House Calls

Not many Americans are old enough – or rich enough – to remember when a physician routinely made house calls to visit sick patients. We see the phenomenon in old black and white movies running at odd hours on often obscure networks, but the memory of those days gone by barely triggers the slightest nostalgic moment; almost every American alive today only knows being dragged to a doctor’s office or to an emergency room where pain and contagion loom large. Of folks in Europe, their national health care still provides this basic service on a fairly routine basis. With so many Americans living without healthcare or having limited means of transportation – particularly when there are down and very out – there is clearly a need to reach out into grassroots communities simply to identify exactly what health needs remain unfulfilled.

Then there is this little experiment in Mississippi, a state where health problems per capita seem to rise well above the American norm. The January 24^th Los Angeles Times writes about a courageous Delta doctor with an even more courageous desire to go down a road that would make most Americans wince: “Dr. Aaron Shirley has devoted his career to serving the rural poor in the Mississippi Delta [he was Mississippi’s first black pediatrician, back in 1965], but now the 77-year-old pediatrician believes the key to reducing the nation's highest infant mortality rates lies in a surprising place: The Islamic Republic of Iran.”

According to a piece in the November-December, 2009 National Institutes of Health Global Health Matters: “After decades of frustration and millions of dollars invested with dismal results, Mississippi health care pioneer Dr. Aaron Shirley knew he needed a fresh approach. In some parts of his state, the infant death rate for nonwhites is on a par with Libya and Thailand. Mississippi's health consistently ranks dead last among states in annual tallies produced by the United Health Foundation. It has the highest rates of obesity, hypertension and teen pregnancy in the country, with about 20 percent of its population lacking health insurance…. Together with James Miller of the Oxford International Development Group, Shirley reached out to Iranian health care experts for advice. He knew WHO and World Bank evaluations indicate positive outcomes from Iran's novel health house concept and thought it might provide the solution for his own population…. He discovered his Iranian counterparts are dealing with many of the same issues he faces: lack of funding and trained personnel. And yet they are having stunning successes, reducing child mortality rates by about 70 percent since 1980 and increasing contraception rates to 90 percent, even in rural areas.”

It seems he heard of neighborhood “health houses” (Iran has 17,000 of them) of healthcare professionals in Iran whose job it is to keep tabs on the status of health in local communities. These weren’t doctors, but nurse and even nurses aids who go door-to-door to take blood tests, check blood pressure, advise on sanitary conditions and just make general observations about what they see. They make necessary referrals when they note a more complex problem. With special dispensation from both Washington and Tehran, “[i]n May, Shirley and two colleagues flew to Iran for 10 days to study a low-cost rural healthcare delivery system that, according to the World Health Organization, has helped cut infant deaths by 70% over the last three decades.” The LA Times. Later that fall, Iranian medical personnel reciprocated and visited the Mississippi Delta, again with blessing from the warring factions in Washington and Tehran. These Iranian doctors were shocked at scenes of brutal rural poverty and wide-spread unemployment, completely unexpected visions of America – blighted communities with run-down housing, weed-filled lots and battered old roads overflowing with mud.

But they also found a spirit in these Americans they had not expected. “‘We played black gospel and blues for those Iranians,’ recalled Sylvester Hoover, 52, owner of Baptist Town's only business, a one-room grocery, laundromat and barbecue grill. ‘They were just hugging us they were so excited. They loved it.’” LA Times. Funny how this little political bridge succeeded when so many overtures at higher levels have collapsed and burned so many times. “Tensions between the United States and Iran dominate daily headlines, but both governments have given quiet support to the little-known initiative in the Delta… In Tehran, the Foreign and Health ministries approved a memorandum of agreement to authorize collaboration between Shiraz University of Medical Sciences and Shirley's team, which includes Jackson State University.”

As Shirley and his colleagues apply for $30 million of federal funding for a three-year pilot program for many Delta communities, it is clear that he is trying a very different approach from the traditional American treatment paradigm. The NIH report cited above: “In Iran, preventive care is a priority and special attention is paid to high-risk groups such as mothers and children. Health care workers are chosen and trained within each community. Preventive and curative programs are integrated seamlessly. The system is decentralized, which encourages regional facilities to become self-sufficient and empowers local communities… In contrast, Mississippi has a fragmented ad-hoc system of hospitals, health clinics and individual medical practices, says Miller. ‘Our public health programs and services aren't integrated and are anything but user friendly. Our health research is often too narrowly focused on specific risk factors and, like the rest of the U.S., we place the emphasis on curing existing conditions rather than preventing them in the first place.’”

Kind of funny the kinds of issues that tear us apart, resulting in military threats and profound exchanges of bludgeoning insults… Then there are those wonderful moments when we see how people are just human beings, facing the same problems, maybe in differing ways. Thank goodness for these terrific little connections.

I’m Peter Dekom, and there is hope out there… sometimes from where you least expect it.