Brief Communication

We wish to refer to the recent article in Health Libraries Review entitled ‘Access to reliable information for healthcare workers in developing countries: an international perspective’ by Neil Pakenham-Walsh.1 We must congratulate him on such an overview, which highlights the problems, mainly in Africa but which are probably present in the developing world in general. The author cites the activities of INASP-Health as one of the players in the UK ‘to build co-operation, analysis and advocacy’ within the international health information community. However the subject of appropriate health information in developing countries is much debated these days in many other circles as well, not least because other fashionable topics such as ‘ICTs’ or ‘indigenous knowledge’ come to the fore. Dr Pakenham-Walsh refers to some of the many fundamental problems such as poor literacy rate, the lack of appropriate reading material and reading culture, the lack of information professionals and their low status when they do exist, the lack of access to libraries by health professionals but also the lack of resources in those libraries, the lack of recognition and priority given by most governments to the provision of health information. It is often presumed that the Internet will miraculously create the answer to all such problems. However, although it is true that the Internet has caused spectacular changes in the globalization of knowledge and economy, these have essentially touched those parts of the world where knowledge, technology and economy were already flourishing, becoming yet another asset. In a continent such as Africa, the traditional knowledge (which is now qualified as ‘indigenous’) has always existed but was rarely consigned to paper. Oral transmission of knowledge with the drawback that it remains very localized has been the norm until the last few decades. A minority of health workers in Africa and probably other developing countries have a reading culture, and an even smaller group have access to the pool of health and medical knowledge from both the North and South through libraries, books, journals and the Internet. To tackle this issue, health information professionals must be prepared to work, not only at the level of medical practitioners, researchers and students, but also at the low level of the health system ladder, targeting the health workers in the field in order to develop a reading culture to gain knowledge, which in turn will benefit the communities. To complement Dr Pakenham-Walsh’s article we wish to bring to your attention a project that the World Health Organization Headquarters Library in Geneva has initiated to help combat these problems. The Blue Trunk Library project was developed in an effort to sensitize the district health worker to the benefit of access to the written world. A health district centre in Africa may be a rural hospital but more often it is a building with a few (often bare) consulting rooms, a pharmacy, an office and a waiting room. In capitals or medium-sized cities, one can expect to have electricity and a telephone line, though both are rarely functioning 24 hours a day. In rural areas such facilities are not always available. Internet connectivity is usually non-existent. Health personnel in health centres are not usually researchers or academics. If they need information it is generally to update their knowledge, experience and practice. What they are looking for are clear guidelines on how to enhance their daily work, the kind of pre-digested medical information found in recent medical manuals or textbooks. Many of them have not used books since their primary training and have had no continuing education. The Blue Trunk library is a collection of one hundred or so books on medicine and public health, together with three or four subscriptions to medical journals, for installation in district health centres to compensate for the lack of up-to-date medical and health information. In order to make it easier to transport and store, the collection has been packed into a blue metal trunk fitted with two shelves, on which the cardboard boxes containing the books are arranged. Among the works chosen, priority has been given to practical manuals (especially those published by WHO), but also those from the Teaching Aids at low cost (TALC) and the African Medical Research Foundation (AMREF), etc. offering an easily accessible solution to the medical, public health and management problems medical staff may have to face. Differing levels of education among district medical staff have also been taken into account. The same topic may be addressed in different publications from a different point of view: that of the physician, the nurse, and the nursing auxiliary or health worker. The collection, which has been deliberately kept small, is not exhaustive. Other suitable local material is available at district level and should be added. Training for the person responsible for the Blue Trunk library in the district, updating the WHO publications and monitoring and evaluation of the operation of the Blue Trunk libraries locally by a national coordinator, are included in the project process. The Blue Trunk libraries are often financed by multilateral or bilateral aid agencies as part of their existing health projects. The person responsible for the Blue Trunk library at the district level (BTL assistant) is chosen locally from among the district health staff and may be a physician, a nurse, a secretary or a health technician. The most important qualification is motivation. The person’s main task is to ensure the upkeep of the collection, to publicise it and to make it available to the district health staff, while ensuring that it is properly looked after. The actual integration of the project into the district’s health activities depends on the BTL assistant: the Blue Trunk library has to be accepted by the whole medical community as a genuine means of improving health services. Thus the training that is given by WHO librarians is an essential element of this project, because it is not merely an operation to distribute books or intended to transform the BTL assistant into ‘barefoot’ librarians, but into active partners to ensure the transmission of medical and health information. For people unable to read or who are not familiar with French or English, the Blue Trunk library can be used to create simple educational material in the form of drawings, pictograms, pictures and diagrams. Health professionals in the field are best placed to translate and adapt theoretical knowledge to local conditions and to the culture of the populations with whom they deal. More than 731 Blue Trunks Libraries have been distributed in about 28 countries in Africa and Middle East. The feedback is generally good. An evaluation of the Blue Trunk library project in six health districts of Guinea was carried out in May 1999 after it had been launched in May 1998 with the first training session. The evaluation tools provided at the start of the project in each country were used. Information sessions had been held by the persons responsible, which has encouraged an increased interest in reading. In one district, 143 of the 209 health workers had enrolled at the library of which 100 had already bought their borrower’s card. In some places, training workshops had been set up for the health workers by the chief medical officer, using the documentation available from the Blue Trunk. A discernible improvement in health care delivery services was noted as well as better communication between staff and patients. The Blue Trunk library project makes it possible to establish a network to disseminate medical and health information that reaches out beyond academic and university circles. The Blue Trunk library operation has defined a target—the health districts, publications have been chosen for this audience, a workable mode of distribution to peripheral health centres has been selected and an informal network set up through which health information will continue to circulate. Undoubtedly, it is the role of librarians to disseminate information further than commercial outlets can reach, to places where the need is so great. The developing world will not leapfrog into the future thanks to the Internet only. It will take much effort to change attitudes towards knowledge acquisition at grass roots level and health information professionals must be ready to take up the challenge. For further information, please see the library’s homepage on WHO’s Website at http://www.who.int or contact Edith Certain by e-mail on: certaine@who.ch