One of my most important teachers, back in my med school days, was Eva Salber, MD, Professor of Community Medicine at the Duke University School of Medicine. Eva believed that there are in every community a small sub-population of altruistic people who provide their friends and neighbors with a surprising amount of health information, advice, and support. Eva called such people "natural helpers." She felt that such natural helpers, overlooked and unacknowledged as they were, are important healthcare providers, perhaps the most important providers of all.

Much of Eva's research was devoted to learning more about who these natural helpers were and the services they provided. In one study, Eva and her colleagues asked the residents of a low-income urban fringe community served by the Duke University medical center, clinics, and emergency room the following question: "Who around here do you know to whom people go for advice on health matters-other than doctors?"

In this community of about 4,000 people, they found that 39 individuals were mentioned over and over again. Eva found that these 39 natural helpers were providing community members with more medical "consultations" than all the health professionals in the medical center down the street-with no budget, no special training, and no formal acknowledgment.

The natural helpers included high school students, housewives, bartenders, ministers, and beauty salon operators. Some were teenagers, while others were in their seventies. They were all highly altruistic. About two-thirds were women. Many were active members of a religious group. In almost other respects, they were similar to other community residents.

Now, more than 25 years later, when I exchange e-mail with online self-helpers who have organized an online support group or built a Web site to help others with the same disease, I often find myself thinking of Eva and wishing she was still alive to see these natural helpers of cyberspace.

Published in The Ferguson Report, Number 4, June 1999

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