In 2001, my mom described her health care philosophy to the Boston
Globe: "Medical care is ideally broad enough to envelop not only the
technical part of treating an illness, but caring for the whole animal - and
the family around it.”
Though my mom’s expertise pertains primarily to animals, Dr. Aaron
Shirley shares a similar sentiment about human patients. In 2010, Shirley
founded HealthConnect, a rural Mississippi medical provider that provides a
“holistic, intensely personal approach” to patient care. His inspiration for
HealthConnect stems from “an unlikely place:” Iran.
In the 1980s, the Islamic Republic of Iran implemented a new primary
health care system to combat the unsettling differences in health care quality
and availability of rural and urban areas. As a result of this disparity, urban
populations that had better access to better health care tended to out-health
their rural counterparts.
The system was based on a single, multitiered structure. The first
level, “health houses,” were constructed to accommodate the primary health care
of approximately 1,500 people all of whom lived within an hour’s walk or
less. The 1000-square-foot houses
themselves consist of exam rooms, sleeping quarters, and staff, who men and
women trained in basic, preventative care. Services included family planning,
prenatal care, nutritional advice, and immunizations.
The next tier was the rural center followed by the district hospital.
This way, those who become very sick or require surgery, had access to a
better-equipped hospital. It was also relatively inexpensive to implement. (http://www.nytimes.com/2012/07/29/magazine/what-can-mississippis-health-care-system-learn-from-iran.html?pagewanted=1&_r=4&hp).
Here you can see the flow of the hierarchical Iranian system and comparison of that flow between rural and urban centers. By the third tier, the urban and rural areas share the same hospitals.
Photo credit: http://www.emeraldinsight.com/content_images/fig/0730190502001.png
I see two crucial and extremely effective features of Iran’s system. The
first is that by establishing good primary care, a more serious condition can
be caught early before it lands the patient in the (expensive) emergency room
or worse, dead. Obviously not all conditions are preventative. But many that
face people living in poverty, such as diabetes, malnutrition, water
contamination, malaria and other mosquito-transmitted diseases, and to an
extent HIV, can be addressed before they reach a point of no return.
The second is that the health care workers are not foreigners imported
in their fancy white lab coats and fancy stethoscopes; they are natives. They
grew up in the villages they serve. They can relate to their patients on a
personal level because they already share common ground, helping to forge an
imperative sense of trust between health care provider and recipient. Such
familiarity allows them to truly understand the problems their patients face
and know certain realities of a solution. Some treatments we consider to be
relatively elementary are impossible to prescribe in rural areas. Anything
needing to be stored in the fridge, for example, is off the table for isolated
areas without electricity.
In explaining how he made the leap from Iran to the United States, Dr. Shirley
told the New York Times, “The Iranian model eliminated the geographic disparities,
so why couldn’t this same approach be used for racial and geographic
disparities in the United States?”
(http://www.nytimes.com/2012/07/29/magazine/what-can-mississippis-health-care-system-learn-from-iran.html?pagewanted=1&_r=4&hp).
Photo credit: http://faithandhealthdotorg.files.wordpress.com/2012/07/screen-shot-2012-07-31-at-8-43-53-am.png
The question now is, can HealthConnect actually help Mississippi?
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