Tuesday, May 06, 2014

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.


Anonymous said...

Great work James. I’m looking forward to reading the book, although it’s unfortunate that I can’t get a paper copy. (Dmitry, if I slip you an extra $20, any chance…?). I’m also a Canadian family physician, I’m also writing a book about future healthcare “Post Peak Medicine” and although it’s unfinished, it’s available for free download from www.postpeakmedicine.com. The plan is that when it’s finished, it will still be available for free download and sharing as a gift to the medical community.

Right now I live a strange double life with a foot in two worlds. By day I’m a 100% conventional family physician who pushes pixels around a computer screen, complies with all the medical guidelines and does nothing unconventional which might attract attention. By night I research material for my book like how to produce opium for pain relief, distil ethanol for antiseptic use and deliver babies. Part of my income goes into conventional savings plans, part into photovoltaic panels, gardening tools and silver. I subscribe to a daily mainstream newspaper but I actually get my news from James Howard Kunstler, John Michael Greer and Chris Martenson. This is probably a familiar story to a lot of readers.

As well as the book, I’m compiling a directory of “peak aware” physicians, nurses and pharmacists, as we might at some stage want to collaborate with each other, or at least know who and where we are. If this sounds like you, please consider contacting me via the website.

Rob said...

No international shipping? Was looking forward to reading your latest work. Perhaps a kindle edition?

Autumn Crow said...

An interesting article and I'm looking forward to the book. However, while I generally agree that gender identity issues in a post-peak world need not be treated medically (for the resources to do so will likely be gone), they need to be treated socially.

Plenty of indigenous cultures handled gender identity issues elegantly by simply allowing people to express and be recognized as the gender identity they felt comfortable with. There's no reason not to other than random overculture nonsense about prescribed gender roles attached to irrelevant biological factors. Besides roles in childbirth, there are few hard and fast rules and it should be quite possible to come up with cultural constructs that handle this quite nicely, as plenty of sustainable communities have done so in the past.

Also, I might point out that characterizing gender identity mismatches as a boutique disease is rather unhelpful and likely to lead to poor results if applied in community. I'd be happy to discuss further with you the specifics of why that is.

Azazel said...

The book Dr. James wrote sounds very similar to the book written by David Werner Titled, Where There Is No Doctor. It's an amazing book written many years ago but still applicable today. The best part about Mr. Werner is, in his book he said the book can be freely copied and distributed and sold at no profit. He just wants his message to help people freely.

Wolfgang Brinck said...

I suspect a future with less modern medicine will be a healthier future. I am generally suspicious of the mis-use of life expectancy statistics since it says nothing about general health of the population. The assumption is that people live longer because they are healthier. I suspect that some of the improvement in life expectancy are due to keeping more people alive in a state of ill health.
The modern view is that until modern medicine came along, life was short and brutish and people died at age 45. But then I look at photos of Lakota Indians from the 1800's men all in their 80s without the benefit of modern medicine.
Another interesting statistic from a Mexican friend. Her people live into their 80's on the Mexican side of the border without ever having visited a doctor. Once they cross the border to live in America, they die in their 60s. I don't know the exact reason, but on the Mexican side they live a life with less stuff and stay busy until death doing manual chores like gardening and doing housework. In the US, they die of complications brought on by stress, a lack of physical exertion and overly rich diet.
Yes, I imagine that in a de-industrialized future people will once again die of a variety of infectious diseases, complications of childbirth and so on, but by and large we will still see people living into their eighties. The population at large will not all drop dead at the age of 45.
We might also recover a knowledge of herbal remedies and general preventive practices and in the absence of food by Monsanto, obesity will also go on decline.
And the ability to practice medicine will be based on talent and desire, not on a diploma.

Wolfgang Brinck said...

and two interesting anecdotes.
A friend who teaches family medicine at a university medical college was volunteering to supply routine medical treatment to the homeless. She did not last long. The reason was that she only wears sandals and the rules of the organization she volunteered with was that everyone had to wear close toed shoes. So conformity tops treatment of the needy.
second anecdote. I was sitting on the beach with some new friends and one of them said "let me look at your feet." I said, yes, toe fungus. The treatment was $900 and I didn't want to pay that much. He said, "you don't need that. I cured my toe fungus with a bleach solution." He also treats himself for other infections with bleach. And this is a guy who runs a university lab on infectious diseases and travels all over the world to set up medical labs in other countries.

Sam McKinley said...

One thing to keep in mind is that 90% (yes, literally) of the benefits available at the PUBLIC health level come from clean water and adequate sanitation.

Another thing is that childhood is where the big difference is made in life expectancy. Before modern medicine, if you made it to your fifth birthday you could expect to live almost as long as the average today. You can see how lots of people dying in the first few years of life would pull down the average.

I've always felt that almost all cases could be handled with pretty simple facilities and tools, by practitioners with pretty much a good apprenticeship and on the job experience. Today's training is pretty much just a barrier to entry, under the cover of training for those very few "miracle" cures of hyper-advanced medicine.

Anonymous said...

And that toe fungus treatment can damage your liver and take away your sense of taste.

Unknown said...

This is excellent. It reminds me of an old The Economist article (I'm no longer a subscriber...) describing the Singapore public healthcare system. Singapore rates in the world top countries in terms of population health. The public system covers emergency care and preventative medicine but nothing else. When people get sick, they use TCM (Traditional Chinese Medicine) out-of-pocket, which is cheap, even in the US ($30-$50 a consultation for a very good licensed TCM MD in San Francisco that we used for a number of years for example).

We are rarely sick, but we use TCM for everything except these 2 cases: serious injuries and serious bacterial infections, for which the Western system is a good choice. For example, my son broke an arm recently, and I don't know how to reset bones, yet. I had appendicitis a couple years back and chose antibiotics instead of surgery, much to the dismay of the surgeon who looked so anxious to get a nice income opportunity.

I'm looking forward to read the whole chapter!

neil said...

Of course we'll see people living into their eighties - the bible refers to the strong reaching four score. We just won't see as many of them.

Ien in the Kootenays said...

This chapter will make the whole book worth buying. Hurry up Kindle!