Villages Without Doctors - Useful for USA also!

This is something that i could not agree with more. I often speak about the fact that for a great deal of simple issues Doctors are not required and that this is creating an financial catastraphe for everyone except the health care industry itself. Insurance rates for families are out of hand.

The idea that only doctors can do what they are doing is limited. Doctors are very smart humans that is why they persevered through medical school and excelled in all academics beforehand. But in many cases actually they are not even helping due to their tendency to prescribe medication for any symptom... even muscle pain or things that are basically mechanical. We seem to live in a pharmacentric society now where Doctors are the drug dealers and real healing is done by the lay people anyway...the yoga teachers...the reiki healers... the people at places like Hippocrates Institute which employ MD's that have seen the folly of their former ways.

Read CONFESSIONS OF A MEDICAL HERETIC by Mendehlson it is tremendous.

Below is a solution reported in the New York Times today!

By TINA ROSENBERG

For the next few weeks, I’ll be writing about an idea that can make people healthier while bringing down health care costs, both in poor countries and in the United States.

The strategy is to move beyond doctors — to take the work of health care and shift down from doctors and nurses to lay people, peers and family. In the United States and other wealthy countries, lay people can fill in the gaps in left by doctors’ care. In poor countries, people with no or little formal medical training are successfully substituting for doctors and nurses.

This is fortunate, as villagers in many developing countries rarely see doctors or nurses. Especially in English-speaking parts of Africa and south Asia, doctors and nurses are often poached by better pay and conditions offered by Canada, the United States, Britain and Australia. Half the doctors trained in Ethiopia or Zambia, for example, have emigrated. (And each doctor who goes from, say, Kenya to Britain represents a transfer of about $600,000 from a poor country to a wealthy one.)

Local women can have huge impact on the health and prosperity of their villages.

Even doctors who don’t leave the country tend to stay in cities, where they treat patients who can pay. The distribution of nurses is only slightly more equitable. Rural villages do not tempt them.

But are doctors and nurses necessary to improve rural health? Two very successful programs in desperately poor parts of India’s Maharashtra state say no. SEARCH (the Society for Education, Action and Research in Community Health), in the district of Gadchiroli, and the Comprehensive Rural Health Project, in the district of Jamkhed, both recruit ordinary women to take care of their villages’ health. They have had a huge impact on the health and prosperity of their villages.

The Jamkhed program works with India’s most downtrodden people. Its trainees are women, many of them members of the Untouchable caste, many illiterate. When I visited the program in 2008, I met Jamkhed health workers who are lepers and those who were married at the age of two and a half.

While Leelabai Amte is a higher-caste Maratha, not an Untouchable, she was totally illiterate when she became a village health worker — she has since learned to read and write. She was married at 10 and had her first son at 13. Today, however, she is a respected authority figure in her village of 6,000 people, Halgaon. Amte was 60 when I met her, a very thin woman with thick glasses and no front teeth.

Twice a day, at nine in the morning and six at night, she set off through the streets of Halgaon, carrying a blood pressure cuff and a baby scale in her black shoulder bag, along with a log book. She visited the newborns she had delivered, pregnant women, old people. Her first stop one morning in January was the home of a three-day-old baby boy. Amte watched the baby suckle and then tied him in a cloth sling and hooked it to her scale. He was three and a half kilos, nearly eight pounds — a remarkable gain over his three-kilo birth weight. She murmured approvingly. “Don’t put anything on the umbilical cord,” she said. “And keep the child in the sunlight in the morning.”

“Twenty years ago, mothers waited three days to breast-feed their babies,” she said – a superstition that deprived babies of valuable colostrum and reduced the mothers’ supply of milk. Today, Amte has banished this and dozens of other superstitions from Halgaon. When she started working in Halgaon in 1977, families had six or seven children. The children often had scabies and other skin diseases. They were unvaccinated and often sick. Night blindness due to Vitamin A deficiency was everywhere. Tuberculosis and leprosy were common, and their sufferers were ostracized. People attributed illness to curses from the gods.

The vast majority of sickness in rural areas could be prevented with clean water, waste-disposal systems and more diverse farming.

Today there is no more infant mortality, and TB and leprosy are gone. Mothers eat better — the average birth weight of a baby has gone from about four and a half pounds to six and a half. New mothers are taught how to feed and care for their babies. Children get regular immunizations. Now almost every mother knows how to treat diarrhea and fever.

At a busy corner in the center of town, Amte was in the middle of a crowd of about 20 men, talking about installing toilets in Halgaon’s houses. Village women in India do not speak out to men, but Amte does. In the street she saw the husband of one of her pregnant patients — a woman overdue for her prenatal visit to the program’s hospital. “Why is your wife not coming to the hospital?” she scolded him. “We’ll check everything, give her blood tests.” The man had the grace to look sheepish. “I’ve been busy with farming,” he told Amte. “Next month I’ll bring her.”

All of the Jamkhed women say that the most important thing they do is teach others. Amte has trained three village women to deliver babies. At one house she quizzed a high-school girl. “If a child has a fever, what do you do?” Amte asked.

“Cold compresses,” said the girl promptly.

“And diarrhea?”

“You give oral rehydration mixture.”

“Do they teach you about health in school?” asked Amte. “Do they tell you about safe drinking water and keeping yourself clean?”

“No,” the girl replied. “You are the one who talks about that.”

The Jamkhed program was founded in 1970 by Raj and Mabelle Arole. Mabelle (who died in 1997) and Raj were first and second in their class respectively at a prestigious Indian medical school. They shared not only medical talent, but a dissatisfaction with the kind of medicine they were being taught — curative medicine, the kind useful for wealthy countries.

They moved back to Jamkhed, near where Raj was born, a location they chose largely for its desolation. They decided that doctors were not the way to help rural villages. The vast majority of sickness in rural areas could be prevented with clean water, waste-disposal systems and more diverse farming. Villages need to end deadly superstitions about health. They need to end discrimination against women and Untouchables, and to learn about hand-washing, nutrition, breast-feeding and simple home remedies. Doctors do none of these things.

“Rural problems are simple,” Raj Arole told me. “We do not need experts. An array of women like village health workers is enough, properly trained and supported.” The very prestige and distance of doctors worked against them. The Aroles found that lack of education was an advantage for village health workers. They knew how their neighbors lived and thought.

The Aroles went to various villages and asked each to choose a woman to send to the program’s headquarters in Jamkhed, which is also the name of the district’s major city, to learn to be a health worker. Mabelle and the couple’s daughter, Shobha, now a doctor who runs the program, conducted the training.

Teaching the women health skills was the easy part. Illiteracy was not an overwhelming problem. The real problem was the women’s complete absence of confidence. Their entire lives had been lessons in keeping their heads down. They had to gain confidence from each other.

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Read previous contributions to this series.

Amte and many of the other active health workers gather at the Jamkhed campus every Tuesday. They discuss problems in their village and learn about new health subjects. New health workers go in groups of three or four to stay with more experienced peers in their village for a week. They watch their mentor as she greets her neighbors with assurance, works with local all-men farmers clubs, sees patients and teaches mothers about breastfeeding or purifying water.

Starting out, none of the women could imagine that their neighbors would ever listen to their advice. There was no magic in it. The answer turned out to be the expected factors: time, demonstrable success and support. There were months, sometimes years of frustration, tempered by the soothing words of more experienced health workers who had gone through the same thing. But eventually, mothers of sick children called the Jamkhed worker out of desperation, when going to the temple didn’t work. Their success in curing a child’s diarrhea or delivering a baby after a difficult labor was the turning point. After that, people started listening when they talked about clean water, breastfeeding and nutrition as well.

Indian statistics have long shown that Jamkhed villages are far healthier than their neighbors. A new study published in the Bulletin of the World Health Organization found that Jamkhed’s program has reduced child deaths by 30 percent but had no significant effect on neonatal deaths — those in the first month of life.

SEARCH, by contrast, focuses on more traditional medicine. Like Jamkhed, SEARCH was founded by a husband-and-wife team of Indian doctors who studied public health at Johns Hopkins University in Baltimore, Abhay and Rani Bang. But there are differences. SEARCH is newer, founded in 1985. It requires its health workers to have more education —literacy at least, and some of the women have finished 10^th grade. SEARCH trains them to work with mothers in their homes to have healthy children. The health workers visit pregnant women repeatedly, attend births, teach mothers about how to keep their babies healthy and check in on the children often. They diagnose and treat illnesses, and even administer injectable antibiotics to treat blood infections.

The Bangs carry out numerous studies of their work. In 1999, they published an article in the medical journal Lancet, showing that their home-based care program reduced neonatal and infant mortality by 50 percent.

That caught the attention of the Connecticut-based humanitarian agency Save the Children. “Neonatal mortality was an important and neglected health issue,” said David Oot, associate vice president for health and nutrition at Save the Children. “But the deaths occur at home without exposure to the formal health system. So people thought there was little you could do.”

SEARCH proved there was a lot you could do. For the past 10 years, SEARCH has worked with Save the Children to study new ways community health workers can work with mothers, and teach these methods to others. On Saturday, I will look at what makes Jamkhed and SEARCH so successful when similar programs have failed elsewhere, and how their ideas are now reaching millions of people around the world.

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Prevention is the best solution! Please people let prevention save you from suffering!

It is impossible to overemphasize the value of prevention. There is no doubt that this is a complex and polluted world and sometimes ailments can not be prevented or are genetic. But that is more rare than you might believe and the fact is that we MUST do whatever we can to act intelligently so we can prevent the Cancer diagnosis that many people are receiving these days.

Cancer is not good. But it can be a sign that lifestyle needs to change and if heeded can lead to a transformational experience and bring enlightenment. The problem with Cancer is the diagnosis itself and the treatments and the lack of quality of life that can follow. Below is a NY Times article on the Side Effects of Radiation that were not well understood by the patient.

If you want to cure yourself of cancer, begin to research the thousands of cases of people who have cured their cancer through raw foods. The best place to cure cancer in the United States is Hippocrates Institute in Palm Beach, Fl.

Prevent Cancer by eating lots of well washed fruits, and vegetable based foods. Eat as much Raw Vegan Food as humanly possible... enjoying the blessings of Fruit that God put on this planet for us. Drink Green Liquids like Spirulina or A.F.A. Blue Green Algae (best) and exercise everyday. Exercise everyday with Yoga if possible, eat according to your primate biology (you are not an omnivore and certainly not a carnivore), and become aware of patterns of self judgment and self criticism and transcend with waves of gratitude and surrender.

This is the formula for the prevention of almost all disease. To the degree that our actions will assist us in prevention, these are the actions to take. Be smart, be aware and then do what you want! It is your life... just realize that health is the only WEALTH.

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NY Times 10/06/10

Wiry, fair-haired and in his 60s, the patient had received a prostate cancer diagnosis a year earlier. When his doctors told him that surgery and radiation therapy were equally effective and that it was up to him to decide, he chose radiation with little hesitation.

But one afternoon a month after completing his treatment, the patient was shocked to see red urine collecting in the urinal. After his doctors performed a series of tests and bladder irrigations through a pencil-size catheter, he learned that the bleeding was a complication of the radiation treatment.

He recalled briefly hearing about this side effect three months earlier, but none of the reports he had been given or collected mentioned it, and once he had recovered from the angst of the emergency room and the doctor’s office visits and the discomfort of the clinical work-up, he didn’t give it more thought — until a few weeks later, when he started bleeding again.

By the time I met him, he was in the middle of his third visit to the hospital. “I feel like I’m tied to this place,” he said. He showed me a plastic jug partly filled with urine the color of fruit punch, and he described a post-treatment life marked by fear of going to the bathroom and discovering blood. “If I had known that my life would be like this after radiation,” he sighed, “I would have chosen the surgery.”

Whether conducted at a laboratory bench or in clinical trials, medical research has long been driven by a single overriding goal — the need to find a cure. Usually referred to more modestly as a search for “the most effective treatment,” this standard has served as both a barometer of success and a major criterion for funding. Most published studies are marked by a preponderance of data documenting even minor blips in laboratory values or changes in the size of a spot of cancer or area of heart muscle damage on specialized X-rays. Some studies bolster the apparent success of their results with additional data on societal effects like treatment costs or numbers of workdays missed.

Few studies, however, focus on the patient experience.

The result of all this emphasis on cure has been a nearly embarrassing richness of choice for patients with diabetes, heart disease, H.I.V. infections and even some cancers. The increasingly sophisticated treatment regimens that now make up medicine’s armamentarium have transformed once life-threatening diseases into chronic ones, but in the process have given rise to a group of individuals who are caught in the unenviable position of living with an illness that never quite goes away. No longer forced to make once-in-a-lifetime life-or-death treatment decisions, they instead struggle each day with the side effects of the very treatments that keep them alive.

For many of these patients, the most important question becomes not “What treatment will allow me to live the longest?” but rather “Which treatment can I live with?”

Now, according to a paper published last month in the policy journal Health Affairs, the Patient-Centered Outcomes Research Institute, a new initiative mandated by the federal health care overhaul, may offer a chance to alter the prevailing winds of medical research so the needs of this growing segment of the patient population are addressed. With a 21-member board made up of individuals from both the public and private sectors, the institute has a mandate to set the agenda for research comparing treatments for common diseases and to finance the most important studies. But according to the paper’s authors, the potential of such an enterprise will be fully realized only if the institute supports initiatives and strategies that place the patient experience not only front and center in research but also smack in the middle of the medical mainstream.

“To some extent, we’ve conquered death,” said Dr. Albert W. Wu, lead author and a general internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “Now we have people living with chronic illnesses, and how they experience quality of life every day has become an important part of how they are doing and whether the treatments are worthwhile.”

To effectively capture the patient perspective, Dr. Wu and his co-authors propose making patient-reported outcomes a more routine part of clinical studies and practice and administrative data collection, in some cases requiring the information for reimbursement. For several months now, they have been incorporating data about patient experiences into routine medical practice at Johns Hopkins. Using a dedicated portal called PatientViewpoint.org, patients can, at the suggestion of their physicians, fill out surveys about their energy levels, social functioning, mental health, nausea and pain. The information is then handled like more traditional clinical testing; access is reserved for the patients themselves and their doctors.

Currently, the site is open only to patients diagnosed with breast or prostate cancer, but Dr. Wu and his colleagues hope that eventually all doctors will be able to order patient surveys that measure experiences like levels of pain, physical functioning or depression, proactively identifying results that are high or low, then reviewing those results with patients. And despite initial concerns that patients might feel overburdened by the questionnaires, most have been enthusiastic.

“Patients want to have more conversations with their physicians and other providers about these kinds of issues,” Dr. Wu said. “Sometimes it’s difficult to cover all this information during the medical encounter, and these surveys may be another opportunity to do that.”

Not all clinicians or researchers, however, are eager to embrace patient-reported outcomes. Many have never received training in the research methods involved and are skeptical about the value of a discipline or drill that is unfamiliar. “This is considered to be squishy, soft stuff,” Dr. Wu said. “It’s still not something you can order on a laboratory slip.”

Nonetheless, Dr. Wu is hopeful that the new Patient-Centered Outcomes Research Institute will provide more direction to all researchers, while establishing new and more comprehensive standards that require patient-reported and quality-of-life outcomes. “I think we have a real opportunity right now, and this institute has great potential to be a positive force in understanding how treatments work and what’s effective and for whom,” he said.

But he also cautioned: “We have to remember to include the patients. We have to include their perspective if we want to come up with evidence that they can really use to make better decisions for themselves about treatment and care.”