|Guide to Health and Hygiene in Agricultural Work (ILO, 1979, 328 p.)|
|6. Organisation of occupational health services and medical inspection of labour in agriculture|
|6.4. Problems of education and training in occupational health and hygiene in agriculture|
One of the distinguishing features of agriculture is that it is carried on in an essentially rural environment where working and living conditions are often closely interwoven. It is therefore necessary to provide the agricultural population with suitable education in hygiene. Hence, agricultural technicians and health officials should have received some training in occupational health and hygiene in agriculture.
As has been seen, in most cases the whole family takes part in agricultural work in varying degrees, or at least lives in the working environment. It is therefore necessary to educate both children and adults, including elderly persons whose useful experience has sometimes been nullified by technical advances in agriculture (by the introduction of new poisons, for example) or by developments in sanitation. To this end, all practicable methods should be employed. Publications may include posters, pamphlets, leaflets and press articles. Since many persons will be illiterate, the spoken word must not be neglected: lectures and broadcasts will be useful.
Furthermore, good use may be made of audio-visual means such as lantern slides, films, television (when it exists) and visits to model villages and model farms.
As regards the question of where health education should be given, the school clearly seems to be the best place for reaching most of the children. However, since education in a rural environment is hampered by a lack of schools, transport difficulties, bad weather, the daily round of work on the farm, and the seasonal employment of children in the fields, the school is not enough and children should also take advantage of courses for older people.
For adults, including the elderly, meetings could be organised in the village, either in administrative or cultural centres or in the premises of agricultural associations. If as much advantage as possible is taken of the various means available, the lessons in health and hygiene will be all the more effective.
The teachers of health education will, in the first place, be health officials, nurses, scientists and engineers, social assistants, pharmaceutical chemists, veterinary surgeons, doctors and perhaps health administrators; but those who have some influence by reason of their function should not be overlooked-members of the teaching profession, whether general or agricultural, technicians, agricultural consultants or administrators and, sometimes perhaps, persons in holy orders.
Specialised services such as medical services, agricultural health services and agricultural medical institutes may be expected to organise health education campaigns. Notwithstanding these campaigns, the day-to-day work of the different authorities will be the most important.
Health education programmes must be both specific and comprehensive. First, they must be specific enough to provide adequate background knowledge for specific remedial solutions to be recommended, and yet general enough so that existing hazards and risks will be recognised and appropriate solutions sought. Topics such as housing, water, waste disposal, nutrition, epidemiological risks, poisoning and accidents should be included.
In conclusion it must be stressed that the multiplicity of problems facing the agricultural sector should be no reason for neglecting education in health and hygiene. It is quite certain that some rural housing problems, for example, will not be solved without adequate economic resources. However, in many cases, simple and inexpensive methods will be sufficient to bring about considerable improvements in both living and working conditions.
Trainees can be divided into two groups: health officials and agricultural officials.
Nursing, social and health personnel. Both in countries where there are enough medical personnel and, with more reason, in those where there are not (and where, accordingly, responsibilities are greater, training briefer and general education poorer), these officials should be aware of the new techniques in agriculture and of their dangers.
Pharmaceutical chemists. In some countries, pharmaceutical chemists can play an important role in health education, prevention and first aid. While some subjects that are useful in country districts, such as cryptogamy and toxicology, are normally taught, it would be desirable to give better instruction on occupational health in agriculture, especially to newcomers to agricultural life.
Veterinary surgeons. The veterinary surgeon has, by his training, a good knowledge of the diseases affecting animals, especially infectious and parasitic diseases. He should in addition be well grounded in agricultural medicine because of his contacts with farm workers and his important functions in the field of epidemiology (since prevention should be for both man and animal) and toxicology (where human and animal problems are the same). Thus he is well qualified to take part in preventive and educational activities.
Doctors. Throughout the world, the problems of agricultural medicine seem to be treated no more than superficially in ordinary medical courses. However, specialised courses should be provided both for those who are actually practising general or specialised medicine in rural areas and for those who are preparing to practise agricultural medicine.
Health administrators. In some countries, it is becoming increasingly common for health administration to be entrusted to non-medical personnel. The lack of general medical qualifications of these people is an added reason why they should be trained in agricultural medicine, especially when they are working in a rural area. Such training facilitates their understanding of the problems they are likely to encounter.
Heads of undertakings. Both on small family farms and in large specialised undertakings, those responsible for management should spend some time learning about agricultural medicine in the course of their training.
In both elementary agricultural schools and highly specialised institutes, courses in agricultural medicine that will be relevant to the educational level of the students must be organised. During his training, the agricultural student acquires the habit of keeping in touch with doctors, so that the medical problems that he will subsequently meet with in practice may be solved more easily.
Agricultural administrators. Agricultural technicians, engineers working on the development of rural zones or on agricultural buildings and agricultural labour inspectors should all, within the ambit of their responsibilities, be familiar with the problems of occupational health in agriculture. Because of the decisions they take and the advice they give, they have an extremely important part to play in education and prevention.
As well as the courses in theory that may be given to health and agricultural officials, practical courses are highly desirable. It would be particularly useful for health officials to take courses in agriculture so as to improve their knowledge and understanding of agricultural technology.
For agricultural officials, it would be useful if they spent some time at medical institutions or services so as to gain a better insight into the problems of rural doctors.
Model farms for the various branches of agriculture could provide courses for health and agricultural officials where, inter alia, they could exchange views on common problems.
The instruction would not always take the same form. Depending on the future career of the students, courses could be organised by agricultural technicians and/or the staff of agricultural health services, agricultural medical inspectorates and agricultural labour inspectorates.
Courses in agricultural medicine, both for health officials and for agricultural officials, should feature in the curricula of educational establishments. However, because of the almost complete lack of such courses in these establishments at present, some post-university or recurrent education or training should be provided.
Education is apt to become sterile if it is not activated with the catalyst of practical experience. Congresses are a valuable means of educational regeneration. They should be organised at the regional, national and international levels. They may be confined to a single subject or cover a number of subjects. Everyone who might be interested (and not merely doctors) should participate. The expression of opposing points of view often leads to fruitful exchanges of information and the clarification of obscure ideas, or to the initiation of research and investigation into hitherto unexplored areas. Comparisons between regional and national experience are equally beneficial.
The teaching staffs of universities are particularly well qualified to conduct training courses. Their experience in research and teaching enables them to master the subjects, express them with the maximum of clarity, keep abreast of changes and (provided that they have the necessary resources at their disposal) undertake research into practical needs.
The medical inspectorate
The medical inspectorate plays an important role in providing agricultural health education in undertakings. It should therefore also co-operate with the universities in the provision of training in occupational health and hygiene. On the practical side, the inspectorate can arrange visits and participate actively in investigations and research projects.
Rural practitioners' experience of specific everyday problems enables them to make a positive contribution to training. They can also participate in education and research through the work of their learned societies and in collaboration with the inspectorate and the universities.
Effective collaboration between the various persons and establishments concerned with training in occupational health and hygiene can most often best be achieved within the framework of institutes. Depending on needs and resources, these institutes may be national or regional in scope.
The institutes discussed here may specialise in agricultural medicine or form part of a health institute or an occupational medical institute.
Their personnel should include not only teachers, medical inspectors and practitioners but also all who can contribute to the declared educational and research goals. Some of the staff would be directly concerned with agricultural medicine (veterinary surgeons, toxicologists, bacteriologists and virologists, physiologists, agricultural engineers), while others, indirectly concerned, would make useful contributions of a statistical, psychological or sociological character.
The function of these institutes would be to harmonise education and research. Their three fields of action would be education, research and evaluation.
The importance of evaluation cannot be over-emphasised. It is poor practice to undertake research without knowing whether earlier work has been undertaken on the same subject and, if so, what its results were.
Such an institute, serving simultaneously as a centre of agricultural medicine, a documentation centre and a statistical office for the rational processing of information, should be supplemented by a centre for conditions of employment, which would be concerned with job analysis, rationalisation, ergonomics, and so forth. There should also be a centre for occupational pathology, which would study toxicology, epidemiology and various advanced medical and technical subjects as the need arose, and a centre for psycho-sociology.
The need for collaboration between the different disciplines must be especially stressed.