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“Taking Action for Women’s Health” | Published in University of Washington’s alumni magazine

April 22, 2013

Cross-posted from UW Medicine. Written by Sarah Shannon and Lily Walkover.


There are moments when the world answers our questions.

For UW School of Medicine alumna Melissa Smith, one of those moments came in 1979, while she was working in a bush village clinic in Liberia. She was deciding between studying public health and going to medical school, trying to figure out what kind of education would allow her to be most effective. Her moment came when a child died in her arms of malnutrition.

“I realized I wanted to do both. I wanted to have tangible medical skills to offer to a community,” says Smith. “But I also wanted to work together with community members to understand the root causes of health problems, to find solutions, and for them to be able to take action themselves to solve those health problems. That was my vision going into medical school.”

While at the UW School of Medicine, Smith was awarded a fellowship that supported travel to and from Nicaragua during her first three years of medical school. Later, she took a leave of absence to spend more time in Nicaragua, part of a program to promote international cooperation and strengthen primary healthcare. The School gave her the flexibility and support to make this possible, and she spent a year training health workers and midwives, work that she continues today.

Several people gathered gathered around health posters

Smith is seen here training community health workers during the Contra war in Nicaragua in 1988, using “Donde No Hay Doctor”. Photo courtesy of Melissa Smith.

Smith’s work in Liberia and Nicaragua also introduced her to Hesperian Health Guides, a non-profit public health publisher. In Liberia, Hesperian’s Where There Is No Doctor, a simple self-help book designed to allow people to care for themselves and their community when they cannot access the medical system, was Smith’s only reference book. In Nicaragua, she used the companion title Helping Health Workers Learn to run her training programs, with Doctor as a textbook.

In the early 1990s, while training health workers in Guatemala, Smith met a group of Hesperian editors who were planning a women’s health book. She helped to field test content for the book with the women she was training, and eventually became the medical editor for Where Women Have No Doctor, published in 1997. While field testing chapters on safe pregnancy and childbirth, many women told her how useful it was to have this kind of health information available. What they also needed, they added, was information about how to take action on the root causes affecting women’s health: cycles of inequality and violence that put men’s needs first. Smith brought up the idea of a companion book of strategies for community organizing, but without funding, the project fell to the wayside.

A decade later, more than 200,000 copies of Where Women Have No Doctor had traveled around the world; it had been translated into 27 languages, and it had done a great deal of good. An Urdu translator from Pakistan shared the following story. “The first 1,000 copies went out like hotcakes,” wrote the translator. “Women’s groups and NGOs [non-governmental organizations] all over Pakistan are asking for more. An NGO leader from the mountain village of Hazara wrote, ‘One night a village woman’s labor pains started. The nearest health unit was seven hours away. We tried the methods and illustrations of the book, and she gave birth to a baby girl. The book saved that woman’s life.’”

African woman pointing at a chart.

African woman pointing at a chart. Women in Kibera, Kenya, facilitate activities from draft chapters of the women’s action guide in order to gather feedback from community members. Similar activities took place in Beirut, Lebanon, and Managua, Nicaragua. Photo courtesy of Melissa Smith.

Finally, the moment was right to start planning a women’s action guide. With support from the School of Advanced Research in Santa Fe, a global steering group with representatives from North and Latin America, Africa, the Middle East and South Asia was assembled.  

Then the work began. Over the last four years, Smith has collaborated with Hesperian writers and editors, the steering group and grassroots organizations in more than 20 countries, building the book suggested years before by those community health workers in Guatemala.

Health Action Guide for Women and Girls will include activities and strategies to help health promoters tackle difficult discussions about sexuality, family planning, safe motherhood, unsafe abortion, HIV and violence against women, among other topics. It is designed to be useful for a range of community activists and health promoters, and while it is focuses on the experience of women and girls, it is designed to include men and boys in activities for social change. 

As the publication date nears, Smith — now back in the U.S. — looks back on a long journey, from the moment in a rural clinic in Liberia when a small child lost her life, to the structural inequalities of our world, and imagines women using the action guide to begin to address these problems.

“A community health worker might pick up this book and use the chapter on family planning to talk with women about how they want to space their children. Or a community-based organization might use one of the activities to work with men on ensuring that little girls get the same nutrition as their brothers,” says Smith.

“It has been a privilege to work with and learn from so many inspiring women and girls to create this resource,” says Smith, awarded the alumni association’s Humanitarian Award in 2012. “And I’m grateful to the UW School of Medicine for giving me the grounding to help them.”