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October 7, 1988

Primary Health Care at the Village Level

JAMA. 1988;260(13):1963-1964. doi:10.1001/jama.1988.03410130171049

The room was bare but for a mound of brown rice in the corner, a small wooden stool missing a leg, and two ceramic pots. The tiny infant lay snugly bundled on a straw mat beside its mother. For the woman, at age 24, this was her third baby. She smiled broadly as she spoke of the baby, who had been delivered at home the evening before, after she had gone into premature labor at 36 weeks. We examined the infant to make sure that there were no signs of umbilical sepsis—the cord had been cut by the grandmother with an unclean knife. The child looked healthy, although small for gestational age. We briefly reviewed with the mother proper breast-feeding technique. Then, touching our palms together in a farewell "namaste," we left the hut.

I was accompanying two nurses in Tamil Nadu, South India, as they made their daily "home