Lessons of grassroots health care

Frank Hendricks (a false name for a real person) weighed 560 pounds. He suffered from congestive heart failure and uncontrolled diabetes. He was a smoker, drinker and cocaine user.     

He needed hands-on help, but in the poor rust-belt city of Camden, New Jersey (where factories are shuttered and industry has flown away to Asia) Hendricks received only hit-or-miss care, until he or someone else discovered that he was in serious trouble. Then ambulance crews rushed him to the hospital emergency ward. 

This happened several times. The American health system offers erratic Medicaid to poor people such as Hendricks. Medicaid alternately rescued Hendricks and turned him loose and neglected him.

Canada — where millions of people have no family doctor or friendly, knowledgeable helper to co-ordinate their care — could learn something from this American distress story and its halfway happy ending.

Dr. Atul Gawande, surgeon, health care analyst and Harvard professor of medicine, told the story in an article entitled “The Hot Spotters,” in the Jan. 24, 2011 issue of the New Yorker magazine.

Dr. Jeffrey Brenner, a creative number-crunching physician, learned that one per cent of patients in Camden racked up 30 per cent of the costs. Hendricks was part of the one per cent.

Brenner set out to help the troubled people. By joining into a team that comprised physician, nurse-practitioners, nurses and  social workers, and offering individually designed preventive and healing care to each targeted patient, Brenner and colleagues (on a lean budget financed by health foundations) brightened 300 lives and reduced health costs by millions of dollars.

Through enquiry, advice and care, they stirred Hendricks’ willpower and expanded his network of helping sources. He lost 220 pounds and now has disability insurance and a steady place of residence rather than welfare motels. He keeps his diabetes and heart ailment under control with reliable medical supervision and abstains from alcohol, tobacco and cocaine.

His visits to the emergency ward are shorter than they were.

Can Canadians apply the targeted care principle more widely? Can we train a sufficient number of health professionals — some of them working in salaried teams in new public clinics — to improve the superior public health care system, that we are so smug about, and thereby restrain its costs?

Can we reinvent health care and the failed strategies of war-on-drugs, skimpy, grudging welfare payments and lock-‘em-all-up justice? 

People whose inner slogan is “I’m all right, Jack, pull up the gangplank, I’m aboard” say we are already doing too much “nanny-state” care.

Pessimists say we can’t do widespread targeted care because we’re too lazy, busy trying to make money, too deeply submerged in hockey, football, movies, video games, tourist cruises, electronic interchange with pals and partners, or lulled to sleep by lobby-group blarney.

But it ain’t necessarily so. I am among the optimists.

We are learning to conserve people, in a way that roughly parallels the recycling of glass, metal and paper in blue boxes.     

The rise of deal-making workers like Brenner suggests that artful, calculated, hard-nosed human-conservation enterprises — rather than pretences of conservation — are becoming the accepted standard of social or technical behaviour.  

Victoria used to dump all the city’s garbage at sea. Unbelievable but true. We still trash and dump human beings.

My hunch is that increasing numbers of us — including simple neighbourly helpers and such power-for-me politicians as Prime Minister Stephen Harper — are getting a clear view of the change in the texture of human relations and the payoff from conservation — in cash, in happy-value and in votes.

Harper won’t repudiate the corporations that sponsor him, but he may recognize that good health brings financial blessings.

I believe teachers and curriculum designers can and will launch preventive-health courses from kindergarten to university. They know poverty and ignorance are major factors in illness and shorter lifespan.


—G.E. Mortimore is a Langford-based writer. Think About It runs every second week in the Gazette.

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