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Illness is their common enemy

COLUMN ONE

When a Mississippi doctor looked for ways to help poor, rural patients, he says he found an ideal system to copy -- in Iran.

January 25, 2010|Bob Drogin

GREENWOOD, MISS. — Dr. Aaron Shirley has devoted his career to serving the rural poor in the Mississippi Delta, 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.

Never mind that America and Iran broke diplomatic relations after militants seized the U.S. Embassy in Tehran in 1979, or that the White House is seeking new United Nations sanctions to punish the regime for its nuclear development program.

In 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.

In October, four top Iranian doctors, including an official from Iran's Ministry of Health, visited Mississippi for a week. They spoke at a conference in Jackson, the state capital, and toured the Delta.

"Sometimes communication was not easy," Dr. Hossein Malekafzali, a professor in the School of Public Health at Tehran University, recalled in a phone interview. "But they can understand our system and translate it to Mississippi."

Iran and healthcare are politically toxic topics in Washington these days. But Shirley and a colleague are to go to Capitol Hill today to seek funding to open an Iranian-style "health house" in Baptist Town, an impoverished neighborhood on the edge of Greenwood, and in 14 other Delta communities.

"We played black gospel and blues for those Iranians," said 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."

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.

In Washington, the Treasury Department granted the Mississippians a license to ensure they were not violating sanctions on Iran. The National Institutes of Health also signaled its approval.

A posting on the NIH website notes that the "remarkable success of Iran's health house concept . . . is providing hope and inspiration to officials in the Mississippi Delta."

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Iran has 17,000 health houses, essentially rural medical outposts staffed by community health workers. The proposed Mississippi version calls for training nurses' aides in each community, and then sending them door to door to help with basic needs, such as taking blood pressure and improving sanitation. The health workers would refer patients to clinics or hospitals for more advanced care and follow up with home visits.

"The community health workers will know who has diabetes, who has high blood pressure, who is 10 or 12 years old and pregnant," Shirley said. "They will know it because they live in the neighborhood and see them at church or the corner store."

Over the years, the federal government has poured tens of millions of dollars into primary healthcare research and delivery programs in the Delta, but the effect has been limited.

"The system is broken," Shirley said in frustration. "It's time to try something new."

Mississippi ranks at or near the bottom of most healthcare indexes. Obesity is rife among children, and teenage pregnancies, hypertension and diabetes are all too common. The state suffers the nation's worst infant mortality rate -- about 50% higher than the national average -- and the lowest life expectancy.

The uninsured mostly go to hospital emergency rooms for basic care, from colds to toothaches. Better preventive care could ease that traffic and lower costs, so local hospital administrators are receptive to a new system.

"People will be skeptical at first because of Iran," said Paula Lang, chief nursing officer at the 34-bed Patients' Choice Medical Center of Humphreys County in Belzoni, which is slated to get a health house. "But I think they will embrace the concept when they see how it works."

Jennifer Tate Hibbler, payroll administrator at the Greenwood Leflore Hospital, the largest in the area, said health workers could help with problems such as identifying children about to quit school because their families couldn't afford glasses.

"I was a senior in high school before I saw a dentist," she said. "Our community definitely needs this."

Shirley's group is seeking $30 million in federal funds for a three-year pilot project and has lined up support from Rep. Bennie Thompson (D-Miss.), who represents the area. But Thompson said colleagues facing reelection could balk at backing anything tied to Iran.

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