Home health care manuals are a dime a dozen, but this one is in a league by itself. Readers may be surprised to find a review in Annals of a handbook designed primarily for nonphysicians in the Third World, but this book will have great appeal for anyone who is interested or involved in improving health and medical care in the rural areas of Third World nations. The authors have presented information clearly and in simple language for ordinary persons to use in preventing and treating most common health problems in their own homes and villages. The book is ideally suited for use as a text and as a guide for instructing medically unschooled villagers in assessing and dealing with the various aspects of health, including housing, sanitation, nutrition, and disease prevention. Basic information on topics ranging from food preparation to plans for building improved latrines is clearly spelled out. The underlying role that inequitable land distribution and poverty play in causing many health problems and obstacles to improvement is highlighted, but not to the exclusion of an optimistic approach to dealing with most health issues.

The book's contents are conveniently divided into seven color-coded sections. An introductory overview defines the village health care worker and discusses how he or she can be effective as a teacher, an evaluator of local health needs, and an agent of change in promoting improved public health and personal health care. The "green section" lists all of the medications that are referred to in the book, listing them both alphabetically with page references and under disease headings with instructions on dosage and use. Emphasis is placed on the economical use of generic drugs and the avoidance of injectable drugs when oral preparations are as effective. In developing nations, most drugs are available without prescription. The "blue section" covers new information and topics, including the acquired immunodeficiency syndrome (AIDS). Other useful information includes addresses for accessing teaching materials from many countries, forms for giving dosage instructions to those who can't read, and a patient report form to use when sending for medical help.

The core of the book consists of 23 chapters that cover the clinical areas one might expect to find discussed in a Merck Manual written for a nonmedical audience, but here the organization is designed to address the problems that villagers may encounter. The interesting first chapter addresses popular folk beliefs, witchcraft, and home remedies and distinguishes between the harmful and the helpful. A brief section on medicinal plants, written for a Mexican audience, could have profitably been expanded. Two chapters are devoted to the examination and care of a sick person. Major emphasis is placed on healing without medicine, on how to measure and administer medicine, and on the right and wrong uses of modern medicines. Information and instruction on first aid and medical, surgical, and obstetric subjects is clearly written and is generally current and accurate, although no references are cited. I disagreed with the advice given for managing hypertension, which suggests that medication is only occasionally required. Without more sophisticated medical equipment than a thermometer or flashlight, diagnosis depends on the senses.

Werner, who is not a physician, wrote the first edition of this book in 1977, after spending time in a health project in Ajoya in Sinaloa State, Mexico. He had prepared himself by learning about medicine in numerous venues and from medical professionals. The Hesperian Foundation, a nonprofit organization committed to improving health care in less developed countries, provided support by publishing and distributing the book. An English translation soon followed, and the book to date has been published in 83 languages. An estimated 2 million copies are in use in more than 100 countries. The book has been widely adopted for use by many international health care organizations, including the Peace Corps. It can be reprinted freely and is sold at less than half price at the "poor countries" rate.

I hope that this brief review gives the flavor of this amazing manual, which successfully brings together modern concepts of public health and personal health care into a usable and understandable format for the Third World villager. If you are a physician, dentist, or nurse planning to volunteer on a medical mercy mission, review this book ahead of time and take it with you.