Back to School

If, in reading this post, you're looking for something that will make you jump out of your seat, cover your mouth with your left hand and start pointing at your computer screen with your right hand while you make unintelligible shrieks at the people nearby to get them to come and read, this is not the post for you. Unfortunately for you, thrill seeking person, this one will mostly be about what I'm learning about health care and what not.

*clearing throat*

Over the last day and a half, the "course" part of my trip has begun. It's been really incredible. Every morning we get up and go to breakfast at seven, and at nine we have a lecture on something about CRHP or go on rounds in the hospital with Dr. Shobha. Every lecture and every round is focused on teaching us how to holistically improve a community's health as opposed to just treating/curing disease. It's about identifying the sources of diseases and eliminating them. That means considering all social and economic factors that either impede or improve health for people. To give you an idea, a person's caste or social status, their religious or political beliefs, their level of education or understanding of basic hygiene, their access to clean water, their gender, their geographical locations, their perceptions about medicine, all affect their health and/or their ability to get health care, even though these factors aren't generally considered components of a health system or even considered to be related to health care. For the last forty years, CRHP has focused on addressing these issues in communities, and with astounding results. I'll tell you about a few lectures we had yesterday and today that were awesome.

First thing yesterday we had a lecture from Dr. Raj, the co-founder of CRHP. He's pretty famous in the global health community for his work, which revolutionized global health and could--if Congress opened their eyes to alternative models of health care--revolutionize health care in the US too. We had a panel discussion with six women who work as village health workers (VHWs) for CRHP. Having "village health workers" is one of the many geniuses of the project. CRHP chooses one low-caste woman from each community take responsibility for providing basic health services and education to the entire town. By choosing under-served women from under-served castes to be in a position of authority and service in a community, barriers of caste and gender discrimination crumble and dissipate. However, some of the biggest barriers of caste discrimination to be dealt with come from the VHW's themselves. These women, especially of the lowest caste (Dhalit), are taught by society that they are worthless and only useful in completing the most menial tasks, like cleaning up garbage and feces. Dr. Raj told us that when VHWs began working for CRHP, their weekly training consisted of about 30% medicine and public health and about 70% self-esteem building. In order for these women to feel efficacious, and like they can help people of higher castes, Dr. Raj and CRHP have had to break through centuries of socially acceptable discrimination that these women are raised to believe is ok. Most of the VHWs we heard from had been married before turning 12 years old and had been beaten regularly by their husbands. One of the most beautiful moments I've experienced since being here happened during this panel discussion when I started to think about the transformation these women have undergone because of the education they were provided and the respect they were shown at CRHP. These women represent a demographic that for centuries has been socially silenced, marginalized and abused but now they are outspoken, honest and expressive about their experiences and feelings toward important issues. Essentially, they have been given a voice and feel like they can make a difference in their communities. One woman, for instance, is in her fourth year as mayor of her community. Forty years ago that would have been laughable/criminal. The VHWs told stories of how they'd organized women's groups in their communities and combined in these groups against drunk, abusive men and also helped women to get loans from a predominantly mysogenist government to start their own businesses. One woman said "I learned to know who I am" by working for CRHP. I got some video tape of this panel discussion, which I'll see if I can post online.

We also heard from the Mobile Health Team, a group of social workers and nurses who travel to villages that have special needs. CRHP covers over 40 rural villages, each of which has an assigned village health worker. The mobile health team has more specialized skills than the VHWs and is thus repsonsible for traveling to give seminars, assess damage caused by natural disasters, start new programs, and organize common-interest social groups for people to talk about local problems. They were all very kind and gave insightful comments about primary health care. Finally, we had another lecture from Dr. Raj. He is so impressive. He lectured on the history of primary health care for about two hours, and allowed us to ask questions. He also talked about CRHP's mission. Their primary goal is equity, which, he explained, is different than equality. For a health system to be equitable it must be set up to give all people--no matter their social class or gender or geographic location or anything-adequate access to health care. In global health work a lot of people throw "equity" around in conversations, but it's rarely achieved in the planning and execution of health initiatives. That's because it means addressing issues like gender discrimination, social hierarchies and government corruption and working to correct them. All of which are uncomfortable/dangerous for people to talk about, especially if the people causing these problems are the people in power. When I was listening to the lecture I was thinking about the ways American and European health systems tend to be inequitable. In Europe and other socialized systems, the long wait for surgeries and other procedures leads many wealthy citizens to travel abroad for quicker care. But what can the poor do? They can only wait, as their health deteriorates. That is inequitable. The way the US has privatized healthcare for so long is inequitable. The fact that some people can be uninsured based on their economic status makes the system inequitable. If you disagree, you probably have never thought of health as a fundamental human right.

Dr. Raj also talked about preventive medicine and why it isn't practiced in the states, or anywhere in the developed world really. Preventative medicine means looking at what causes people to get diseases and addressing them, rather than practicing merely curing people of their diseases, which is generally done with therapy, prescriptions and surgery. Just think of what would happen to the soaring costs of healthcare if some of the money that's spent on sick care was allocated to preventative care. Costs would definitely taper off. People would need fewer prescriptions, fewer trips to the ER and less coverage from their insurance companies, and we probably wouldn't need an overhaul of the national system. Unfortunately, preventative care isn't lucrative. A doctor who can help you maintain a healthy lifestyle is not in demand. However, when there's a sharp pain in your chest, and your left arm goes numb, a doctor that can unclog the arteries surrounding your heart is in high demand, and you're willing to pay him a lot more than the doctor that would have helped you prevent the heart attack in the first place. That's probably an oversimplification but it makes an important point. Until preventative medicine is lucrative (which means, until the government subsidizes it, unfortunately) health service costs will continue to soar, on our bill. That's a non-partisan reality. I'm not sure, but we may be way beyond a CRHP-type model in the United States. I'll probably talk about that some more in another post.

*Stepping off of soapbox*

Alright, that's all for now, I'll give you some more soon.