David Werner, Carol Thuman, Jane Maxwell
Macmillan Education, £7.25, pp 446 
ISBN 0 333 51652 4
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Rating: ★★★★
Chances are that if you visited a remote district hospital in a developing country you would find a well thumbed copy of Where There Is No Doctor in its library. The book is intended primarily for village health workers, but generations of doctors and medical missionaries who have worked in underresourced communities globally will vouch for its value in providing concise reliable information.
This book is an all time medical favourite. It has been translated into over 50 languages since its initial publication in Spanish more than two decades ago, and it is still listed among the top 200 bestsellers by a popular internet bookstore. It has also found favour among writers of travel guides (as the ideal medical guide for today’s global traveller), experts in military survival, parents, and teachers.
Much of the book’s attraction lies in the simple illustrations that complement the clear, concise text. It has the easy to read appeal of a comic book. Although the emphasis is on the prevention, diagnosis, and management of illnesses found in poorer communities, the authors’ commonsense approach makes it equally useful to a villager as to any sophisticated city dweller with no medical background.
The book’s scope extends beyond just dealing with diseases to issues such as home cures, popular beliefs, healing without modern medicines (including the “right and wrong” use of them), and community development such as advice on how to build pit latrines.
Werner believes that people can and should take the lead in their own health care. However, he has an idealistic view of the community health worker and adopts a preaching tone when advocating values such as “work for the joy of it.” My experience is that these workers may be more materialistic and less compassionate today.
The book does have deficiencies. In the era of evidence based medicine, can the use of a soap enema for constipation still be acceptable? And who would recommend salt for heat cramps? A major revision is due—this was last done in 1993—to encompass newer knowledge. More space should be given to HIV and AIDS, particularly to issues relating to preventing transmission from mother to child. As a paediatrician, I would also like to see the WHO guidelines on acute respiratory infections incorporated into the text. Greater emphasis on the role of vitamin A and other micronutrients, and modifications to the recommendations about antibiotics, could only enhance its established status.