Friday, September 25, 2009

Communities of Healing Hands - The Hesperian Example

In my last post, Making The World Sick, One Country At A Time, I stated some key facts to illustrate how the American health care system prevents ordinary citizens from achieving economic resilience and self-sufficiency by bleeding them dry. I also said that I don't really expect the U.S. Federal government to enact any serious health care reform of the kind that would lighten the financial burden on the backs of ordinary users of American health care. I then stated my opinion that over the next several years, American health care will probably come to resemble the care provided in many Third World countries. (By the way, there are signs that this is happening now.)

My post then explored the sort of care that is now provided in the Third World, as well as explaining the philosophy behind much of that care as embodied in the 1978 Alma Ata Declaration of the World Health Organization. I cited the concept of Primary Health Care (PHC) embodied in that Declaration, as “...essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford...”

I then described how rich First World entities such as the World Bank and International Monetary Fund have worked to weaken Primary Health Care in the developing world, how they have forced the governments of Third World countries to dismantle their government-provided social services, and how they have worked instead to force an American-style privatized system of health insurance coverage on the poor citizens of the developing world. This failure to achieve a universal good for the world's people has occurred because the attempt to achieve this good relied on national governments that were beholden to selfish, rich corporations and other holders of concentrated wealth.

Yet there are good examples of individuals and volunteer organizations banding together to create social safety nets, including basic affordable health care, in the Third World and in the poorer parts of the First World. These groups are often quite innovative, due to the limits on the resources at their disposal, and the work they do is worthy of high praise. In his paper, “The Life and Death of Primary Health Care,” David Werner makes mention of the good work of non-government, community-based health programs and the groups that administer them.

One such group deserves particular mention. The Hesperian Foundation (, based in Berkeley, California, is a non-profit publisher of books and newsletters for community-based health care, as stated in the “About Us” section of their website. Their published information is developed in collaboration with formally-trained doctors, citizens of poor communities in the developing world, and untrained or informally trained health care workers in these communities. Their literature is very simply written and is designed for people without any formal medical training, and it not only covers the treatment of disease, but also covers the underlying social factors in building healthy communities. Their most well-known book is Where There Is No Doctor, a book that has almost become the Bible of primary health care in the developing world. Hesperian has also joined forces with the worldwide People's Health Movement to promote health for all and the widespread implementation of Primary Health Care as defined in the Alma Ata Declaration.

I recently had a chance to conduct an e-mail “interview” of the Hesperian staff, which I have included as part of this present post. My questions are written in bold type, and their answers to each question are shown immediately below that question. I would like to especially thank Hesperian staffer Ingrid Hawkinson for taking the time to reply to my e-mail inquiries and to collect all the answers to my questions. The approach set forth by the Hesperian Foundation could prove to be a vital part of the response by ordinary Americans to our present health care crisis.

In reading the “Our Philosophy” section of your website, it seems that you have incorporated all of the principles of the 1978 Alma Ata declaration of the World Health Organization. That declaration defined health as “...a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity...” and stated that health is a fundamental human right. It also went on to address the underlying societal factors that influence the health of a nation. Are you familiar with the Alma Ata Declaration, and was it an influence on your philosophy?

Yes, we are definitely familiar with the Alma Ata Declaration – we have spent the past 30 years building on the successful model of Where There Is No Doctor to create other resources that also help people discover not only the ways they can have equal access to health care, but to do so in a sustainable way that examines the social, economic, and political issues that not only block access, but make our communities unhealthy. In line with the Alma Ata Declaration, our mission is to achieve the right to health for all people.

If ordinary people put their heads together to examine their health problems, come up with solutions, and organize, so many issues will be addressed including the power balance, the state of the environment, our sense of wellbeing. . . The concept of “health” and the reasons behind poor health are woven into the fabric of our existence.

Your programs match the definition of “Primary Health Care” as stated in the Alma Ata Declaration. After that Declaration was issued, many rich First World nations protested that implementing this Primary Health Care would be too “expensive.” Yet you seem to be able to provide what rich First World governments could not. How do you do it?

What we do is very simple. We supply information that people can use in formats they can understand and easily share. Our books are developed collaboratively to ensure they make sense to the end user. Once this information is in people’s hands, they come up with solutions that work for them. So if, for instance, our readers don’t have money, our books help them figure out how to take care of their health using the resources available to them under the circumstances, and to prevent health problems before they become serious and costly.

One barrier to affordable health care is that there’s so much mysticism surrounding what doctors do. Yet the methods doctors use to diagnose and treat the most common and basic health problems are simple. In addition, the vast majority of medical information is available but not accessible. Typically, it is in dry, expensive textbooks full of elaborately constructed sentences; jargon confusing even to those studying medicine; and illustrations that depict illness rather than communicate ways for the viewer to visualize a concept or technique that will lead to its cure.

Another barrier is that many rich, first-world countries are run by governments supported by industries with a lot of money, such as the healthcare industry. And of course, if people could spend much less money on health care, they would. It’s not in the interests of governments to champion alternatives to the industries that supply their funding. Their argument -- that providing a single-payer program would be too expensive -- strikes those who are suffering right where it hurts: in their pocketbooks. The argument is illogical, yet it’s still somewhat effective because it weakens those who have the most potential to make change.

You have evolved a community-based, non-governmental approach to providing health and basic human services. Yet I am sure that you have interacted with governments in the nations where you work. Have you been able to collaborate easily with them? Are there any cases in which the relationship was strained or in which you faced opposition?

We are based in Berkeley, California, and we don’t provide health and human services – we produce materials to allow ordinary citizens to improve their health and organize for justice. We have an open copyright policy that encourages people to translate and adapt our books to suit their communities. Those who do adapt our materials negotiate with their own governments. We don’t normally work directly with other governments, though many large governmental health agencies use and distribute our materials.

Over the last two decades, the World Bank and International Monetary Fund have pushed many governments in the developing world to dismantle their social safety nets, including free health care. Have you ever encountered opposition or hindrances from the World Bank and IMF, or from First World governments, or from for-profit providers of Western medicine?

No, not that I know of.

What are some of your opinions about the present health-care reform debate in the United States?

Health care needs reforming, and as currently outlined in H.R. 676, with a single-payer system in which the government is the only health provider. In the United States, we could eliminate co-pays, deductibles, and employer contributions. At the same time, additional taxes would be added to individuals and employers (see the Healthcare-NOW website for a clear explanation of how H.R. 676 funding would work).

It is quite possible that the present recession will deepen, especially in the United States, while medical costs continue to escalate, and that there will be a sharp rise in the number of Americans without access to a doctor. If that happened, could individuals and communities in the U.S. implement the programs and approaches that the Hesperian Foundation has developed for the world's poorer countries? What would be the potential barriers and sources of opposition to such an approach?

Yes, absolutely, people in the United States could implement the approaches in our books, and some do already (people living on reservations, nurses, midwives, employees and volunteers at free clinics, travelers and sailors, professors of public health and environmental studies, ministers. . .). The only barrier is lack of knowledge and an unwillingness to change.

Is there anything you'd like to mention that I haven't covered?

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