Urban volunteers: Helping communities combat diarrhoea themselves.
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Participation rates of health care workers in voluntary free hepatitis B virus immunization programs are 35% to 40%. University teaching hospital employees at risk for hepatitis B virus and presenting for immunization were surveyed as to vaccine preference. Both plasma-derived and recombinant hepatitis B virus vaccines were available. During a 10-month period, 173 health care workers enrolled in the study. One hundred seventeen received recombinant vaccine, and 56 received plasma-derived vaccine; 66 were immunized postexposure. Concern of a relationship of human immunodeficiency virus to hepatitis B virus plasma-derived vaccine was acknowledged by a small number of health care workers as important in vaccine selection. Recombinant hepatitis B virus vaccine rapidly and substantially supplanted plasma-derived vaccine but did not increase program participation. We suspect that mandatory immunization or proof of immunity will be necessary if hepatitis B virus protection rates in health care workers are to improve.
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A community volunteer programme was initiated in rural Jamaica in May 1990. The main aim of the programme was to monitor the growth of children less than 36 months of age through community health volunteers (CHVs) and improve their nutritional status. At the end of the second year the programme was evaluated to determine its effectiveness. The results of the evaluation indicated that almost all (95.6%) of the children were covered by the CHVs. In addition the participation rate was high (78.5%). However, only 50% of the children were adequately covered. Nonetheless, 81% of them gained adequate weight. Indeed, malnutrition levels declined by 34.5%. The annual cost per child per year for the total programme was fairly moderate (US$14.5) with growth monitoring accounting for nearly half (42.7). The results suggest that CHVs can play an important role in primary health care programmes in developing countries.
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Recent legislation in Washington opened the door to organization and unionization of health workers in voluntary hospitals and highlighted the poor pay and unorganized status of this enormous work force of at least 1.5 million persons, many of whom are women, black, or Spanish-speaking. The authors, who are senior officials of District 1199 of the National Union of Hospital and Health Care Employees, chart the factors associated with the low priority given over the years to organizing hospital workers, and the first breakthroughs, in New York City hospitals, in 1958. From a start with lowest income hospital workers, the subsequent inclusion of technical and professional workers and linkages with the highly publicized hospital workers' strike in Charleston, South Carolina in 1969. The benefits of unionization and the broader social goals of the union are discussed.
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