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Community Health

Dr. Ying Lowery: Making a Difference

Actually, there's a lot of stories I can remember but out of all of them, I remember the most was one girl who was two years old at that time, and I was in the field working. And it was a mom and a pop just came to me and they said "googee googee" —means "please, please, and help my daughter." When I took a look, this girl's eyes were virtually just fixing some place, definitely a very, very serious problem, and so I measured her temperature. It was very high and the heart was— really, I just could not really feel the pulse. So I tried everything I could at that time to try to save her life, and even, I tried to make some injections. She could not take it, so I had to use some sugar water and to feed her through a spoon, just make her to drink that, and apparently she was very ill. Then during the middle of the night, her parents were very tired. They went to sleep. I held this baby for the whole night and while I read the book to try to find out exactly what the problem was and constantly gave her water and gave some medicine. And the next morning this baby opened up her eyes and then she looked at me: I was just very, very moved. I just feel sort of, "Oh my gosh, I saved somebody's life."

Dr. Jack Geiger: Challenging Inequality

In Mississippi it was transparent. What was making people sick? Unemployment, hunger, malnutrition, dirty water, ramshackle shacks that were not fit for human habitation, low educational levels in segregated schools that didn't deserve the name of educational institutions, and we decided to go after all of those. So, in addition to providing primary medical care, we dug protected wells. We built sanitary privies [...] we did a lot of home visiting and public health nursing. It took us a good while to build an actual community health center.

And so finally, knowing that we really had to begin to deliver, we rented a church parsonage and the living room was our waiting room; couple of bedrooms were examining rooms; the kitchen was our lab.

The first thing we did was start an Office of Education at the Community Health Center, recognizing that this was a population that had been cut off from that kind of resource and set of contacts and knowledge and we began by teaching a high school equivalency course at night for the people who hadn't finished high school and wanted to, taught by the professional staff under the umbrella of a local black junior college to make it official.

One of the people who came to us to join the staff early on was a woman named L.C. Dorsey. L.C. Dorsey joined our staff in 1966 or thereabouts as a trainer of nurse aids; went on to become the Deputy Director of the Farm Coop that produced all of that food and vegetables for the thousand families; and then just skipped college and was admitted to the Graduate School of Social Work at the State University of New York at Stonybrook; and then, in the 1980s she came back to Mississippi and took my old job as Executive Director of the health center where she had started as a trainer of nurse aides so many years before.

The people now into the third generation, some of the patients that my colleagues and I saw in the 1960s, are grandparents of the children that we are now seeing at the Delta Health Center. It is the people who have all of those hundreds of people who have moved on to careers in the health profession or in other work. It is the community organizers, our staff trained, from the local population who went on to become city councilman, mayors, county commissioners and other political leaders in their communities once voting rights opened up and the Civil Rights Act took hold; but it was our training that gave them the skills that they could apply politically.

Dr. Aaron Shirley: Beyond Medicine

Anybody involved in health care needs to know that health care is not just about a diagnosis and a pill and a shot. Many of the conditions that—especially the most vulnerable and those most in need—many of their health conditions are secondary to their living environment. So, we can prescribe as much medicine as we like for a person with high blood pressure and we can give them an excellent diet for better control of the high blood pressure—and we let them go out the door and we don't have a clue what happens once they get back home. We don't know if they can afford the medicine. We don't know if they're having side effects from the medicine. We don't know if they are eating the fruit and vegetables that we are encouraging them to eat, and the only way we'll know that is if periodically we go sit out on the porch and talk to them or go to their churches and do a health fair in the community.

Action on AIDS

President Ronald Reagan: Taking Questions

Q: Mr. President, the Nation's best-known AIDS scientist says the time has come now to boost existing research into what he called a minor moonshot program to attack this AIDS epidemic that has struck fear into the Nation's health workers and even its schoolchildren. Would you support a massive government research program against AIDS like the one that President Nixon launched against cancer?

The President: I have been supporting it for more than 4 years now. It's been one of the top priorities with us, and over the last 4 years, and including what we have in the budget for '86, it will amount to over a half a billion dollars that we have provided for research on AIDS in addition to what I'm sure other medical groups are doing. And we have $100 million in the budget this year; it'll be 126 million next year. So, this is a top priority with us. Yes, there's no question about the seriousness of this and the need to find an answer.

Q: If I could follow up, sir. The scientist who talked about this, who does work for the Government, is in the National Cancer Institute. He was referring to your program and the increase that you proposed as being not nearly enough at this stage to go forward and really attack the problem.

The President: I think with our budgetary constraints and all, it seems to me that $126 million in a single year for research has got to be something of a vital contribution.

Q: Mr. President, returning to something that Mike [Mike Putzel, Associated Press] said, if you had younger children, would you send them to a school with a child who had AIDS?

The President: I'm glad I'm not faced with that problem today. And I can well understand the plight of the parents and how they feel about it. I also have compassion, as I think we all do, for the child that has this and doesn't know and can't have it explained to him why somehow he is now an outcast and can no longer associate with his playmates and schoolmates. On the other hand, I can understand the problem with the parents. It is true that some medical sources had said that this cannot be communicated in any way other than the ones we already know and which would not involve a child being in the school. And yet medicine has not come forth unequivocally and said, ''This we know for a fact, that it is safe.'' And until they do, I think we just have to do the best we can with this problem. I can understand both sides of it.

Victoria Cargill: Making a Difference

I would say for any young person that wants to do HIV/AIDS, do it. This is one of the most difficult, challenging and rewarding things I've ever done. I can't imagine doing anything else. I didn't start out to do this. I happened into it and it's a wonderful field. Why? Because you'll be challenged intellectually. Why? You'll be challenged personally. But most importantly why? Because you will be forced to grow in ways you absolutely cannot predict. But in the meantime, at the end of the day, if you're challenged and you respond by growing and reaching out to those who really need you, you can go to bed every night knowing that somewhere, someone's life is a little bit better because you went to the hoop. And I don't think there are many jobs you can say that about.

Gyawu Mahama: Fighting HIV/AIDS

When I came to school, I was looking for student organizations which were service oriented, things that I could learn from, and what was really appealing about the Student Global AIDS Campaign was that they're really really well informed and they make sure that all their students are really well informed, and they're also well connected—this overarching umbrella of AIDS can be really daunting to think about at times. Once I went to a couple of meetings and I was exposed to simple ways that countries can change a situation, or at least show that they are making a commitment towards fighting AIDS, the whole overarching idea becomes less daunting and it becomes very concise, and there are definite things that people can do to stop it. So for me, it seemed like something that I could do as an individual: putting efforts into it could make a really big difference.

Hanni Stoklosa: Getting Involved

The thing about activism and advocacy is that while you're engaged in it, it's sort of self-feeding. It inspires you to take that next step, to design that next program, to engage further in the work that you're already doing. So, for example, tomorrow I will go back to the clinic and work on my surgery rotation, but I know in the back of my head that I am also working with the AIDS Advocacy Network right now, and we are designing a program for World AIDS Day where medical students across the country are going to be able to make a difference in the fight against global AIDS. And maintaining those ties to advocacy in whatever you do is very very important. I just found myself rubbing shoulders with people from all levels of society. People in power, but then people that were pretty marginalized but really had this passion, who were able to be effective with their voices.

The Legacy of War

Dr. Bernard Lown: Disarming Nations

On the one hand when we started, the New York Times had a big editorial praising the doctors who are doing something intelligent and noble; but thereupon, there was another element in American media who started to say that we are Soviet dupes. We were stupid. We were being misled. We were idealists. We are romantic whistling in the dark. Don't you know what Russians are like? They will use and exploit you.

At this point, we have a press conference and it's crowded with about two hundred journalists and the questions we are being asked are so ignominious, so insulting and primarily not me they were attacking but Chazov. A journalist sitting to my left raises his hand; before I could recognize him, he stands up and he falls over. We didn't know whether he fainted or what happened, but Chazov and I were the closest to him so we came and immediately it was apparent to us this guy dropped dead. He had a cardiac arrest, and so we began to pump and give him cardio pulmonary resuscitation, Chazov and I.

Then the rescue squad comes, brings in the very defibrillator I developed, the very cardio, the very drugs... We give him a shock; it doesn't help. And we give him another shock and it doesn't work. At this point, the Norwegian says he's dead and they declare him dead but some of our people were very insistent and they kept on shocking him and he came out and he was hospitalized. All over the world this was shown and next day the Norwegian media became very kind to us. These doctors saved a human life.

So, it's inconceivable that we would say, I wouldn't treat this man because he's a Communist or a Capitalist. That sounds so ridiculous to the doctor mental frame.

And where we are now is both good and bad. It's good that we are not living on the brink of extinction. It is totally implausible that the Russians or the Americans will launch an attack against one another. It's implausible. It's not going to happen. That's the good news.

The bad news is that we have enough stockpiled to destroy the world many times over and the terrible mistake we have made as a country, which the penalty to future generations is awesome, is that we did not make a serious attempt, which we could have, to eliminate nuclear weapons.

You know how much we have spent since World War II on military? More than $15 trillion. With that, we could have had health insurance for every American. We could have had a college education for every American. We could have had every American own a home. We could have had every American have the best of healthcare imaginable.

Are we more secure? No, we are not more secure because we are caught up in a mad world to buy security through militarism rather to buy security by solving global problems.

And in my mind, security's achieved when you have a people that are educated and healthy. If that is good for us, it's also good for the rest of the world. 

Preventing Disease

Dr. D. A. Henderson: Eradicating Smallpox

Many people don't realize really how few people, international staff, or how little money was really put into this from the WHO budget, for example. And working worldwide and with not very good communications in those days, it was a tremendous job. But what we had attracted to this was a group of people who were really dedicated, really imaginative, and I was always struck in going to the field that these people worked day and night. They were at great risk of their lives at times. They would be away from home months at a time and the sacrifices were tremendous, but it was a band of people who believed in what they were doing. They all did and would sacrifice for it. And this was all nationalities that were involved here. So we had the Russians, we had Czechs, we had Norwegians, we had Brazilians all working together and it was a very interesting international group. It was an exciting experience.

Melinda Moree: My Motivation

There's always an interesting question of who should be responsible for trying to help meet the health care needs of poor countries and, you know, it's an interesting question. I'll be honest, I don't spend a lot of time thinking about who should do it. I just try and find the willing parties and run with that as fast and as far as we can. I do think that the governments of rich countries have a responsibility, even if it's in their own self-interest, to be able to help poor countries and to bring them, you know, out of poverty and into economic development. I think we have a moral obligation with the inequity that's out there to try and at least, not make everything equitable but just make sure that, you know, some people, their every day is not thinking about survival but it's actually thinking about, you know, living and maybe even thriving, and I think we're all responsible for that.

Health as a Bridge for Peace

Conflict in El Salvador, Nicaragua, and Guatemala in the 1980s caused thousands of injuries and deaths. The fighting also undermined health care services across Central America.

In 1983, governments in the region began working with PAHO—the Pan American Health Organization, and the United Nations Children's Fund, to address the crisis. Dr. Carlyle Guerra de Macedo, the director of PAHO, named their plan "Health as a Bridge for Peace." Their goal was to create solidarity between nations by sharing resources for health.

In the first phase of the program clinics and hospitals were rebuilt, new health care workers were trained, and essential medicines and food were distributed. Projects were also begun to control malaria and dengue fever, and improve the supply of clean water

In war-torn areas, more children were dying from preventable illnesses than injuries caused by the conflict. Global health experts at the Pan American Health Organization debated the best way to solve the problem. Dr. Ciro de Quadros, Director of the Division of Vaccines and Immunization, suggested they focus on one disease: polio. On May 14, 1985 PAHO launched a program to eradicate polio from the Americas by the end of 1990. Mass education campaigns took place in countries across the region to publicize "immunization days" and to build support and participation.

In El Salvador, after more than six months of negotiations, the President and opposition forces agreed to a temporary ceasefire to allow for immunizations. 20,000 people, including health workers, volunteers, and guerrilla forces gave vaccinations to the country's children.

All of these activities improved relationships between the Central American nations and contributed to the peace process. As conflicts ended, soldiers, including many children, were offered health care and the necessities to begin a new life.

In the second phase of "Health as a Bridge for Peace," the recovery and expansion of health care services improved medical treatment. As well as polio, neonatal tetanus and measles were also eliminated from the Americas.

Rebuilding societies that had been burdened by conflict, and providing health services to all, improved daily life and helped to foster long term peace. In 1998, the World Health Organization adopted Health as a Bridge for Peace as part of its own work around the globe.