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.

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.