Changing Planet

Where There Is No Doctor: Delivering Healthcare in Hard-to-Reach Places

Medicine and technology advance at astonishing rates. But these advances don’t always reach everywhere. Often it is indigenous knowledge and creative solutions that fill the gap. In today’s Digital Diversity, Sarah Shannon explains how one organisation, Hesperian Health Guides, provides appropriate and effective advice for people living in regions where there is no doctor.

Digital Diversity is a series of blog posts from FrontlineSMS about how mobile phones and other appropriate technologies are being used throughout the world to improve, enrich, and empower billions of lives. This article was curated by Olivia O’Sullivan, our Media and Research Assistant.

By Sarah Shannon

I was only 22 when I arrived in the Salvadoran refugee camp in rural Honduras. Refugees were streaming over the border, running for their lives in the midst of a civil war. They were malnourished, terrified, wounded, and carried nothing but the clothes on their backs. For my part, I had a suitcase full of clothes, and a copy of the book Where There Is No Doctor given to me by a mentor as I was packing.


Salvadoran refugees cross the border into Honduras. (Photo: Ed Scholl.)


Shortly after I arrived, I was awakened in the middle of the night by a girl who said I had to come help deliver a baby. Although I knew nothing about delivering babies, I stumbled across camp where I was relieved to find the mother-to-be well attended by an experienced community midwife. As she let me stay and watch, and as I followed along in Where There Is No Doctor, I recognized that “untrained” people have a lot of skills and knowledge and that “trained” health workers — like me — have a lot to learn.

In the weeks and months that followed, I found that Where There Is No Doctor was very useful in helping me — and a crew of refugees — set up nutrition programs, water and sanitation systems, and provide extra training to people who had always taken care of their own health. Despite the alien environment of the refugee camp, all of us were learning the basic skills and knowledge to become effective health workers. The accessible presentation of information and self-reliant focus made the book an incredibly useful tool.


'Where There Is No Doctor', “the most widely used public health manual in the world”, according to the World Health Organization. (Photo: Hesperian Health Guides.)


Many years later I returned to the States to work for the non-profit Hesperian Health Guides, which publishes Where There Is No Doctor. I have heard countless stories similar to mine, from people who rely on Hesperian books to work alongside or train community health workers, and from those who have translated these resources into over 80 languages — from Arabic to Zulu.

Now when I go back to visit Honduras, the refugee camp where I lived is gone and the sleepy little village near it boasts several  Internet cafes. Campesinos walk down cobblestone streets talking on their mobile phones. Electricity and running water may still be scarce, but cell phones are everywhere (more people in the world today have access to a cell phone than to a toilet.) Exciting advances in technology have enabled the world to address incredibly complex challenges, yet in the next 90 minutes 1,200 children and 60 young women will die of easily preventable health problems — problems that could be solved with simple and inexpensive care, and the knowledge needed to provide it.

Over the past few years, Hesperian has been working to respond to this paradox — taking advantage of new technologies to make the kind of clear, accessible health information that many years ago showed me how to train health workers available to more people in more places. Our first cell phone app on Safe Pregnancy and Birth, released in January as part of the new Hesperian Digital Commons, has so far been used in 70 countries. Our health manuals, including Where There Is No Doctor, are now available online for free download online in 26 languages.


Women in Orocuina, Honduras use the new Hesperian Digital Commons to develop health education materials. (Photo: AMDV, Honduras.)


Last year, in the rural, rugged, and deforested Honduran town of Orocuina, 15 women came together to learn how to use computers by designing hand-outs on various health topics. Some of the women walked several hours to attend the trainings, motivated by a desire to access information and help their communities. Only a month after they learned to manipulate a mouse to move a cursor around a screen, they used the tools in the Digital Commons to produce flyers on dehydration, nutrition, and breastfeeding. Designed for people with limited computer experience or formal education, these tools are helping health workers solve some of the world’s simplest, yet most intractable, health issues. While new developments in technology offer exciting possibilities for increasing access to information we need to ensure that they don’t further marginalize the people who need it the most.

As technology and the world we live in continue to evolve, we at Hesperian will evolve with it, and do our best to provide lifesaving health information through every channel that has a chance of reaching one more person, one more village, one more urban slum Where There is No Doctor.

As Executive Director of Hesperian Health Guides for the past 15 years, Sarah Shannon has led the development of several books, coordinated projects involving field partners in over 40 countries, and most recently oversaw the launch of the Digital Commons. Prior to joining Hesperian in 1996, Sarah worked for 15 years in Central America, training community health workers, developing training materials for low literacy audiences, and administering health and community development programs.

Digital Diversity is produced by Ken Banks, innovator, anthropologist, National Geographic Emerging Explorer and Founder of / FrontlineSMS. He shares exciting stories in Mobile Message about how mobile phones and appropriate technologies are being used throughout the world to improve, enrich, and empower billions of lives. You can read all the posts in this series, visit his website, or follow him on Twitter.

Ken Banks is an innovator, mentor, anthropologist and National Geographic Emerging Explorer. Founder of, he devotes himself to the application of mobile technology for positive social and environmental change in the developing world. His early research resulted in the development of FrontlineSMS, an award-winning text messaging-based field communication system designed to empower grassroots non-profit organisations. He shares exciting stories in "Digital Diversity" about how mobile phones and other appropriate technologies are being used around the world to improve, enrich, and empower billions of lives.
  • […] Where There Is No Doctor: Delivering Healthcare in Hard-to-Reach Places Go to this article […]

  • […] F&#959r m&#1091 &#1088&#1072rt, I h&#1072d a suitcase full &#959f clothes, … Read more &#959n National Geographic This entry was posted in Free Medicines Information and tagged Civil, Doctor, Lastest, News by […]

  • Neil Pakenham-Walsh

    Hi Sarah, I had a similar experience when, back in 1987, I left UK and became a single-handed rural doctor in remote Andes of Peru, with a copy of Where There is No Doctor. It was invaluable. As a result, I dedicated my life to bring stakeholders together to create a world where people are o longer dying for lack of basic healthcare knowledge. WTIND and other Hesperian guides are a fundamental part of the solution to empower health workers in low-resource settings. I invite everyone to join our campaign Healthcare Information For All by 2015 –

    Dr Neil Pakenham-Walsh MB,BS, DCH, DRCOG
    Coordinator, HIFA2015 and CHILD2015
    Co-director, Global Healthcare Information Network
    Corner House (John Kibble Room)
    Charlbury, Oxfordshire OX7 3PN, UK
    Tel: +44 (0)1608 811899
    Skype: neilpw1
    Follow us on Twitter:

    Join HIFA2015, CHILD2015, HIFA-Portuguese, HIFA-EVIPNet-French, HIFA-Zambia:

    “Healthcare Information For All by 2015: By 2015, every person worldwide will have access to an informed healthcare provider”

    With thanks to our 2012 Financial Supporting Organisations: British Medical Association (main funder), Chartered Society of Physiotherapists, Commonwealth Nurses Federation, European Association of Senior Hospital Physicians (AEMH), European Federation of Salaried Doctors (FEMS), Global Health Media Project, Haiti Nursing Foundation, International Child Health Group (Royal College of Paediatrics and Child Health), International Clinical Epidemiology Network, Joanna Briggs Institute, London School of Hygiene and Tropical Medicine, Network for Information and Digital Access, Partnerships in Health Information, Public Library of Science, Royal College of Midwives, Royal College of Nursing, UnitedHealth Chronic Disease Initiative.

  • Godwin Johnny Ekwere

    Please, someone should help me get a copy of the book for me.
    My postal address:
    No. 8 Ekong Edon Street,
    Off Afaha Eket Road ,
    Eket , Akwa Ibom State
    Phone No.m 234 8033411651

    • @Godwin – See my comment to Steve on January 18th at 7:47 am. You can download the book online for free, or probably order it if you search online. We don’t sell books.

  • Amos Gerson NDIMURWANKO

    Please, I have tried to locate this book on the internet to no avail. Please help me. I desperately need a copy of this book “Where there is no Doctor” in French. Being in Burundi, French speaking country and in a remote area where at times accessing medical care is a problem. I request you to distribute this important book.

  • […] I’m excited for IHSC’s, #IHCareerTalks with Hesperian Health Guides’ Executive Director, Sarah Shannon, the same organization that gave us “Where there is no Doctor”. Sara Shannon, also the IH […]

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