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

MY WORST THANKSGIVING EVER

   It has been a rough time for me since my last post. I have been through a lot and will eventually tell all in a screenplay I am now writing called "Elkton Rules: The Little Prison That Thought it Could." I found a director who is interested in it. More later.

   In the meantime, I am finally getting my book My Worst Thanksgiving Ever published as installments. The first three chapters are available for only $2.99 which is the lowest price I could negotiate with Amazon. Please buy it if you can, and spread the word.

   I know this isn't a health-related post but in a way, publishing the book is doing wonders for my mental health. So far, the only version of what happened to me in Nicaragua has been Angie's and this is my chance to set the record straight. It isn't just a matter of telling one version of the story. It is the ONLY version since she was not there when it happened. It is amazing how powerful hearsay can be when it is made up.

   I have to learn the hard way, but discovered that there are easier ways to increase the traffic to your blogs. In my opinion, there are great ways to spread my messages about health and nutrition. For example, check out Grow Traffic and see what they have to offer you.

  Enjoy the book and if you have any constructive criticisms about for me, let me know.
Thanks.

A Calorie is Not Just a Calorie

Does this sound familiar? You want to lose weight so you buy into an established program like Weight Watchers or Jenny Craig. Or you buy yourself yet another dieting book, perhaps the latest craze everyone is talking about. Conventional diets have you counting calories: not only what you consume but how much you  presumably expend during exercise. You measure portion sizes according to some pictures, the size of your hand, or even pre-made plates they sell you. The stress rises from all the attention to detail and attempts at perfection.

You do lose weight initially. It seems all "diets" lead to some weight loss in the first few weeks. What happens then? You plateau. No matter how hard you exercise and how much attention you pay to your food portions and avoidance of fats, you can't seem to make the same inroads any longer. So you stop counting calories, maybe unconsciously  at first. Your metabolism has slowed on the calorie-restricted diet and now established eating patterns result in increased weight and fat deposition. Now you are heavier than when you started. What to do next? Of course: try the latest dieting fad. The cycle repeats itself.

What if I told you counting calories and fat-restricted diets are things of the past? That the added stress of counting calories consumed and expended increases cortisol levels which in turn increases fat deposition? That there are ways to lose fat and tone muscles that allow you to eat all you want of the correct, nutritious foods?

There are. I lived it myself.

In February of 2012, I weighed-in at a whopping 220 pounds, 45 pounds heavier than my college graduate weight. We had Dolphin Therapy for Jon coming up in March and I wanted to lose some of my rolly-polliness so I started practicing what I had been preaching to my patients for the last 2 years. I attacked the problem in two ways: jump-starting my weight loss with the 2 week "induction" phase of the Atkins Diet. I knew it would work since I made astounding progress on it when I was training for a body building contest in 1997. I then followed that with the Wheat Belly Diet, devised and written by my friend and cardiologist Dr. William Davis. I also monitored my body fat, cholesterol levels, and C-Reactive Protein (CRP) levels. CRP is a generalized measurement of acute inflammation. Chronically elevated levels of inflammation are associated with cardiovascular disease among other things:
                   "Recent research suggests that patients with elevated basal levels of CRP are at an increased risk of diabetes, hypertension and cardiovascular disease."

Six weeks into the program I had lost 30 pounds. My total cholesterol level had dropped from 220 to 187. My body fat had decreased from 30% to 22%. And I never went hungry. Admittedly, the Atkins part of the regime was rigorous. The Wheat Belly part is just fun. Discovering new ways to prepare wheat- and gluten-free meals appealed to my inner Chef.

This is the gist of the program that I advocate for all my clients, friends, and relatives. There are obviously more details that I will explore in later posts. But for now, please consider buying or borrowing these two books. Learn that "diet" refers to a lifestyle (not THE Lifestyle which I will talk about some time later) and that you can enjoy eating sanely and nutritionally.

And stop counting calories: it's not healthy.

Where There Is No Doctor

Where There Is No Doctor is book published and sold by the wonderful people at Hesperian Health. I used the book myself while in Nicaragua. For a physician, the content can be a bit simplistic at times but I do acknowledge that the intended audience is for non-physician health care workers. Only 10 percent of pathologies and medical states constitute 90% of what any given provider will encounter. Workers can easily be trained to diagnose and treat those conditions. The remainder would need to be referred to specialists  (ideally over the internet) who will work with the providers to ensure adequate care and follow-up.

During my tenure in Nicaragua, I applied for a grant that addressed the need to bring quality health care to underserved areas of that country. My proposal was based on Mao Zedong's attempt to do the same thing in China. He called the program "Barefoot Doctors" and, in a real small nutshell, medical doctors would train motivated individuals picked by their respective villages in the essentials of medicine (like the 10% mentioned above) then send them back to the villages as primary care providers. My proposal did not receive the grant (I submitted it too late) but it served as the basis for my third book Barefoot Doctors (A Quiet Revolution).

The biggest and  best advantage my Barefoot Doctors idea has over Chairman Mao's is the internet. Surprisingly, internet access is available in the least expected places. Where it is not, there are many like-minded groups such as PATH trying to transform the face of medical access throughout the world. MY vision includes getting access to volunteer specialists 24 hours a day, 7 days a week. We CAN do this. It will just take time, money, innovation, and motivated people.

Hesperian Health is a wonderful endeavor created and run by people who have a real heart for serving. If you get the chance, head over to their website, browse around awhile, purchases the resources you are interested in, and donate to them if you feel the need. Their mission is similar to mine.

FATHER'S DAY

This scenario was so common in my clinic that it is almost cliché: men refusing to acknowledge they have an illness until it is too late. I don’t know if this is a genetic thing, perhaps some DNA located on the hairy ear chromosome, or if it is cultural. I know, it is difficult for American males to admit weaknesses and ask for help. Even when we get to the point of crisis and ask for help, a common response in this country is “help yourself.” Been there; heard that.

Let’s talk prostate cancer. It is a touchy subject, one that men don’t want to discuss and many females find “yucky” for some reason. For example, when I found the supplement called “Man Gold” at the Vitamin Shoppe, one of my daughters originally “liked” it on facebook then retracted it when she read that it “supports prostate health.” I guess thinking about your father’s private parts is taboo.

Here are some prostate cancer facts taken from the American Cancer Society website:

            Other than skin cancer, prostate cancer is the most common cancer in American men. The American Cancer Society’s estimates for prostate cancer in the United States for 2014 are:

• About 233,000 new cases of prostate cancer will be diagnosed
• About 29,480 men will die of prostate cancer.
• About 1 man in 7 will be diagnosed with prostate cancer during his lifetime.
• Prostate cancer occurs mainly in older men. About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 66.
• Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 36 will die of prostate cancer.

This avoidance of men’s issues is evident on a national level, too. According to the New York Times:

            “Among the big cancers, breast cancer receives the most funding per new case, $2,596 — and by far the most money relative to each death, $13,452. Notably, prostate cancer, the most common cancer, receives the least funding per new case at just $1,318. But on a per-death basis it ranks second, with $11,298 in N.C.I. funds.”

You can help change both scenarios: men’s seemingly natural tendency to address health issues and the avoidance/repulsiveness attitude about the prostate. Us TOO International Prostate Cancer Education & Support Network is “a grassroots, registered 501(c)(3) non-profit prostate cancer education and support network of 325 support group chapters worldwide, providing men and their families with free information, materials and peer-to-peer support so they can make informed choices on detection, treatment options and coping with ongoing survivorship. The organization was founded in 1990 by five men who had been treated for prostate cancer.” Go ahead, click on the link and give your support. The group gives good advice to family members who have a loved father, grandfather, or husband with the disease. Talk about it. If mom developed cervical cancer would you shun discussing it with her?

As a tribute to fathers everywhere, including my own dad Norbert Mangold who died way too young, I am offering my book How to Think Like a Doctor for free for two days starting June 15^th. Please, download it, share it, and review it on Amazon.com whether you like it or not. I appreciate thoughtful reviews and have made modifications based on some of those comments. It really is a good read.

Learn and enjoy!

Dr. Mike

THE WHEAT BELLY DIET

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 (see my Recommended Reading list). 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!

Following My Passions: Healing & Teaching

LET THERE BE LIGHT

This post will be brief because of time-constraints (yes, even Minimalist Sojourners are pressured for time at times). I'll delve into this deeper later when I talk about basic human needs and SCANCAPS, but for now I'd like to introduce you to two companies that are working to bring light to what the good people at mpowerd call "energy impoverished" areas of the world. Their contribution is the Luci Light. We ran across it at an outfitter's in Boone, NC and fell in love with it immediately (https://www.mpowerd.com/). The other company is Nokero (www.nokero.com). We ran across them at the Global Health Initiative at Yale last year when they were just starting-up. We still have the solar-powered light they sold us then. We gave it to the Young Padawan and it has held up well under very strenuous conditions. I'm afraid growth or success may have gone to their heads, though: the responses to our last emails to them were stock "go to our website to make your online purchase" replies. Oh well.

I encourage everyone to do what they can to shine the light. Patients die in the dark; women give birth in the dark; horrendous crimes are committed in the dark.