We had the pleasure to speak with Paula Worby, a long-time editor at Hesperian Health Guides. Paula discusses Hesperian’s history, her own journey to public health, and Hesperian's latest resource: Promoting Community Mental Health.

Thanks for joining us, Paula. Will you briefly introduce yourself?

My name is Paula Worby. I currently work for and am an editor, writer and project coordinator for Hesperian Health Guides, based in Oakland, California.

Would you mind just sharing a little bit about Hesperian and its work?

Hesperian is a wonderful non-profit organization with more than 50 years of history. Hesperian writes and distributes user-friendly health information in many languages used all over the world. Hesperian is known for being trustworthy and for its practical approach to health information. Our resources show, not just how to treat a health problem--let’s say asthma--but how to think through the causes of health problems, like who tends to get asthma and why. One tag line is “Health for All,” an ongoing reminder of the need to challenge the inequalities behind health problems.

Hesperian's most well-known book, Where There Is No Doctor, has been used all over the world and in dozens of languages for decades, and we keep updating it. But Hesperian has many other resources—3 mobile apps that are private, and don’t take personal data as tech companies do, and more than 15 book titles. Topics include women's and reproductive health, helping children with disabilities, environmental health, worker health and safety, and most recently a book I'll be talking about more which is called Promoting Community Mental Health. 

Almost all of Hesperian’s resources are available to read free online (our HealthWiki platform). A book publisher that also makes the information free! That is unusual but as a non-profit organization, our mission is to get that information out there.

Could you talk about your journey a little bit? It would be great to hear more about your background and how you got to Hesperian. I can imagine that going into public health you didn’t expect to be working for a book publisher one day!

I came across Hesperian’s book Where There Is No Doctor a couple of decades back when I was first working in Central America. I used it for my own health and saw health promoter organizations using it. That’s how I knew about Hesperian.

My journey to Hesperian parallels my path that led to the field of public health. As a young person, I was shocked by U.S. foreign policy’s harmful effects in many countries and this concern took me to Central America. I studied sociology in college, drawn to analyzing the complex causes behind social issues and ripple effects from social movements. Appreciating different levels of cause and effect ties into how I think about my work at Hesperian.

I ended up working in and living in Guatemala for 13 years. This was in the aftermath of armed conflict there. First, I worked with a Guatemala research group documenting the situation of rural and indigenous people displaced by war and then for the United Nations Refugee Agency (UNHCR) for nine years in support of repatriating refugees. Those experiences showed me how pretty much everything is related to health and how public policy shapes community health.

Wanting new skills and to try life in the U.S. again, I went to the Berkeley School of Public Health in the San Francisco Bay Area for my MPH and later, continued for a doctorate in public health, a DrPH. As a student, I did health-related research and volunteer work with immigrant day laborers who were from Mexico and Central America, a good transition to the U.S. after my years in Guatemala. After finishing school, I was associate director for a non-profit providing services to immigrants and through mutual connections, met people at Hesperian.

Coming to work for Hesperian was a homecoming for me, tying together the global awareness that brought me to Central America, my time working with refugees and immigrants, and my public health training. My Hesperian work is a wonderful blend of creating something concrete (health information), getting to connect directly to people who use our materials, and still letting me think about a big picture analysis because of how we infuse that in the writing we do.

Earlier you said that you are an editor, writer, and project coordinator at Hesperian. Can you share a little more detail about what you do and what your role entails?

I joined Hesperian about 10 years ago as an editor on a project to create updated booklets about various health conditions. These materials follow the tradition of Where There Is No Doctor but expand on topics that have become more important over the years, such as non-communicable diseases. These newer materials reflect the changing roles of women and gender in societies, how so many people are now in urban settings, and how community health work is always evolving.

I worked to develop publications on diabetes, heart health, mosquito-borne illnesses, cancer, and vaccines, among others. For some of these chapters, we had outside experts do a first draft and on others I wrote the first draft.  But, ultimately, all were developed through collective processes, with my colleagues at Hesperian and a range of external volunteers contributing different kinds of expertise and community feedback.  

So, now let’s talk about the latest book which you worked on, Promoting Community Mental Health!

It is a real pleasure to be associated with this book and to be its primary author, though important to again emphasize the collective process—I have a co-author, Todd Jailer, and many others at Hesperian and beyond were involved. 

Hesperian has always included mental health in its resources. For example, dedicated chapters in the books Where Women Have No Doctor and our Workers’ Guide to Health and Safety. Our book on supporting children who have HIV embeds mental health sensitivity throughout with warm and caring language.  But we really wanted to do an in-depth and practical guide dedicated to community level aspects of mental health.

This book was written for the U.S. context. Different from Hesperian’s typical global approach, but what an important time in the U.S. to be talking about this. Even with all the privileges here compared to many countries, including heightened awareness of mental health issues, the overall response is just not good enough given what people face.

The title of the book, Promoting Community Mental Health, suggests a different approach than the usual focus on one-on-one therapy and seeking treatment from a provider. 

Yes! As you point out, the title doesn’t only say “mental health,” but rather "community mental health," and emphasizing “promoting,” adds even another layer—that of active engagement. It’s true we’re so used to thinking about mental health as a one-on-one helping experience: Can the person get therapy? Do they have a counselor? Those concerns are huge and we do say in the book sometimes professional help is needed, no question. But so many people don't have ready access to a therapist or professional help. Given this harsh reality, we point out all the ways for people to plug in: helpers at a family, neighborhood, and community level to change the landscape underlying our collective mental health. How are we all managing this together? The book is really trying to pick that up. And we call out how the powerful support of one-on-one counseling can also be peer counseling—a flourishing and successful model.

Another emphasis is how there is no bright line between “good” vs. “bad” mental health. Instead we talk about the spectrum of how all people are, each person has many elements to their emotional health and well-being. And profound sadness, deep grief, anger, feeling anxious, are all emotions that are natural and positive parts of anyone’s mental health. Pushing back against the taboos and stigma limiting conversations about mental health is really important.

How do you, in the book, zoom out to look at mental health on the community level?

We say that many, many people out there who are helpers or playing any kind of a community-building role are doing mental health work by helping others and trying to make things happen on a community level.

For example, I think about teachers, librarians, faith leaders, or the friendly receptionist at the health clinic whose work is not thought of as mental health work, yet they really shape others’ day-to-day experiences. Community organizing and community building also builds community mental health, changing how we interact and what people accomplish together. There are countless examples, and we feature many, of how people come together—reducing isolation while doing something positive: community gardens, family-friendly events featuring cultural traditions, creating art or music in a group, mutual aid networks, and many others.

Can you give us an overview of what’s in the book?

The book has nine chapters and can be used in many ways in addition to reading whatever topics look interesting. For example, choose a chapter or section for discussion as part of a training. Or adapt the dynamic activity ideas that are included. Or use one of the drawings and captions to generate reactions. In addition to explaining the community focus in the first chapter, we have clear explanations on topics like anxiety, depression, and trauma as well as supporting wellness and listening to each other. The section about people in crisis can inform protocols for what to do if someone is having a mental health emergency. There are chapters on the effects of violence and on how mental health relates to alcohol and drug addiction. There’s an interesting chapter on life phases: how do we create the best environment for bringing children into this world and what are unique challenges and ways to support people from childhood through old age. Another chapter covers setting up and running support groups, and shows that anyone can do that—it doesn't have to be a highly trained professional. The final chapter is about burnout and self-awareness, and speaks to the real difficulties of being a compassionate person working in the community.

How might this book be different from some of the other mental health resources that are out there?

There are tons of pamphlets and online information on anxiety, panic attacks, depression. These terms are now part of our daily lexicon, and it's helpful to get a handle on some of that. But instead of leaving it as: “you might have this condition, seek help,” the book shows how we help each other with these types of stresses. How to notice what someone might be going through. How to be a good listener, ask the person what might feel helpful, and assess if the person needs more help. And the community-level aspect I was describing—that is harder to find in traditional medical and mental health materials and is probably the biggest contribution of this book, meant for anyone and everyone wanting to help others and work for change.

The book gives people a concrete way to understand complicated ideas. It doesn’t oversimplify–it's not a simple book–but we try to make it really readable. Also, our situations, context, language, culture, community dynamics, and personal experiences are different, so we are very careful never to say one-size-fits-all. The book has drawings and examples from real-life situations so that people can see what applies to them and their situation directly or if there is something that feels adaptable.

What has the reception to the book been?

We’ve gotten a really warm response both to the published English book and also to the draft Spanish version we are working on. I think people feel it fills a gap and offers both useful information and inspiring ideas. I get the sense people are nodding along as they read. The book highlights real examples and reflects approaches that people are already taking, the same people who may have been thinking: too bad there’s not a book for that! So, they are finding this book relatable, validating and that it has pieces they can use in their work.

We usually wrap up these interviews with words of advice for public health students and other young people. So, based on your experience, what advice do you have for young people and students today?

Being a student is such an amazing time to explore. When choosing paths, think about what will feel important and stay satisfying over time. If it involves working with community members or on their behalf, I’d say learn to listen deeply, be prepared to rethink your own beliefs, and accept you’ll get things wrong sometimes. Also, I can’t say enough about how learning a language other than one you grew up with can broaden your perspective as well as open doors. In my case, moving to another country was a humbling reminder that the more you know, the more you realize all you don’t know. And there are things you only learn about yourself and where you come from, once you leave and go somewhere else.