The Age of Information

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Will Durant became widely known for his early books, especially The Story of Philosophy.*  My copy is from 1933, the 15th printing. A yelloeing newspaper clipping is inside; it is an interview with the Durants in 1963 by Jim Bishop, and  includes a brief account of their 1913 marriage: Ariel  was 15 years old; Will, her tutor, was 25; yet they obtained approval to marry. She rollerskated to the courthouse; a ring she wore ever after was donated by an attendant; the marriage lasted 68 years until their deaths two weeks apart. Ariel was a collaborator in all of the Durant’s subsequent books, and co-authored the later ones; their commitment and devotion is palpable in the dedication of  Story of Philosoply which reads:

To My Wife

Grow strong, my comrade… that you may stand

Unshaken when I fall; that I may know

the shattered fragments of my song will come

at last to finer melody in you;

that I may tell my heart that you begin

where passing I leave off, and fathom more.

The same features of Durant’s book that made it popular were offensive to many formal historians: it is clearly written, and contains opinion, commentary, and humor. In other words, it was written to be read. understood, and enjoyed. As I open up my old copy again, the preface pages seem relevant to us in the 21st century; “Science teaches us how to heal and how to kill; it reduces the death rate retail, then kills us wholesale in war.” .They argue that only wisdom, as revealed through  “desire coordinated in the light of experience, ( philosophy)   can tell us when to heal and when to kill.” I will suggest that the world-wide chaos all around us in this new century is only another chapter in  an imagined Story of Creation: There is no author other than humanity:

Book One, The Age of Agriculture is unfinished. It begins with the creation of farming and husbandry, which promote stable communities at the expense of hunter-gathering. Stable communities lead to social order, and in time, to science, art, land ownership, geometry, mathematics, commerce, architecture, rule of law. The chapter now being written in an increasingly urban 21st century is titled,   Malthus, Speak.

Book Two, The age of Information,  is also unfinished. Its dominant theme is that to create easy access to information can lead to chaos, which in turn, creates change in human behavior. How ironic and circular it is that humankind creates that which creates change in humanity!  The chapter on the Biblical Genesis suggests that too much knowledge– information– is too much power; and power is something humans do not manage well.  When the forbidden fruit of the Tree of Knowledge is eaten, God becomes enraged and expels Adam and Eve from Eden. Now  we billions of tiny fleshy gods suffer from knowledge: Infomania, or infodynia.

The chapter on the creation of the Printing Press was about  the time when printed information became available to the entire world, information  formerly accessible only to Church, Wealth and Monarchy (one and the same). The result is a still evolving revolution in various degrees, and weakening of the three-in-one powers. Only Wealth seems still healthy; yet for how long? Perhaps we shall see. Many grotesquely wealthy people are divesting through charity already, aware that their life is finite, and wealth is anathematic when hundreds of millions of people, whose voices, unheard light years distant, are now loud and clear on Social Media.

The chapter on information  is still being written but, Ready or not, Social Media is here now, vital and alive, making books, magazines, and TV Old Media;  still of interest but mainly in retrospect.  We might have noticed the change when Talk Radio heralded new media, but was  less interactive. Social Media, in countries where not suppressed, is egalitarian,  and remains in the hands of the limitless number of individuals whose collective voice is very loud even though each one by itself is– pipsqueak–  unless it goes ‘viral’. That Info-genie, is out of the bottle; it’s body is made up of various aspects of the internet, browsers, email, skype etc.;   social media is its mind and voice,  where live information is instantly available to almost anyone, anywhere. Any image, any idea,  can spread in minutes around the globe.  Any single voice can be heard. Meanwhile traditional top down sources of information shrivel , snivel, and fail: newspapers shrink to the size of circulars, sirviving  on snippets of local news, and remunerative misleading medical or  cure-all ads. Information offered on TV remains stale, dull, repetitive, and uniform; talking heads  are entertainers on the order of professional wrestlers or football players, but less entertaining; some are serial sexual predators, violent scofflaws and drug users, yet they  foppishly foist political views on viewers who turn to free media, social media.  However we  face a  tsunami of information which creates chaos, both internal and societal. We are unable to evaluate, filter and sort it all. And until we are able to live wisely, and adapt, or create new ways of dealing with all this information, we are likely to remain factionalized, frustrated, fragile, and furious.

The Durant position is that people gnerally  lack wisdom, which they see as the realm of philosophy. They decry epistemology, as an analytic approach or scientification of philosophy. The introductory paragraph  in The Story of Philosophy, titled To the Reader suggests that:

‘epistemology has kidnapped modern philosophy’.

‘the knowledge-process … (is) the business of science,

‘philosophy (is) interpretation of … experience rather than (its) analytic description’

‘Analysis belongs to science, and gives us knowledge, while

‘philosophy must provide a synthesis… wisdom.’

The four and a half page extended  introduction expands on these assertions.  “… to seize the value and perspective of passing things, and …pull ourselves up out of the maelstrom of daily circumstance we need to know that …Science is analytical description, ( while) philosophy is synthetic interpretation. The philosopher ‘tries to put together that great universe-watch that science has taken apart”.  The Durants claim that if we break philosophy down like scientists, into– logic: ideal method in thought; esthetics: ideal form; ethics: ideal conduct; Politics: ideal organization; and Metaphysics: ultimate reality, “ it becomes dismembered, loses its beauty and joy. That is found by studying philosophers. We have had the same experiences they had but we did not suck those experiences dry of their secret and subtle meanings. So let us listen, ready to forgive errors, and eager to learn.” So maybe this is a good time to hear the philosophers speak to us through a book that is clear, short, enjoyable, and perhaps can make us a bit more wise.

*The Story of Philosophy, 412 pp, focuses on the West, and excludes Asia. But the first volume of their 12 volume History of Civilization is devoted to Eastern Philosophy and History. Caution: 1150 pp. Both are free PDF on-line. But not without cost: that of mostly shutting down Critter, Glitter, Fritter, and to some extent, email, Siri and Browser. Enjoy!

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ACROSPEAK

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I have long treasured an original issue of The Mother Tongue by Lancelot Hogben. Lancelot, a Brit? Curiously, the author’s name is metaphoric for miscegenation, as is Bernardo O’Higgens, the revolutionary founder of Chile. In rather didactic fashion, Hogben makes the case for English as the most universally useful world language today.

 

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You know what that Acrospeak is; you too have suffered from it. Acrospeak is used by experts to inform those desiring to become informed;in Powerpoint slides and lectures to symposia attendees. Incredibly, Acrospeak, which is usually familiar to those already schooled in a subject,  confounds the uninformed who are hoping to learn. Is that stupid? Or What! While seekers of new knowledge puzzle over strings of CAPS which could represent– anything– the meaning is nowhere defined in hand-outs or powerpoint slides. As would be learners consider possibilities of obscure letters, the lecturer’s string of meaning becomes tangled.

Acrospeak could very easily be called acrodynia, acrolalia, acrothymia, acrodystrophy ; or any number of such invented but fairly understandable terms; terms we immediately recognize because they contain clues that come to us on the Indo-European language stream that flows through Sanscrit, Greek, Arabic, and Latinized European or Cyrilic languages. They are clues we don’t need to study, because they are embedded in our common languages, and especially in scientific language.

English, in particular, is a beautifully polyglot language. It is not only the most used language of science and business today, but one with roots in many other languages. Those of the Celts, Romans, Saxons, and Norman French conquerors were grafted onto English as it evolved over centuries. The result is modern English. On the one hand English spelling seems bizzare because it reflects the languages of all those who ruled the islands for centuries at a time; and the language of the conquerors themselves,  whose language also had been inseminated by other conquerors. Therefore anyone who learns to read and spell English well has completed an introductory course to an array of Indo-Europan languages; most prominntly are those of Europe, but also those of the Mideast, and West Asia. What, for example does Hamas suggest? Never, as in Spanish jamas, planted there over centuries by Arabic Moors. Cognates for the word mother are recognizable from Sanskrit on, and similar language strings are common.

I once was ship physician on a research vessel to the Antarctic Peninsula. It was an abandoned former USSR icebreaker refitted  in Finland. There were 17 scientists, not one from the same country, many from different continents. We all had to communicate in English

So here is my question to knowledgable and earnest people standing in front of colleagues who come to listen and learn: Why abandon centuries of language, and revert to CCP? Well, then, Clueless Cap Puzzles. And my plea: Do not abandon millenia of shared meaning that we all are at least  vaguely  familiar with. Do not tear out the common threads of language in favor of CCP. It may save space on slides, or breath for the lecturer. But that’s a poor tradeoff if the intent is to inform. And if you do abandon those clues of language, and revert to CCP, at least provide something on every slide to clarify, the acronyms,  or a ledger that can do so.

I made a careless comment long ago to my brother-in-law, a proper Massachusetts elitist, by declaring it is a waste of time to study dead languages like Latin; or, ( more offensive,) French. It was an attempt to wake him up for a moment; it did but he was as Outraged as if I spit on his mother. Now, considering the power of language that comes to us down to us through the millenia I realize he had a valid point. He is long gone from this life; but perhaps he can hear this somewhere above or below. “In the face of CCP, I apologize for that crude remark.”

Some acronyms are so common they are almost universally understood: like ASAP or USA;  or those a first grader learns on the street or from media– like this one which can also serve as a comment on Acrospeak: WTF! What’s That For? Well, No.

My Mentor, Minnesota Med School Class of 1954-5

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I don’t know why I was admitted to the U Minnesota Medical School one month after turning 19, without a particularly impressive undergraduate record. In large part I attribute it to my friend who mentored me in High School and Pre Med. He is the friend I have known and loved longest; all my prior friendships had been fleeting; that is a downside of being raised in mining towns all over the world, which has distinct and unique advantages, but long-lasting childhood friendships don’t happen. We met in High School when we both were moved to Minneapolis in a Minnesota cold mid sophomore January 1946; despite time distance, and different roads travelled, we have been close friends ever since.

During pre med years it was his suggestion to take engineering physics and chemistry rather than pre med classes, because Med School acceptance was unlikely; there were many highly qualified applicants, among them those with real life experience, like marriage, work, or serving in WWII; they were far more mature by any measure, than we. Yet we both were accepted in the Fall of 1951. The U of M Medical School apparently saw something in us. He was a better scholar than I, but they also saw something in me that I did not. From my point of view it was a great leap of faith on their part.

However, I was only a child who didn’t know who or what and where he was. My needs, as I saw them, were social, and economic rather than intellectual. I had to pay my own way, by working part-time, and migrating to California in Summers to do farm work. I was able to work for room and board at a Fraternity; in those days that was possible. My brothers often carried me. I was welcomed, and participated socially, fully enjoying those relationships while trying to appear grownup; but all that was at the cost of academic excellence. I graduated near the bottom of my class while my friend and mentor was near the top. Looking back, I regret not being a devoted and excellent student, but did what was most urgent for me to do.

While my mentor is well-known in Minnesota medical politics and in business circles, a permanent and significant part of the community, I am a generalist and soloist in every sense of the words.That is as true in medicine as in my life itself.  My MD degree has been a passport to places, people, languages, and human experience what is sometimes called the private practice of public health. My CV seems more remarkable for its breadth, rather than its depth. After 60 years of medical practice we both, my friend and I, remain active in retirement; he in business and medical politics, while I consult, mentor, volunteer, read, write, and blog. In mid 9th decade we are in fairly good health, and may need to continue for a few years more.

I have few regrets. I doubt my mentor does either. And yet I would have liked to also have had an adult physician mentor during med school. I had no ongoing personal interchange with any particular faculty; academic medicine is a demanding master– or mistress, to be more politically proper. I believe it would be ideal if all med students had a physician mentor, someone they talk or meet with regularly to discuss the life of physicians and students; perhaps a mentor who is a blood and guts doc in private practice, whether group or solo, with a volunteer clinical appointment under the aegis of a Medical School. 1 I my case, however, my mentor is still with me. Our lives as physicians have been quite different, reflecting our natures; and yet we have traveled separate roads, and the same road, together. In the words of Robert Frost, ‘that has made all the difference.’

1 As an aside, physicians are not the only people in medicine; medical people are increasingly interdependent. I find that undergrad students who are interested some aspect of medicine benefit greatly from an association with the School of Medicine in general, and with physicians in particular. As a preceptor for student free Saturday morning clinics, I find pre med and other medical undergrad students are the muscle, heart, soul, and guts of the clinics, which are not easy to fund, organize, and operate; such clinics simply would not happen without enthusiastic active undergrad students. No one else has the time, motivation, and enough fire in the belly.

A History and Memoir of Salud

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This is a history and memoir about the Salud Concept of communty medical clinics, and its impact on the the Salud Clinic in Broderick California,  which opened on May 21, 1971, and still operates on its 46th anniversary in May 2017. Details and time line are taken from public documents, board minutes, and personal records. I dedicate this history to the Board of Directors; to the community that gave rise to the clinic; to the Broderick Christian Center which encouraged and nourished the seminal ideas of the Salud Model, and the building of the of the clinic itself; to the entire staff, but in particular to Salud Community Health Workers and Family Nurse Practioners.

In October 1968 Central Broderick was an older unincorporated town like West Sacramento, the adjacent relatively prosperous port and residential community of West Sacramento,  and Bryte, the smallest town, home to many East European immigrants, notably those from Russia and the Ukraine. Collectively the towns were known as West Sacramento or East Yolo. Older streets are still lined with one and three quarter story buildings, like those seen in central Sacramento; the lower level rises only seven feet above ground. They had been built that way in expectation of frequent flooding common many years before.  As flood control became more effective these low-ceiling spaces began to be used for living or storage.1

With the completion of the cross country Lincoln Highway in 1916, travel boomed.  The auto court was the way people settled for the night. Many large tree shaded lots were later converted into trailer parks, and in Broderick, some were filled with clusters of ten by ten wooden shanties, without indoor plumbing,  rented to single men. Despite attempts to condemn them, these shanties, sometimes owned by politically powerful people,  survived until incorporation of the city in 1988 2.

East Yolo was a short distance in miles, but over  50 years distant in time, from Yolo County administrative centers in Woodland, where county services and low cost medical care were  available at the Yolo General Hospital. Across the Sacramento River were the State Capitol, and the the Sacramento County Hospital, but medical care was not readily available there to uninsured Yolo county residents. There were two  West Sacramento  pysicians in private practice. Many people survived in an economic and political backwater even though Yolo County maintained a Dept of  Public Health office and a sheriff’s substation in Broderick.  There seems to have been a self effacing humility; the I Street Bridge is still named  for a Sacramento alphabet street,   and the area of West Sacramento,  sounds like an appendige to a cross river county.

I arrived in 1959,  and was the only Spanish speaking physician in the county until  eight years later our office took on a bright new partner, Brooks Smith.   We become the first physicians for the Family Nurse Practitioner  ( FNP) program at U C Davis; we hope that FNPs will work in small clinics and towns under the supervision of a licensed physician who need not be physically always on site.  The Salud Model concept develops after Herbert Bauer, former Yolo County Director of Public Health gives me a long list of places where migrant workers live seasonally.3  That leads to a series of small free night clinics for migrant workers in rural Yolo County. The first is at Madison; it’s still there on highway 16 just before getting to Esparto, hardly noticeable to people en route to Casche Creek Casino.

A pre-medical student Paul Hom, will would later become the Director of Public Health for Sacramento County, is also a lawyer. He creates  a non profit corporation, The Salud Health Foundation, in order to help build and operate the several migrant farm worker clinics. These have the support of many  local volunteer physicians. That name, Salud,  is  familiar to Spanish speakers because it means ‘health’ as well as ‘Drink up!” Some non Spanish speakers in Broderick, later rhyme it with ‘mud’, which rather nicely describes the drinking water in Broderick at that time… so bracksh that some people bring their own when working to build the clinic  there. 4

The Foundation first helps the ” U C Davis Amigos”, a group of students, to build a clinic building at the Madison camp. Later, people from Chico, Woodland, and small rural Yolo County towns, like Yolo and Esparto, request assistance to develop clinics. I  am able to explain the Salud Concept of community clinics, and the process; but projects require more than ideas. or words. They require commitment, and action; I can advise, but not commit or act on them all.

In a short time there are two  more bare bulb Migrant Health Worker weekly evening clinics; my favorite is at a large operation on the El Macero Ranch, south  of El Macero. A two story building holds a large bunk house for up to 100 men upstairs; below is a big dining room and kitchen. There are family units adjacent.  Meals are delicious, ample,  and authentic. After clinics I always chow down and schmooze with the cook.

Men who immigrate for farm work one way or another, are gererally economic  pioneers, admirable adventurers, like those of the Gold Rush… at least as I see them.  They are generally healthy enough to invade illegally, work, live on  very little, and send money home. When I was young I interpreted for them during the WWII Bracero program;  much later, often live with them during  my own summertime migration from Minnesota to work in the N Calif almond industry.  In time that  pays for my college. We are thereore generically, and animically, brothers,  even though I work for myself,  while they do mostly for relatives. Many stay on indefintely, some spending a lifetime alone and estranged from the family they support.

A friend in Woodland was an elderly peg  legged cook at a small restaurant where I often ate lunch. He had lost a leg in a  Texas farm accident at age 18. One day he told me his daughter, a judge in Leon, Mexico,   was flying in to the local airport; could I take him to meet her? Of course; we picked her up from her private plane and went to lunch.  But the enconter was quite ugly, confronttional and difficult. She made clear he was an uneducated old man; and worse,  a victim of the abusive capitalist Yanquis who stole half of Mexico, and abused and oppressed Mexicans.  He made clear that whatever she had achieved resulted from his work here, which he was grateful, for and proud of. He loved the this ncountry and the people.  End of visit. I took her back to her plane, and him to his work. Such personal stories  are not rare.

Of course there were also women and children in migrant worker camps,  in  families who move with the crops, mainly people who live in other  parts of  the US. The children in particular often had health problems: anemia; parasitosis; malnutrition related to diet where the hallmark is a mouthful of stubby decayed yellow teeth; silent tuberculosis; inadequate immunization for childhood diseases; chronic otitis. The beauty of those conditions is that all are easily diagnosed and treated. The Yolo County Health Department and the County Hospital were very helpful. 5

In a few years the UC Davis School of Medicine appears on the Davis campus. The migrant clinics are interesting and appealing, with superb medical and community support; they address the needs of farm workers, an important ethnic community. Very alertly, the school of medicine asks for help to  submit a several million dollar  Federal Grant application and it is  approved, with UCD administrative  responsibility for the project. Unfortunately two complications quickly impact the project:

First, by the time the University obtains control,   technology has already changed Yolo County agriculture amazingly rapidly and radically. Seasonal migrant workers have  been replaced by chemicals and machines; they are no longer needed, at least not here. Second, the medical school mismanages the program, perhaps because their main challenge, and burden, is to build a new school from scratch, rather than provide migrant care. They lose the grant.

However the project is large, and significant from a human and political standpoint. There is a need for  basic rural health care in small towns, the  same situation that Salud  conceptt addresses; and there is a desire to support Spanish speakers in education and in health. So the migrant project is salvaged, becoming Regional Rural Health, RRH,  generally along the lines of the Salud Model with the addition of  bilingual education, a popular idea of the time.  RRH, managed by a Spanish speaking Board of Directors,  would establish bilingual rural primary schools and offer health care to local people of all sorts.  Salud Clinic, meanwhile, proceeded at Broderick with the strong support of the Christian Center and the Broderick-Bryte Neighborhood Council.

Paul Gutierrez and John Siden introduce me to Broderick. Paul was disillusioned with the politics of the Economic Opportunity Council; although he told me nothing of the details, apparently the feeling was mutual. He wanted to open a food service for the poorer residents in the area and call it Paul’s Kitchen, and to organize the community to develop a health care facility. He and Jess Perez had gathered some 4000 signatures in support of a clinic. John was director of the Broderick Christian Center, and expressed similar hopes regarding health care. The Center hosted a series of meetings where  the focus was a health facility. It remained the planning, meeting, and eating place while the clinic was built. Without that support the clinic would not have been built. I was invited to discuss the Salud concept with emphasis on local control, and  ownership, by a Board of Directors. The council decided to adopt a comprehensive plan for the Salud East Yolo Medical Facility.

October 6, 1970 Council Meeting: The Salud East Yolo Board forms, and draws up  organizational papers. East Yolo lawyer William Dedman acts as consultant to the board.  They continue to meet regularly at the Christian Center. Emilio Lopez,  (Human Rights Commission) is elected president of the Board of Directors. Pete Villarreal takes the job of fund raising. Carlos Salinas ( Washington Unified School District) chairs the Building Committee;  John Pagett is  sub chair for Carpentry, with French Francis.  Ray Gutierrez, (Bryte Council) electrical, and grounds.  Lillian Newton PHN, Publicity Chair; Janette Vaughn, East Yolo Youth Council; and Carlene Sharples, Welfare Worker, Legal Chair. For many years Lillian has been tireless in promoting dental health for E Yolo children.

November 22, 1970 Escrow closes on  the building in Broderick. It is condemned and the lower floor reeks  of rat offal, but it has some unique assets besides rats: 1)  it comes with a second lot to the East that could be a community garden. 2)   the main structure is solid; 3) there is a wedge of vacant land in front of the building that could be used for off street  parking, and might be acquired from the State, as it has no other useful purpose. 3) a complete  second floor apartment is in good condition.

The condemned house is brazenly named the Salud East Yolo Medical Facility, with plans to open in 1971. Mike Kolar, UCD student who had been a driving force in the building of the Madison Migrant Camp addtion, had graduated and is hired part time as part of his conscientious objector deferral from the military draft. The Salud Health Foundation assists in raising funds, with much community support. They have many pages of donors mainly in amounts less than $20.00.

November 28, 1970  There is a sudden flurry of interest from  Yolo County. Captaine Thompson [County Director of Mental Health Services, whose spouse becames a County Supervisor] organizes  a meeting of dignitaries with the Salud Board. It does not go well; I note some quotes from my personal  record:

Dan Kelly, Administrator, Woodland Memorial Hospital (read Woodland Clinic)

“You are naïve.”

Glenn Snodgrass: UCD Medical School:

” UCD Med School is fully committed and unable to help.”

Emilio Lopez: Board President Salud E Yolo Medical Clinic

“The trouble with outsiders is you go home to your cushy life and remain ignorant of our local reality.”

French Francis: Salud Board Member and favorite professional curmudgeon:

“We don’t need any help. Or want it.”

January 4, 1971 Every weekend volunteers work at the building. We have lunch at the Broderick Christian Center. Adolph (Tiny) DiGiulio is a 300 lb genius who organizes the meals. Rumor has it that he solicits food like day old bread and slightly outdated vegetables and meat from known but safe sources. Whatever the truth, the three course meals with beverage are simple, tasty and ample; they usually cost Salud about $20 for 20 people, including but not limited to:

Alex Creighton,

Lloyd Newhall,

Emilio Lopez

Felix Mejia

Jessie and Alberto Rodriguez

Fred, and Robert Loofbourow

Carlos Salinas

French Francis

John Pina, and

Chuck OHara and others from Johnny’s Time Out Bar

Members of the Jay Cees

It is awkward for me to list these names, because I’m certain there are many missing. For example, I recall Steve, a UCD student, but can’t remember his last name. I apologize to those volunteers, with only the excuse it’s more than 45 years since I saw you last. Mike Kolar, worked with many local people during the week to meet the complicated code requirements of a commercial building including lab, and lead shielded X-ray.  The Second floor is used  for meetings and training of clinic staff.

We always are short of funds of course. Arguably,  that shortage is a cost of freedom or independence. There are many inventive activities that we, and I, are involved in over the next two years; some are contracts for services, others things that the board accomplishes; anything that allows us to complete the building, and later  will support operations. These include:

A contract with Yolo County Compensatory Education to do 200 child exams.

Auctions conducted by the Board

Consultation with EOC to organize, train and supervise staff for Senior Citizen Screening Clinics, coordinated by EOC director David Pollard in Auburn, Forest Hill, and environs.

Contract with the Sacramento Concilio New Careers Project providing Health Workers with the option to go to Sacramento Community College with half time support.

Consultation and testimony regarding pesticide legislation ( Petris SB432)

Family Planning clinics in Yolo county and at Salud.

On the recommendation of Dr. Helen Kleviscus, a volunteer in the Yolo County Migrant Clinics, we apply for, and the Board of Directors agrees to participate in, a drug trial for Abbot Labs. This would  now be called a phase III investigation, and while it is not so well compensated as similar trials today it is very helpful, providing volunteer subjects with a physical and lab workup. Many have never had that experience before.

Broderick was ground zero for the diabetogenic and atherogenic diet, the alcohol stricken family and individual, the tobacco toxic lung, kidney, and heart. The environment was often dismal, or harmful; like the water previously noted; I felt that the soul, the ethic, and the driving force of a community clinic lives only within the community itself. The physical manifestation of that soul can be reflected in a  Board of Directors, and  by their operation of the clinic, involving people in the community. 

Therefore I write a grant proposal   for A Community Health Worker ( CHW) Training Program for submission to the Yolo County American Cancer Society, where I had previously served on the board. The grant application is predicated on the idea that the development of cancer is generally a many year  process– like many other chronic health problems– greatly affected by life style and environmental conditions.

There is a time-honored principle of  Public health: No law, or fine, or regulation is very effective in changing harmful personal behavior; what is effective is when people  conclude themselves  that a  beneficial behavior is in their interest. The corollary is that nothing can be so effective to improve health  as involving people who are a part of the community itself.  Emilio Lopez and I present  the proposal to train CHWs, and it is approved. We are forever admiring and  thankful for the Cancer Society sprit, and intelligent foresight;   oterwise I don’t think the CHW project would ever have been completed.

We would train local people to  both work in the clinic  and learn about the main factors affecting health in the community.7 Community Health Workers,  and later, FNPs become the most effective and unique  feature of the Clinic.

May 21, 1971 Opening of Salud Clinc with participation in the ‘Rub out Rubella Campaign.

Herbert Sabin, volunteers as clinic nurse. He is a dedicated worker, always There, decisive, authoritative, dressed in his white uniform. He is capable and experienced in Xrays.  On the other hand he is a take charge guy,  often dramatic, who likes to Intervene in a way  that makes me uncomfortable. I am a more conservative minimalist who likes to keep in mind how our citizens suck up pills as if there were never any side effects; and feels that Beg Pharma and Big Tech seed  TV and the ‘news’ with misleading true lies.  Observe that today’s  medical consensus is all to often tormorrow’s medical sin. As it turns out the board later has to negotiate about a child with a temporary patch of subcutaneous fat loss after Herbert gives a steroid injection without consultation. It was a minor self limiting complication, but at the time, looked ugly.

September 1971: Interview and selection of CHW trainees.

Victoria Odem

Ray Rubio

Carmen Shelley

Geraldine Hernandez

Raquel Carmona  left for nursing school was replaced by Anna Sankey

Mary Romo

A felon, who violated parole was replaced by Joan Schauberger

March 1, 1972 Dick Noble, MD, is hired as part time physician, but leaves abruptly in September without giving notice other than writing Pig on his desk.  He had never objected and never said why he was so intemperate or outraged. Maybe we couldn’t pay him enough;  or What? It was not as if he worked for free! Ouch.

July 1972 Data on 600 Senior Citizen Screenings8: ( % approximate)

50%  abnormalities of vision, Blood pressure*, hearing.

10% fasting blood sugar diagnostic of Diabetes*

5% anemia

3% abnormal intraocular pressure.

* These abnormalities are based on old criteria. Today some % would be much higher because criteria have tightened.

September 25 1972 A proposal to the California Community College system to develop a career ladder for CHW training and progression, beginning with a program to train and certify CHWs is rejected

January 6, 1973 . The Salud CHW Training Manual, in which the beautiful artwork is done by Sandra Tiller, is adapted for use by George Kent for the Chico State Satellite Closed TV training projects. 9

February, 1973 The clinic continues to be busy, seeing nearly 50 patients daily. Yet Salud has not become self sustaining. We all realize that the ambitious and arguably arrogant attempt to provide medical services without accepting government funds will not succeed unless I continue to subsidize the operation at about $2000 monthly  or become the government myself. That makes me slightly sympathize with Congress; but only for an instant can I sympathize with people who  live high,  and exempt themselves from laws and regs they lay on the rest of us.  But my physical, emotional, and personal resources are drained. I am divorced, and my contribution to that personl loss is having pretty much abandonded my wife and children in favor of Farm Workers, Broderick and even, I suppose, to my own fading idealism, which might be viewed as ambition.

‘Revenue Sharing’ has been started by the Regan government, and I reluctantly apply for funds. I know, as does the board, it is a pact with the devil. But.. Who Else?

May 1973 Two years after the opening of Salud our  Federal Revenue Sharing Grant receives preliminary approval. Yet the devil is here: the Yolo County Board of Supervisors must agree. They reason that it is wrong to add a third ( and relatively independent)  entity  in the county to provide care for indigent  East Yolo people. Their approval requires that 1) the entire operation be turned over to the Yolo General Hospital or to the Yolo County Public Health Department; our choice! 10 2) that the Board remain only as an advisory body. 3) that the County acquire the clinic for what I originally paid for the building, without consideration for what the community or anyone else invested. We smell brimstone and sulfur, but agree, providing:

1) We are assured the CHWs individually and as a role model be kept as employees with full benefits. 2) The advisory status of the board be documented.  After discussion the Salud Board elects to go with the Health Department, under the direction of Otis Cobb. If I or the Board had more determined, if we knew our true strength, one of us might have refused; in view of the nature of politics, the County very likely would  have back tracked.  But I ,for one, was whipped, not sure whether I was Faust or Don Quijote.

After a brief time the original Salud clinic Street is abandoned by the Health Department and moved to a building nearby. Our cherished little medical office with lab and X-ray will be put to other uses; maybe.  The littered lot remains as it was, though perhaps the county improved the clinic building; they acquire the parking area in front, something we were not able to do. In the next few years I occasionally visit when Salud is in an old school near the I Street Bridge. It operates reasonably well, and health workers are included.  Yet there is a sense the sprit is dead despite  devoted and inspired efforts of the physicians, nurses, FNPs, and CHWs who seem unable to move the Public Health behemoth into the arena of Primary care. Maybe that is inevitable, because it  that kind of service never has been the Health Department’s primary job.

To quote John Siden:

” Although Salud was subsumed under the health dept in the early 1970’s, soon thereafter all the county’s health functions were administratively reorganized and the clinic became a branch of Yolo General Hospital’s outpatient clinic…  It acquired a little more of a look of a traditional clinic, but in fact it was always the ugly step sister as far as the hospital was concerned.  But it had a dedicated and devoted staff, from the health workers through the MDs.

“The (original) organizing effort was so powerful that to this day the rather meek and mild Salud Advisory Board that lives on in county ordinance is listened to by local politicians far in excess of its present strength. …The forces (of) … the early 70s were still at work when the county set out to replace its facilities in WS in the early 90s… ( including) a new ( and far more luxurious ) Salud … (W)hen the hospital was closed in 1991 the clinic operations were taken over by Davis Community Clinic (now Communicare).”

Salud has come full circle, arriving at its beginning as a community clinic. Nonetheless, the new owners are absentees, and distant; they are not familiar with the local reality; they have far larger and more significant concerns, even though Salud remains the most active, profitable, and productive of their several clinics, like an ugly stepsister who is otherwise admired by the polyglot and multicultural  community for her CHWs and FNPs, and the constant, consistent, and  persistent devotion of David Katz, the chief Salud physician, who has a long history and awareness of the Salud Model and concept.

After Salud is suibsumed into the county government,  the RRH, stepchild of the Migrant Health project survives, but barely. I still have a soft spot in the brain for them, and agree to become medical director. They build a Dixon clinic and rent space in Esparto, and Courtland.  For a couple of years I try to breathe life into those operations, but fail miserably.   The millions of Federal dollars fade away. I leave but am still unwilling to let go of my own illusions, and  then agree to become medical director for a Federal project attempting to create an HMO for  Sacramento, where CHWs and FNPs are key providers. But again, the Federal DNA is fatal, and after a number of million dollars, the patient dies.  Yet,  I am  cured, at least superficially,  give up the private practice of Community Health. I devote my  next 25 years to Emergency Medicine,  to my family, and to traditional medicine

The most significant personal events of these past nearly fifty years have been:  First, 41 years with my fierce and stubborn  but tolerant wife and children; Second,  25 years in Emergency Medicine, the last 20 at Kaiser PMG. I think  often of Salud, vaguely aware of the changes over the years.

For a while after retirement I volunteered at Salud; it was rewarding to care fpr the same  patients we saw early on. Salud,  nominally,  has come full circle, arriving at its beginning as a community clinic. Nonetheless, the new owners are absentees; they are not familiar with the local reality,  the people, the history of Salud, or the concept. It seems they have far larger and more significant concerns to attend to, though Salud remains the most active, profitable, and productive of their several clinics–  a weird stepsister who survives and is adored by locals for polyglot and multicultural CHWs,  for FNPs, and  for the persistent effort of David Katz, who has a long history, devotion, and awareness of the Salud Model and concept.

Recently I spoke with Katz, and found the clinic name on line is name is now Communicare Health Center. Yet there is much unchanged–The CHWs and FNPs remain the body and soul of the operation, providing interpretation not only of language and culture, but of spirit, and community,  through vital connections that would never otherwise exist.  The heart of Salud remains the Board of Directors; it beats only quietly in the background, but it is alive.

To my family,  my love, sincere admiration and gratitude for patiently or at least kindly tolerating my excesses; and to  you all at Salud , for preserving, and further developing that which we began to create so long ago.   Because of you May 21, 2017 was the 46th anniversary of the opening of the Salud Clinic.

Bravo; Brava!

 

1 See three articles in the March 2004 History issue of Sierra Sacramento Valley Medicine pp 5-20. Trappers came down from Oregon finding only the Sutter Buttes sticking up out of an inland fresh water sea; they brought malaria with them which decimated the native population. Cholera came up the river and decimated Sacramentans. In the 1850 flood of Sacramento, Dr Morse, whose office was on the second floor, floated dead bodies in the water below, until they could be moved. That was a very bad year!

2 One generations is often very different from the next, each unaware of the values and physical reality of the other. These buildings were structurally and hygienically marginal, but rents were $75, the equivalent of about $200 now. Yet they compared favorably to neglected motels, public housing, and rest homes, precisely because they offered a certain freedom, an independence, a dignity, in the way the people  interacted with one another and the surrounding community. The renters were from an age past, with their own set of truths and values. Single, usually older men, could be called bums. But they were a driving force in building Salud, and active on the Board.

3 I have a 1966 list of 117 migrant camps in Yolo County alone. Some 10,000 workers were required yearly from March to September. With the help of the Yolo County Health Dept, County Hospital, and Medical Society, we established four night clinics with follow-up at the Yolo General Hospital. Later the UC Davis School of Medicine opened and became involved. However within a very few years agricultural practices changed so radically that the camps are nearly all gone, and migrants generally seek work elsewhere. The migrant clinics became obsolete.

4 For a perceptive study on the East Yolo and the development of Salud, including the water problems, see Donna Fazackerley’s ‘The Politics of Health Care in East Yolo‘, which she submitted as a Senior Project for the UCDavis Department of Applied Behavioral Sciences in June 1973. Donna moved to Broderick and lived there for three months in preparing for her report. I also have somewhere a 4 page history of Salud, author unknown. It relates the development of the facility and includes a nine point exposition of the Salud concept for Community Clinics. It ends with the notation “Salud- Power to the People, 1972.”

5 We had to send stool samples to be examied for parasites, and of course the parents collected the samples, and took them to the hospital lab. I had once a wonderful letter from a lab technician where he colorfully described how he would arrive at work to face a clutter of bottles and cans, filled to the brim with stools. He hoped we would teach migrants how better to collect save the specimens.

6 There were many more. Among them Alfred Biles, Chuck Snodgrass, Ray Pines, Paul Gutierrez, David Ingberg, Alex Creighton, Gary Oschner, Tiny Di Julio, and Fran Molina were sub committee members, some on more than one committee. Fred Adams, Harold Hocker, Lloyd Newhall and Len Ortiz( plumbing), These were the people who sustained Salud in the difficult times ahead.

7 The training course held five afternoons weekly for 6 months, and was relatively intensive. Though the Salud CHW Training Manual was adapted by other programs, and went trough several revisions, I have only the templates for the first two sections and the Table of contents, for the original version. ( I am missing section 3.) Although local community colleges declined to offer a course or a career ladder for CHWs, it has been done elsewhere.

8 An El Dorado OEO project for Senior Citizens where CHWs performed most of the screening, and abnormalities were referred to local physicians.

9 I later was hired as physician and developer of a CHW training project for a federally funded HMO project in Sacramento. However it lacked community support and control, relying solely on very generous ( millionary) federal funding requiring a huge federal burden of oversight. It died almost as quickly as the money disappeared.

10 See: The Politics of Health Care in East Yolo. The problems and deliberations of the Board are presented with sympathy and accuracy by the author.

Isocrates, Milton, Osler, and the Internet

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Democracy destroys itself because it abuses its right to freedom and equality. Because it teaches its citizens to consider audacity as a right, lawlessness as a freedom, abrasive speech as equality, and anarchy as progress. Isocrates, 436-338 BCE   

Some 2360 years ago, Chios, Cos, Rhodes, and Byzantium bolted from the Athenian Confederacy over abuses of central power by Athens. Isocrates wrote a long essay urging peaceful resolution of the conflict. It was surely not delivered orally for the reasons he mentions in the opening paragraphs:

“…you do not hear with equal favour the speakers who address you… while you give your attention to some, in the case of others you do not even suffer their voice to be heard. And it is not surprising that you do this ; for in the past you have formed the habit of driving all the orators from the platform except those who support your desire …you ( cause them to say) not what will be advantageous to the state, but what (pleases) you. …how can (we) wisely pass judgement on the past or take counsel for the future unless (we) examine and compare ( opposing ) arguments? …although this is a free government, there exists no ‘ freedom of speech ‘ except that which is enjoyed…by the most reckless… .

It sounds very 21st century USA, doesn’t it?

Fights broke out Saturday during pro- and anti-Trump protests in Berkeley, California.

February 1, 2017 - Berkeley, California, U.S - Anti-fascist protesters dressed in black arrive at a protest on the University of California-Berkeley campus against Milo Yiannopoulos, a Breitbart writer who has grown notorious for his comments targeting women and minorities. Yiannopoulos was scheduled to speak Feb. 1 at the invitation of College Republicans but he left the campus an hour-and-a-half before his scheduled talk as protesters grew unruly, throwing objects and setting off a bonfire

Anti-fascist protesters using “black bloc” tactics – covering faces, dressing in black – arrive at the protest last week.Jeremy Breningstall/ZUMA

 

In the mid 15th century, thanks to the printing press, common people began to acquire printed material containing ideas or knowledge formerly limited to wealth, state and church’  which were joined at the hip. Later, In 1522, Luther published the bible in vulgar German, instead of Latin, making it widely accessible for the first time. Over the next hundred years wildcat or unschooled publishing exploded, causing rulers to fear a access to information- arguably knowledge- putting power in the  hands of a gullible and ignorant public. In 1641 Britain–to protect the public (of course) !– made all printing illegal without prior official approval. Two years later a defiant John Milton published Aeropagitica, a title he adapted from Aeropagitcus, where Isocrates urged the revival of the Aereopagus, a court to control education of the young and public immorality.

Since the1990’s the internet has become exponentially available to an entire world. Authority is challenged or attacked by unschooled, unapproved wildcat non line e.publishing that is consumed by an awakened, restive national and transnational public. Free Speech is again so intolerable that Isocrates’ stale words echo down the hallways of time, and it seems clear that –again– civil dialogue and speech are true lies that recur throughout what we call history. While in the past, technology driven change required centuries to come to a boil, this pot took only a few decades to boil over.

I try to believe our little e.fire  will cool down, that we will control the pot of the e.verse. Yet it seems even more techno-crises are almost upon us: artificial intelligence; bioengineering; bioprinting; robotic automation and their spawn; Mars; and driverless cars (though two story high trucks of open pit copper mines in Chile have not had drivers for many years.) I was once an arrogant little pilot, like so many physicians who fly and sometimes die. But long ago on a several week trip to Punta Arenas, on the straits of Magellan,  I found that even a simple array of instruments was a better pilot than I. Therefore, thinking of the unknowable,  which is now seems almost everything ahead, I know that–looking back– my greatest good fortune was to become a physician, not so much through merit as luck, and the influence of a friend. To study my physician predecessors and colleagues is to move outside my own limits. It reminds me of this from Empedocles:

The nature of god is a circle of which the center is everywhete and the circumferance is nowhere—!

and this from Mathew Arnold’s Dover Beach:

I say: Fear not! Life still
Leaves human effort scope.
But, since life teems with ill,
Nurse no extravagant hope:
Because thou must not dream,  
thou need’st not then despair

So today, wanting a dose of something other than alcohol, I pulled down Osler, but quickly put him back, in favor of pulling him up : such is the joy of a browser! Aequinimitas was his valedictory address, University of Pennsylvania, May 1889. He spoke of the physician’s need for equanimity:

 “ clearness of judgment in moments of grave peril, immobility, impassiveness, or, to use an old and expressive word, phlegm.”

Phlegm! How choice a word for equanimity that is! He continues in that grandiloquent elite euro-greco-roman slang :

“in the Egyptian story…Typhon with his conspirators dealt with good Osiris; …they took the virgin Truth, hewed her lovely form into a thousand pieces, and scattered them to the four winds; and, as Milton says, “from that time ever since, the sad friends of truth, such as durst appear, imitating the careful search that Isis made for the mangled body of Osiris, went up and down gathering up limb by limb still as they could find them; We have not yet found them all,”

And there it is again! The quote is from Milton’s ...Areopagitica! 

 

The Areopagus as viewed from the Acropolis.

From a Troubled Knee

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To a Surgicenter and KP:

          For listening

For hearing,

For lovingkindness

 And skillful doing:

         From the first step

off the gurney,

to the very last,

I’ll remember you,

        The skillful people,

whose attention

was gently lavished

on a troubled knee,

        That slept on attic floors

of Alta Peruvian Lodge

doing light work,

to ski free that Spring of ’53;

         Was injured in a fall

leather strapped to 7 foot boards

with strips of metal

screwed to the edges;

         And since those days

went many mountain miles,

but often effused complaints,

until it could  no more.

       How is it, Dr David,

that so many people become

a selfless, seamless whole

at a  Surgicenter,

       To give a stranger’s knee,

A second chance to ski,

lead pack llamas up trails,

bike, or walk the city,

         When the mother country

burns with uncivil strife,

enraged by opinions

not our very own?

        This old knee

doesn’t give away

it’s private opinions,

except only to say:

       From the first step

off the gurney,

to the last off the earth,

… Thank You.

Lighting for Literacy, Colonet, Baja California 2017

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“The greatest Christian virtue is doing, the least is talking”             John Wesley

I HAVE SELDOM BEEN so rewarded for being a Methodist as on my fourth trip to Colonet, Baja California to help build the 39th and 40th small houses there; and to interpret for a Lighting For Literacy (LFL) project, where middle school science teachers and students lighted up the lives and nights of eight families in Ejido Punta Colonet. The students had been enrolled in STEM programs (Science, Technology, Engineering, and Math), inspired by their science teachers, to put together solar panel powered lighting systems and to actually go to install them.

About 1.5 billion people (20 percent of the world’s population) must resort to some sort of carbon based fuel for night lighting; it is unhealthy, contributes to the CO2 burden, and is a significant fire hazard around flimsy remote structures. Otherwise they have no light after the sun sets. The cats at Los Gatos Methodist Church and Rotary International (RI) know LFL well, having witnessed it’s lightening fast 60 day gestation and assisted its birth.  The very first LFL solar lighting system installation was actually in Colonet, Baja California in 2013. It was developed one afternoon at a fast food restaurant by two members of the Methodist Church; one was Doug McNeal, also a Rotarian, who promoted support by the local Rotary. Already, affiliated programs reach more than eight continents, introducing STEM and LFL to more than 1,200 middle school teachers and their students who are at an age where inner places and lives can be lighted up in the process of lighting up remote places. Kevin Kinsella, who was also at Colonet this April, is an inspired and enlightening science teacher with LFL.

I felt enlightened, as well. The photographs below reveal the depth of our experience more clearly than words. They also speak of the nature and the power of Family; in this case, families who keep animals in, and desert varmints like coyotes out by fashioning close-spaced fences from brittle, dead stalks of cactus plants, wire and woven plastic waste; who carve out a place in the desert to  imagine a house – a home – into existence, though often largely made of trash. That’s something only families like those pictured below, can do.

As to my own family, I would have never gone to Colonet without following my daughter, Amy, who coordinated the complex project involving two countries, more than 40 people, and the finances involved; or John my son in law; and my son, Fred, a builder who hauled his tools and powerplant 3,600 miles round trip; and Tom, another builder from the South Bay who brought tools and material to the sites; or Ivan a local builder; or Antonio, a local pastor; or the many other volunteers and donors, the glue that held it all together.

After each solar lighting installation, instructions are given. The switch is turned on by one of the children. The student who put together the unit signs it and makes the final point by giving each child a set of age appropriate Spanish books. We take a  group photograph. Adios is then the only perfect single word speech.

These live links  tell about LFL better than I:

LGRI Rotary

LFL

 LFL Ivory Coast

 

The photographs  below and speak more clearly than words, and may encourage the reader to consider the possibility of LFL:

Doug McNeil

 Kevin Kinsella

First job of every morning  putting together two  units  for two houses. I couldn’t see how it was done, but these people did. A cell phone charger  pug is included.

The plastic bag holds mounting brackets and connectors. Note  all the wires, and the name of the student on the lid.

The rechargeable battery goes in the box too. Simple, no? Yeah, Right!

Jessica

Tom in a moment of silent, serious concentration. He is a monk in the skin of a grizzly.

Below is a wash-house. Behind is a fenced garden and unseen in the distance is a small mountain range where 10000 ft high peaks pull water from moist sea air in winter, providing water for this productive sun drenched agricultural region.

A fence perfectly representing the environment. The stakes are dried up spikes of cactus plants. They are strung along barb wire wrapped in salvaged black plastic bags.

Below are dried roots of the same cactus- Maguey- dug up from the sullen and reticent gravelly soil at considerable effort, to serve for cooking.

Alejandro cleaning the spines from Prickly Pear cactus leaves for very common vegetable dish, nopales,   He gave us a one week old dried rattlesnake which he advised us to let dry more, then grind up, and use with any food…like re fried beans and ground rattlesnake.  Cascabel con frijoles refritos.

I fell under the spell of this woman. She was a migrant farm worker from Chiapas, not speaking any Spanish; met  and married. Their 15 year old son  son works for a builder and did much of the construction;  15 years is adult at times. (During WWII my dad worked at a copper mine in Chihuahua. When I was 10 my he took me to El Paso and put me on a troop train with $5. I got to  Northern CA  with some help from the soldiers. Like children in Colonet, we were old when young then.  From this distance that doesn’t seem a bad thing)

I can’t  pronounce or recall  her name but will never forget her.  In this photo Antonio, the pastor of the Christian church in Colonet is helping her dig a footing for a table in her wash house.

Another home when the light was turned on in this dark  windowless room. It is only the equivalent of a 60 watt incandescent bulb, but What a difference! I like this photo also for the high heeled shoes over the door. There were 3 pairs but i didn’t want to be too intrusive; however they appear in the last photo.

Little silent things like those shoes have much to tell if we listen.


After the lights are installed, instructions for their use given and   the switch thrown turned by one of the children LFL makes the final point by giving each child a set of  age appropriate books; we take a last  group photograph; and  Adios is the perfect one word speech.