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The primary aim of the research project was to develop conceptual models of rural ambulance service delivery based on different worldviews or philosophical positions, and then to compare and contrast these new and emerging models with existing organisational policy and practice. Four research aims were explored: community expectations of pre-hospital care, the existing organization of rural ambulance services, the measurement of ambulance service performance, and the comparative suitability of different pre-hospital models of service delivery. A unique feature was the use of soft systems methodology to develop the models of service delivery. It is one of the major non-traditional systems approaches to organisational research and lends itself to problem solving in the real world. The classic literature-hypothesis-experiment-results-conclusion model of research was not followed. Instead, policy and political analysis techniques were used as counter-points to the systems approach. The program of research employed a triangulation technique to adduce evidence from various sources in order to analyse ambulance services in rural Victoria. In particular, information from questionnaires, a focus group, interviews and performance data from the ambulance services themselves were used. These formed a rich dataset that provided new insight into rural ambulance services. Five service delivery models based on different worldviews were developed, each with its own characteristics, transformation processes and performance criteria. The models developed are titled: competitive; sufficing; community; expert; and practitioner. These conceptual models are presented as metaphors and in the form of holons and rich pictures, and then transformed into patient pathways for operational implementation. All five conceptual models meet the criteria for systemic desirability and were assessed for their political and cultural feasibility in a range of different rural communities. They provide a solid foundation for future discourse, debate and ...

Traditional medicine is the main, & often the only, source of medical care for a great proportion of the population of the developing world. Systems of traditional medicine are usually rooted in long-standing cultural traditions, take a holistic approach to health, & are community based. The World Health Organization has long recognized the central role traditional systems of care can play in efforts to provide primary health care, especially in rural areas. This article provides an overview of national policies adopted by African governments following World Health Organization recommendations for the incorporation of traditional & allopathic systems of care. 12 References. [Copyright 2002 Sage Publications, Inc.]

This edited volume presents a comprehensive analysis of the public and federal policy, clinical trends, and empirical literature relevant to the provision of health care services in rural and frontier areas. Leading experts from different professional disciplines examine the economic and social problems of rural and frontier areas, collaborative methods for service delivery, and the specific needs of special populations. Contributors also explain the unique cultural characteristics of rural areas compared with urban areas and offer a detailed look at the differences between frontier and rural areas. The book unites a broad spectrum of information and elucidates the distinctive health care challenges that service providers and residents of rural and frontier areas face. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

Reading product labels is a common and important use of literacy and numeracy skills in daily life. Instructions for commercial oral-rehydration-therapy salt solutions were examined. The products are widely available in rural Kenya, where they are purchased for alleviating the symptoms of life-threatening diarrheal dehydration. Many features of these texts do not facilitate comprehension. Information about preparation, dosage, administration, storage, and precautions is difficult to locate, few discourse conventions are used to enable readers to efficiently process information, and much tacit knowledge is presumed—including knowledge of English even when a Kiswahili translation is provided. Numeracy tasks associated with compliance with the treatment regime cannot be easily performed with school-learned mathematical algorithms. Measuring and teaching functional literacy and numeracy skills necessitates a better understanding of the kinds of texts that readers will encounter and analyzing the comprehension and problem-solving skills they require.

Morality and medicine are inextricably intertwined in rural Haiti, and both are shaped by the different local religious traditions, Christian and Vodoun, as well as by biomedical and folk medical practices. When people fall ill, they seek treatment not only from Western doctors but also from herbalists, religious healers and midwives. Dr Brodwin examines the situational logic, the pragmatic decisions, that guide people in making choices when they are faced with illness. He also explains the moral issues that arise in a society where suffering is associated with guilt, but where different, sometimes conflicting, ethical systems coexist. Moreover, he shows how in the crisis of illness people rework religious identities and are forced to address fundamental social and political problems

Medicines in Context: an Introduction -- The Transaction of Medicines -- Introductory Note -- Commercial Pharmaceutical Medicine and Medicalization: a Case Study from El Salvador -- Traditional Practitioners and Western Pharmaceuticals in Sri Lanka -- Medicines and Rural Health Services: an Experiment in the Dominican Republic -- Buying Drugs in Addis Ababa: a Quantitative Analysis -- 'Casi como doctor': Pharmacists and their Clients in a Mexican Urban Context -- The Articulation of Formal and Informal Medicine Distribution in South Cameroon -- The Rise of the Modern Jamu Industry in Indonesia: a Preliminary Overview -- The Meaning of Medicines -- Introductory Note -- Culture and Pharmaceutics: Some Epistemological Observations of Pharmacological Systems in Ancient Europe and Medieval China -- The Use of Herbal and Biomedical Pharmaceuticals on Mauritius -- The Power of Medicines in East Africa -- Traditional Medication at Pregnancy and Childbirth in Madura, Indonesia -- The Reinterpretation and Distribution of Western Pharmaceuticals: an Example from the Mende of Sierra Leone -- Cultural Meanings of Oral Rehydration Salts in Jamaica -- Penicillin: an Ancient Ayurvedic Medicine -- Cultural Constructions of Efficacy -- Conclusion -- Pharmaceutical Anthropology: Perspectives for Research and Application -- List of Contributors -- Index of Names -- Index of Subjects.

The main objective of this epidemiological study was to assess the incidence of unintentional non-fatal injuries, together with their determinants and consequences, in a defined Vietnamese population, thus providing a basis for future prevention. A one-year follow-up survey involved four quarterly cross-sectional household injury interviews during 2000. This cohort study was based within a demographic surveillance site in Bavi district, northern Vietnam, which provides detailed, longitudinal information in a continuous and systematic way. Findings relate to three phases of the injury process: before, during and after injury. The study showed that unintentional non-fatal injuries were an important health problem in rural Vietnam. The high incidence rate of 89/1000 pyar reflected almost one tenth of the population being injured every year. Home injuries were found to be most common, often due to a lack of proper kitchens and dangerous surroundings in the home. Road traffic injuries were less common but tended to be more severe, with longer periods of disability and higher unit costs compared with other types of injury. The leading mechanisms of injury were impacts with other objects, falls, cuts and crushing. Males had higher injury incidence rates than females except among the elderly. Elderly females were often injured due to falls in the home. Being male or elderly were significant risk factors for injury. Poverty was a risk factor for injuries in general and specifically for home and work related injuries, but not for road traffic injuries. The middle income group was at higher risk of traffic injuries, possibly due to their greater mobility. Injuries not only affected people's health, but were also a great financial burden. The cost of an injury, on average, corresponded to approximately 1.3 months of earned income, increasing to 7 months for a severe injury. Ninety percent of the economic burden of injury fell on households, only 8% on government and 2% on health insurance agencies. Self-treatment was the most common way of treating injuries (51.7%), even in some cases of severe injury. There was a low rate of use of public health services (23.2%) among injury patients, similar to private healthcare (22.4%). High cost, long distances, residence in mountains, being female and coming from ethnic minorities were barriers for seeking health services. People with health insurance sought care more, but the coverage of health insurance was very low. Some prevention strategies might include education and raising awareness about the possible dangers of injury and the importance of seeking appropriate care following injury. To avoid household hazards, several strategies could be used: better light in the evening, making gravel paths around the house, clearing moss to avoid slipping, wearing protective clothing when using electrical equipment and improving kitchens. Similarly, improving road surfaces, having separate paths for pedestrians and cyclists and better driver training could reduce road accidents. In Vietnam, and especially in a rural district without any injury register system, a community-based survey of unintentional injuries has been shown to be a feasible approach to injury assessment. It gave more complete results than could have been obtained from facility-based studies and led to the definition of possible prevention strategies.

Decisions concerning child labour, education and nutrition are taken by parents simultaneously with decisions affecting fertility and infant mortality. This implies that child labour cannot be abolished without altering the conditions that make it optimal for parents to make their children work. Such conditions can be altered not only by educational policies, such as free or subsidized provision of school facilities, but also by more broadly aimed policies, such as sanitation or preventive medicine.