," observed Dr. Salber. "People want to give, and to be given, the opportunity to help ... and when provided with that chance, they'll blossom before your eyes."