Resilient Health Care

When I asked people to contribute content to the book on Communities that Abide, which is now nearing publication (with two chapters already at the proofreading stage), I didn't know quite to expect. The results went far beyond my expectations. This week I will highlight the chapter by James Truong, MD, who practices emergency and family medicine in rural Canada. His chapter, “Appropriate Health Care for a World In Flux: A Strategy,” is a must-read for anyone thinking about founding or joining a resilient community. It is an in-depth guide to health care in a world where the Health Care System that currently exists in the developed nations of the world is inaccessible, unaffordable, or nonexistent. His subtitle reads: “Monday: feed the family. Tuesday: don't get sick.” But what if you do? Dr. Truong explains the options.

Dr. Truong carefully teases apart the overwhelmingly complex subject of “health care” into elements that anyone can, and should, understand. First, he teaches us to think about health conditions, by putting them into categories: each condition is either acute or chronic, and either benign or dangerous. Each combination of these requires a different approach: acute-benign better get treated at home, acute-dangerous may require expert intervention from the community's designated health care provider(s) (whoever they may be), but with no guarantee of a positive outcome. Chronic-benign conditions (lifestyle diseases, boutique diseases such as cosmetics or gender identity) are, in this context, not handled as medical issues at all. Chronic-dangerous conditions (obesity, heart disease, hypertension, diabetes) will, to make a long story short, result in shorter lives.

Next, Dr. Truong focuses on the three aspects of medical preparedness at the community level: Toolset, Skillset and Mindset. In explaining the Toolset, he lists the different categories of drugs and supplies, and describes a general strategy for deciding what to stock. Under Skillset, he describes which skills can and should be practiced at the community level (dressings and stitches), which require expert intervention, and which need not exist at all (surprise: CPR isn't on any of the lists). But the most important section is on Mindset. Here all the mental clutter caused by two or three generations of medical “miracles” is cleared away, and replaced with an appreciation for the value of good health and an unsentimental understanding of one's mortality:

“It is sometimes said that past a certain point when you’re climbing Mount Everest, your body is busy dying and the race is just to get to the top and get back down before it finishes the job. There can come a point of literal no-return, where, if the weather changes, or equipment fails, or you can’t descend fast enough, a return to base camp becomes impossible. Yet summit attempts continued despite a tacit understanding that some people are never coming back. I’m not suggesting that climbing tall mountains is appropriate for everyone, but in a sense we all do it anyway, and the mindset when thinking about our own health should be analogous. There’s no point in worrying about the fact that we can’t walk backwards in time, as a society or individually. It's enough to keep gazing ahead while choosing our footsteps with care, all the while recognizing that we’re climbing the only mountain we’ll ever climb, and that the air is getting thinner.”

In the end, Dr. Truong reminds us, your health care begins with you and ends with your friends:

“Take care of yourself first. This is known as the “airline oxygen mask doctrine”: In case of cabin depressurization, put your own mask on first, then help those beside you. This seems counterintuitive to prospective lay healers, but it holds true. If everyone adopted this policy, we would all be more self-reliant and resilient and more able to pass on a surplus of caring.”

“We need to get away from some of the taboos and hangups of our current medical model. One of them is the prohibition against treating people you know socially, friends and family. In a small town like mine, this is already difficult. In an even smaller community, it would be impossible. I would propose that it is undesirable in the first place. Some of the proudest care I’ve ever given, I’ve given to people close to me.”

“I would remind people to cherish community and the help of others, as they are the cornerstone of a resilient health care system. Other people are the best, most effective tool in your first aid kit. In Emergency Medicine terms, everyone knows (I hope) that the proper response to profuse bleeding is constant, direct pressure. You may know that but if you are alone it’s just that sometimes, you just… can’t… reach. I’ve sutured myself up twice (once without anaesthetic)—both times out of necessity. I’m an excellent surgeon normally. But both times, the result was suboptimal and I would have done better with the help of my seven-year-old daughter.”

Please pre-order your copy of the book by clicking the “Buy Now” button on the right. Just one printing is planned, based on demand, and so this is the only way you can be sure of getting a copy. This is not a book that you will read just once. I promise you: if you are serious about community, it will stay on your bookshelf forever.