BAREFOOT DOCTORS

Coming off of the success of launching my newest book My Worst Thanksgiving Ever, I went back to my previous publications and decided to edit and republish my pamphlet Barefoot Doctors. I updated the links, wrote a new Introduction, and generally cleaned it up by getting rid of obsolete references. I also increased the font size a little in concession to my aging eyes.

Although it has been almost three years since I first published it, we have made very little headway getting the concepts and proposals into practice. That is largely due to the powers-that-be but I am partly to blame. Such grand schemes take effort and time and I have had precious little of both. The full text is available on Amazon for $2.99 but I would like to include snippets on this blog every now and then. Please feel free to leave constructive comments below.

THE PROBLEM

How to ensure that isolated populations receive NECESSARY medical assistance, with an adequate supply of dietary supplements that improve nutritional outcomes of these populations

I would like to address these issues directly but am convinced that eventually all answers need to be integrated together in order to produce a quality, self-sustaining health care model for underserved areas of the world (“USAW”). My current focus will be on Nicaragua for several reasons. Firstly, I live here and while I am not an expert on all aspects of their health care system, I do have an acquaintance with and an appreciation for it.

Secondly, Nicaragua is the second poorest country in the Western Hemisphere (behind Haiti). I do not present my ideas to “show them what is good for them” but rather as an attempt to have this country become a role-model for others; in other words, to be an inspiration.

Thirdly, Spanish is the third most frequent first-language in the world, behind English and Mandarin Chinese. Many of my ideas would not need to be translated to have their most profound effects although my goal is to make this model accessible to all USAW’s.

The question I am addressing is composed of two parts. The first is to ensure that isolated populations receive quality health care. This means adequate primary health care. This issue was addressed by Chairman Mao Zedong in 1965 and is the inspiration for my proposal:

“In the 1930s, the Rural Reconstruction Movement had pioneered village health workers trained in basic health as part of a coordinated system, and there had been provincial experiments after 1949, but after Mao Zedong's healthcare speech in 1965 the concept was developed and institutionalized. In his speech, Mao Zedong criticized the urban bias of the medical system of the time, and called for a system with greater focus on the well-being of the rural population. China's health policy changed quickly after this speech and in 1968, the barefoot doctors program became integrated into national policy. These programs were called "rural cooperative medical systems" (RCMS) and strove to include community participation with the rural provision of health services.”

--From Wikipedia “Barefoot Doctors” (1)

The success of the Barefoot Doctors program inspired the World Health Organization to hold a conference in Alma Ata, Kazakhstan in 1978 where the Alma Ata Declaration was signed unanimously. The declaration addressed several attitude changes that challenged the existing Western-based models (2). Specifically, it called for

1.      local communities participating in deciding health care priorities

2.      an emphasis on primary health care and preventive medicine, and

3.      sought to link medicine with trade, economics, industry, rural politics and other political and social areas.

The second part of the question is concerned with getting vitamins and minerals to these isolated communities. For clarity’s sake, I assume that this is an attempt to integrate preventive medicine measures into this health care model. This issue was not directly addressed by Chairman Mao nor by the WHO participants at Alma Alta but appears to be covered under their emphases on primary and preventive care. If this is a training issue for health care workers, we can integrate it into their education. If it is a matter of logistics, that would be covered under the “supply chain” question and will not be addressed here (although I have my own ideas about that, too).

The Barefoot Doctors died when China changed course and started emphasizing small, family-based businesses as its model for economic sustainability. Ironically, several thousand of the providers who were trained as Barefoot Doctors eventually went on to medical school and became licensed physicians. This is not a bad ending to the story: just one that was unexpected.

How to Think Like a Doctor

My flagship book How to Think Like a Doctor is available as a free Kindle eBook for the next five days. It really is amazing: there are more than 10,000 copies out there. Keep the ball rolling. If you don't have a Kindle, you can download the free Kindle Reader to any PC, tablet, iPod, or smartphone. I personally have over 1400 eBooks and about 1200 were free.

The following excerpt is from the Preface:

I came to Nicaragua originally to teach medical English to Nicaraguan medical students and intended to use this version as their textbook. My eventual goal is to revive Chairman Mao’s concept of Barefoot Doctors and make quality medical and health care available to underserved areas of the world. It is not only a dream of mine but is the logical follow-up to my first non-profit endeavor The Medicine Cabinet, with which we collected, repackaged, and sent medications and medical equipment to areas of need. Our first shipment was sent to the Rwandan refugee camps in Zaire in 1994 and was one of the first humanitarian projects to arrive there since the tragedy was not recognized as a humanitarian crisis by developed nations for several months.

The world desperately needs kind, compassionate, and capable health care workers. Ironically (and sadly), this is the polar opposite of what is happening in the United States now where a “good doctor” is now defined by how quickly he or she charts. I personally do not want to go to the grave with the epitaph “Here lies Michael Mangold, a good doctor because he charted on time.”

Lastly, a portion of the proceeds from the sales of this book will help fund the Barefoot Doctors Project, Nicaragua.

Mangold MD, Michael. How To Think Like a Doctor (A Quiet Revolution) (Kindle Locations 15-21).  Kindle Edition

GET OUTSIDE, PLAY WITH YOUR DOG, AND EAT DIRT

"Atopic dermatitis (AD)" is the medical term for what is more commonly called "childhood eczema." A new study out of Harvard shows that lower levels of prenatal maternal Vitamin D (25(OH)D) correlates with a higher risk of atopic dermatitis in early childhood. The researchers did not find a correlation between Vitamin D intake and early childhood eczema but did find a slight correlation between intake and mid-childhood atopic dermatitis.

In my own practice, we drew Vitamin D blood levels on approximately 1000 patients. ONLY ONE patient had a normal level. All of the rest were below normal. Granted, this was in a predominately White suburb of Milwaukee but the message is clear: get your Vitamin D on. If you can get outside, do it. Observe the normal precautions against sunburn, of course. If you cannot get outside every day, consider taking Vitamin D as a supplement. As always, discuss this with your health care provider first. Personally, I take a fish oil/Vitamin D combination capsule twice a day. Each capsule contains 2,0000 International Units (I.U.) of Vitamin D3 and 600 mg of Omega-3 Fatty Acids. Vitamin D supplementation is also an effective treatment for AD.

Other non-medical treatments (meaning that you don't need a physician's prescription) for AD include probiotics (the greater the variety of bacterial strains the better), moisturizers, and possibly a gluten-free diet. Exposure to ultraviolet light also helps flare-ups.

Prevention entails letting "kids be kids." Those who are raised in a "sanitized" environment develop eczema more often than children who habitually play outside. In the dirt. And children who are exposed to dogs while growing up also have a lower risk of developing AD.

So the moral of the story is this: get outside, play around, and pet your dog. Sounds like a prescription for a good life anyway.

My Worst Thanksgiving Ever

I am taking a break from writing about health issues here to promote my new book My Worst Thanksgiving Ever which is an account of the abduction of my son Benjamin by the U.S. embassy in Nicaragua over the Thanksgiving weekend of 2013. Even worse, I was subsequently blamed for "abandoning" him despite being mugged 5 times in two nights trying to find him. That just confirms one of my sayings: No Good Deed Goes Unpunished.

So please do me a favor and download the book. It will be available for free for the next three days. You can download a free Kindle Reader here. There are also free versions for your iPhone or Android device.

Download, read, relate, and pass on the news. I really appreciate it.

Wheat Belly

This is a re-post from 2014. The advice is timeless.

Anyone who has followed my dietary advice knows that my first recommendation is to ditch the wheat and all other products that contain gluten. When I talk about "diet" I don't mean losing weight necessarily (although that will follow) but rather your nutritional lifestyle. My revelation about going wheat-free came about with a talk one day at a Starbucks with the author of the book Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health, William Davis, MD. In my own experience, I lost 30 pounds in six weeks when I first started the diet then another 10 after I incorporated a "cheat day" once a week. A cheat day is the one day a week (I chose Friday) when I would eat what I wanted and as much as I wanted. Despite the fact that I never got hungry following Dr. Davis' advice, my metabolism did eventually slow down and I revved it back up by pigging out one meal a week.


But the "diet" part is actually two-fold: avoid gluten AND avoid sugars and simple starches. While "Wheat Belly" measures the effects of carbohydrates on a person's insulin response, I found it easier to stick with the standard Glycemic Index, avoiding "fast carbs" and consuming only "slow carbs." Those phrases were popularized by Timothy Ferriss in his book The 4-Hour Body . Warning: not for the faint-hearted. He also gave me the idea of the cheat day. The thing I like best about Ferris is that he tries his ideas on himself first. This just supports Dr. Mangold's Rules for Good Living No. 2: Never Trust a Fat Dietitian.


Search for "Glycemic Index" and you will find no lack of sites that not only explain what the term means, but also give you lists of foods that are low and high GI. Sugars and simple starches are highest, while more complex veggies are low. Simply put, I did fine with cabbage, asparagus, kale, spinach, nuts, and legumes. Dr. Davis narrows the choices down even more but I still lost weight eating non-recommended foods. He also has a Wheat Belly Cookbook. As I said, I never went hungry nor should you.
Here's to your start of healthy eating!