philosophical essays
ACROSPEAK
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
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
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. 6 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.
A Return to Panamà and Pànama after Fifty Two Years:
Panamà… as we pronounce it would be Pànama… is a metaphoric inversion expressed by the different accents. I first went there as an intern in 1954-55, not yet age 22, interested- vaguely- in tropical medicine but more concretely in adventure. Among my 8 colleagues, half were preparing for missionary work, one for public health, one for psychiatry. Before 1903, Panama was an isolated part of Colombia, an oligarchy run by four or five families. It was inaccessible by land across the Darien. The current sometimes road, actually highway 5, or the Pan American Highway, is still often impassable.
A canal had long been considered to facilitate travel between the Atlantic and Pacific, which required a long sea voyage around Cape Horn or difficult overland Balboa took across the isthmus of Panama. A French venture acquired permission to build the canal under the direction of Ferdinand deLesseps ( Suez Canal, desert, flat, no locks). He wanted to cut a similar sea level swatch across Panama. 40,000 French (and French colonials) died there due to that miscalculation, graft, malaria, yellow fever, poor nutrition and dysentery; it was abandoned. But in 1903 the US felt it could big crazy things. Teddy Roosevelt tried to arrange a canal treaty with Colombia and failed. But because of the isolation of the isthmus from Colombia the locals felt like colonists, and resented their voiceless circumstances and distant and neglectful rulers, like the rebellious British Colonies in North America. They found common cause with Teddy Roosevelt who wanted a canal, and revolted, assisted by U S gunboat diplomacy.
The US Canal Zone was about 10 miles across and some 50 miles long. Panama is Water, and water is the Power that could operate the locks of a canal. A dam was required to store that water, and also control the swampland created by the ever flooding Chagas River; and thereby to control mosquito borne diseases. Incredibly the huge project was completed by 1914! The original locks still operate unaltered, today.
Overall, The US Army Corps of Engineers and Black Caribbean laborers really did the heavy lifting: John F. Wallace conceived the engineering of the canal but became a victim of the terrain, disease, and the political bureaucracy; he survived there for less than one year. John Stevens, a famous civil engineer, took seriously the yellow fever/malaria problem. The largest earthen dam ever built controlled the Chagas River, and drained the swamps; which controlled the mosquitoes, malaria and Yellow Fever, and provided the gravity flow water power to operate the canal locks. Col. George Washington Goethels was finally given unrestrained authority, and was able to complete the job over the next 7 years. William C Gorgas, a U S Army physician who understood the relation of malaria to mosquitoes, convinced the Army to drain the swamps, making it possible from a medical standpoint to build the canal. A second canal was started but abandoned because of WWII; now it has been completed, arguably by China, who also had studied the sea level alternative as across Nicaragua but abandoned it.
In 1954 the canal was still operated by the US civil Service. There was segregation of several sorts. First, upper level administrators and U S military had the option to live on base, with typical military housing and commissary privileges with access to US goods and food. Most privileged long term US citizen employees of the Canal Company lived in bungalows. Second, short term US citizen employees like MD interns, lived in curious multi family wooden apartment buildings, each apartment located upstairs from a parking area below. The apartment buildings were oriented with long sides facing the sea breezes. They were two story wooden structures with space for parking underneath, and 12 ft high ceilings. There were no internal doors; the kitchen, dining and bedroom were in one line so that that the sea breeze, could flow through open screens placed above 8 ft. Each apartment had a bathroom off center and a heat closet to keep clothing dry. Construction was so light that people learned to speak quietly, even quarrel in harsh whispers. Sexual revelry was often audible, though as invisible as the morning alarm clock, flushing of toilets. Notice the 6 ft eves, a traditional style there. In the city they offer much needed shelter for passersby on sidewalks but shoot waterfalls out onto cars in heavy rain.
When I was there in 1975 the buildings were scheduled to be torn down. But the location was ideal, and all the infrastructure already in place. They were acquired somehow and have been gentrified, rebuilt so nicely that the old structures can hardly be seen. In the photo above, some of the screened breezeways persist. The open lower floor also is still there, but made into a living area, like a covered outdoor garden or patio.
The third level of segregation was provided to ‘local raters’ whose situation devolved from the building of the canal. The US Army had recruited English speaking workers among blacks of the Caribbean. Communication was more practical in English, and the work performance was superior to indigenous workers. ( Only the Spanish had managed to induce los indios to work through a brutal choice made clear in a statue at a Mission in Baja CA: a priest holds a bible in one hand and a skull in the other. Believe or die. Work now to live, and die for the glory of God and the Catholic Queen. But the Caribbean blacks were different, perhaps in part because, though paid less than US citizens, and they had significant inducements: Local raters’ were provided decent livable wages, living quarters, medical care, and allowed to buy US imported goods at a reduced rate from a local rate commissary. In the long run, however local raters felt abandoned after September 7, 1977, when President Jimmy Carter gave the Canal to Panama; a long standing local resentment of blacks with special privilege boiled over. Soon many ex local raters had nether job, nor any apparent citizenship. Yet there was, and is, a Black American Atlantic Coast and black Carribean island archipelago; it may be largely invisible to most of us in the USA, though it consists of many black communities which are the source for much unique American and Brazilian music, art, dance, custom, and language. Therefore, the abandoned black local raters of Panama, did not live in limbo; they have adapted or relocated. It’s instructive to kindle and google the many American Black authors, and the Quaker beginnings of the emancipation movement. The very first American revolution was black: Haiti. * Like most US citizens I often focus only on the Northern Hemisphere. We tend to forget that we are all Americans: one continent, one hemisphere, with a shared history, indigenous, immigrant past, and present.
We visited Panama City in late 2016. Much has conspired to make it the commercial and banking center of South America, rivaling Miami. The canal was gradually and totally transferred to Panama control by 2000. Panama has retained the $US as their currency, which stabilized the economy; despite many problems it became a place where people with means could find refuge from chaos at home, or for various thieves to hide money, including drug money.
The former head of the militarily, Manuel Noriega, a cooperator with the CIA, became de facto dictator and drug lord .The US invasion to depose him in 1989-90 was complex, while brief was a real war that has left a shambles of Noriega’s base of operations still unpaired. And the whole episode has became the source of many true lies: afterward there was an election at the insistence of the US; but the winning candidate was assaulted and Noriega declared the election null and void. While US invasion was widely supported by the populace, it was real warfare against a well prepared military, deadly and destructive. It was hugely condemned, as customary, in Europe and the UN; The Panamanian military was dissolved. However, the emergence of Panama as a commercial and banking center, and a repository for suspect money, continued.
The second canal has been completed, financed largely by the Chinese. Transit fee $100,000,000. A Trump hotel, shaped like a huge sail, looks like a twin to one in Dubai. A metro was completed last year.
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Upscale barrios and yacht harbors, continued to appear. Old is being gentrfied, the president lived there near a fast growing tourist area, and expensive restaurants flourish. As to the currently strong US dollar, Panama is something of an exception, comparable to Chile. Most other countries today are, by comparison, a bargain. But it is a good place to visit, safe for the average sane foreigner, usually cool at night, when the ocean breeze is up. In the 50’s that meant street dancing to Lucho Ascarraga’s wild electric organ: Cha Cha Chas, with typical flat foot moves, keeping the whole foot including the heel on the floor and moving The Rest… none of that heel-high stuff. That, happily, is the same today.
Ancon Hill is the highest spot overlooking the Pacific entrance of the canal, with old gun embankments at the top, set among tropical forest. Several hundred yards down hill is the site of Gorgas Hospital where I interned in 1954. My oldest daughter was born there, delivered by a descendant of one of the founding families.
My Grandparents, Leon and Anna founded the Methodist church just at the edge of the Canal Zone. It was built and supported by the North American population of the Zone who operated the canal, and large number of military people who guarded it. But when the canal was given to Panama that U S population very quickly disappeared. The old church is imposing, but obviously neglected now. There was no pastor, but we spoke with a woman in the parish and she took us inside the elegant but sad and tired building.
We visited the site of the old Gorgas hospital, of French design. It had a stolid central administration building surrounded by a series of white one story buildings in colonial French style… a series of medical units, white wooden buildings with 11 foot high ceilings where the top four feet were open screens. The units were interconnected by covered walkways among sculptured tropical gardens to allow for air circulation. How well I recall doing a femoral stick on babies or spinal taps, sweating in the humid night air. At least that is the way it all comes to my mind; it is all gone. One wing of the admin center where interns stayed and sometimes slept during 36 on and 12 off shifts looks down darkly past the surrounding neglected padlocked wire fence strangely dressed in banners left over from some event. No one was around to ask if we might go in; and yet that seemed a small loss. I didn’t much want to view the corpse from the inside.
Otherwise, Panama was no corpse, but alive and well.
Even most of the relics of Old Town were full of color and life, on the way to being restored. thier roof still extended out 4 feet over the sidewalks and balconies to shelter people from the rain.
And the restoration was everywhere evident as well, set among the colorful lives of a small rich country whose future seems bright.
And we pretended to be rich turistas nortamericanos:
*You may want to kindle and google the many black authors of the Americas, the John Woolworth and the Quaker beginnings of the emancipation movement, and the first American revolution, which was black: in Haiti. Like many US citizens I often focus only on the Northern Hemisphere. But we are Americans: one continent, one hemisphere, with a shared history, indigenous, immigrant past, and present.
* * There is a 645 pp third edition of a book Americas by Peter Winn. But frankly, it seems to me simply a compulsive compilation of the ‘news’ we read in the US. Whenever the author treats places and peoples I know very well, the omissions and commissions of errors really rankle me terribly. My bias is this: The record of a people and a time are found in between the lies, and lines; and in fiction, poetry; in other words in Literature. Usually what we call News or History is moribund fiction without flesh or soul.
Letter 10: American Syncretism
Feb 6 – Mar 25 2015 Brazil and Chile
In the USA we are familiar with syncretism of the Northern Hemisphere, especially in what we call The West, meaning Greece, Rome, and Europe. We speak of the Melting Pot especially in that regard. Yet The Americas, meaning the continents of our hemisphere, also share the unique mestizo heritage of our indigenous and European past. Syncretism often reflects change, hopefully progress. But it can send a message; in several American countries, Mexico, for example, El Día de la Raza – or racial day- is celebrated on October 12, which is Columbus day in North America. But there it is devoted to the mestizo or mixed race. Syncretism can be seen everywhere. In the Americas, especially in North and South America there are some curious inversions, geographical, linguistic, and cultural:
In the South, Daylight savings is ‘Spring back, Fall forward’; and Winter lives in the Deep South not the Far North. Santa spends Christmas in South America though he and his reindeer sweat in Summer heat. The global map below is a way of looking at the same world from another viewpoint.
In the Americas we share some holidays that sometimes seem out of place; the indigenous altiplano peoples love dance, song, and colorful costumes and in Puno, on the shores of Lake Titicaca, Halloween is celebrated with wild abandon: jack o’lanterns, witches, trick or treats; the next day is a traditional Día De Los Muertos, or day of the dead, with feasting and ceremony held at a local cemetery, more strictly a Spanish American religious holiday.
In Cuzco Cathedral there is a beautiful painting of the Last Supper by an Inca artist – of the people who actually built the cathedral with stones originally carved by their ancestors, from structures torn down by the hands of the conquered at the command of the conquerors. The Cuzco painting features not wine, but chicha, a purple fermented corn drink. The meal is cui– roast guinea pig. There are corn based dishes the table. Judas clutches his gold in the lower right hand corner wearing the curiously browned face of Pizarro who looks directly out at the viewer, as does Christ. It is a syncretic symphony.
Where the Valley of the Inca meets Lake Titicaca, small groups of Uros live on their floating reed islands; I first was there 40 years ago, when they were isolated, impoverished, fearful, sickly and short lived. The children attend a floating totora reed island public school. They have solar electric panels, with connections to the world, and have become quite worldly, taking visitors on guided tours in 30 foot long reed boats, welcoming them onto their islands, greeting them with multilingual songs, and coaxing visitors into conversations, story telling and singing. They invite visitors into their reed homes, explain the raising of guinea pigs and birds for meat, speak about potable water and waste disposal, and recycling systems. They welcome overnight visitors. The change from 1975 is almost inconceivable, until one takes into account syncretic development.
The oldest painting in a Sao Paulo museum, was done by a French artist who had never been there; all his native subjects wear white skin and French faces, a curious syncretic error. In North America Spanish and native place names are everywhere, among those of classical Greece, Rome, and Europe. Yet while we myopically worry, pander, and focus on the forever fratricidal Mideast and Europe, we become ever more American—North and South. Ordinary Americans are by most measures relatively apolitical, hardworking, and productive. That is a priceless advantage in a chaotic world; we try to preserve American syncretism, and reject Mideast bad tempered tribal misogynist and vindictive jealous gods who urge us to destroy one another in- of course- His name.
I am writing this at the home of a rancher in the Lake District of Chile. Even in this, the 4th year of drought, his farm is green because of the unique climactic conditions where mountain and sea air clash. He has set up a small hydro-power plant purchased in– of all places–Redding, CA. His home is modern, with automated radiant heating, showers– no tubs, no bidets. It is electronically world connected, but preserves a fancy old wood-burning kitchen stove that conveys a feeling of simpler times past. Even in summer, the old stove is lighted and used for cooking; it is ecologically sound for this region, operating on modest amounts of renewable fuel. It is a perfect syncretism of North, South, old and new.
Language itself a verbal and cultural living recording of syncretism; indo-european group winds its way across the globe- from Sanskrit to English. Spanish and English in particular are melting pots of Indo-European languages, rich with related words, ideas, literature. In the Americas there is constant ebb and flow of language fostered by our proximity and shared past and present.
While everything in our Americas North, South, or Central, is not ideal, or without troubles and unsolved problems, by comparison we are far more civil than much of the world, avoiding America wars. To young Americans everywhere I suggest this: Don’t just look East or West: Look North and South. The Americas are your home, our home; savor them, save them, cherish them, share them. As the saying goes, if everywhere is your home, Where is your home. While you should not reject the East and the West but your true syncretic home and your wider American family is here, and now.
Lighting For Literacy, Colonet, Baja California, 2017
“Do all the good you can, by all the means you can, in all the ways you can, in all the places you can, at all the times you can, to all the people you can, as long as ever you can.
“The greatest Christian virtue is doing, the least is talking.
“Beware you be not swallowed up in books!
“An ounce of love is worth a pound of knowledge.
John Wesley
I have seldom been so rewarded for being a Methodist as on my fourth trip to Colonet, Baja California, where I was privileged to interpret for Doug McNeil and Kevin Kinsella while they worked on a Lighting For Literacy (LFL) project guiding middle school students in lighting up the lives of eight families living in Ejido Punta Colonet. In doing so they also lighted up middle school STEM projects (Science, Technology, Engineering, and Math) in the minds of students who put together the lighting systems and went to Colonet to install them.
The cats at Los Gatos Methodist Church (LGMC) and Rotary International (RI) know (LFL) well, having witnessed it’s lightening fast 60 day gestation and assisted its birth in 2012. Their very first solar lighting installation was actually in Colonet, Baja Ca. Within the next two years LFL projects reached 8- and counting- continents, and introduced STEM and LFL to 1200 and counting middle school students at that age where inner spaces and lives can be lighted up in the process of lighting up remote places. AT Colonet this April I felt enlightened as well. I would go anywhere with these dudes and these children.
Without burdening the reader more heavily with words, a browser will lead to many links, here are a few that can tell about LFL better than I.
The photographs below tell of the experience more clearly than words, and may lead 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.
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 and serious concentration. I believe he is a monk in a grizzly bear skin disguise.
A fence perfectly representing the environment. The stakes are dried up spikes of cactus plant shoots. They are placed on barbed wire, then tied on with rolled up salvaged black plastic bags.
Below are dried roots of the same cactus- Maguey- dug up from the sullen and reticent gravelly soil with considerable effort, to serve for cooking fires.
Dogs, dogs, dogs, everywhere. We saw no house without doggy gangs of 5 or more. They alert arrival of strangers and fend off coyotes, if they are lucky; but numbers help.
The little Pichons must take care of their own hygiene.
Alejandro cleaning the spines from Prickly Pear cactus …new growth leaves, or nopales are used for a very common vegetable dish. 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 admirable woman. She was a migrant farm worker from Chiapas, not speaking any Spanish; met and married. Their 15 year old son works for a builder and did much of the block construction; 15 years is adult at times. (During WWII my dad worked at a copper mine in Chihuahua. When I was 10 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 older when younger 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 with my photos.
Little silent things like those shoes have much to say if we listen.
Another wash-house with a dog in its shade, and a fenced garden in back overlooking open countrywide. Unseen are 10,000 ft
peaks to the East. –The Sierra de San Pedro Mártir. But here the only vegetation remaining is thorny scrub brush and
maguey cactus; nonetheless it is a beautiful green Spring after heavy Winter rains, and there are stubborn tiny flowers everywhere.
The lights installed, instructions given; the switch is turned on by one of the children; and LFL makes the final point by giving each child a set of age appropriate books; we take a last group photograph. Adios is the perfect word.
Observations about Family
I would have never gone to Colonet without following my children, Amy and John and their Los Gatos family. The April 2017 buildings would not have been successful without my son Fred, who drove 1800 miles to be here; or 3600 if he gets home; or his Colonet counterpart, Ivan. Or pastor Antonio. Or, need it even be said, the VIMers who were the glue that put it together. It strikes me that this LFL project post tells of the nature of family. Families who keep animals in, and desert varmints and coyotes out with close spaced brittle dead stalks of cactus plants, wire and plastic waste; who carve out a place in the desert to imagine a house into existence– no, a home– largely made of trash. That’s what only families can do, like those pictured above.
I acknowledge that fat, happy, flawed, or failing, all I am is family. My parents and grandparents, and my Methodists; even my intolerant or rude fellow citizens; and not least, my children who refuse to let me go through my own rosy second childhood quietly, but take me to places like Colonet, to be nourished or frightened by the life forces of VIM and LFL.; I blame you all for disturbing my golden years; but especially Amy, Fred and John; if they aren’t a blessing disguised as family, who is?
Here you are, in the photos below, my babes, late on that Sunday afternoon, after a long trip and a long drive, framing the first wall. Like, Wow! What Energy! What discipline! What Organization! What Execution! But unfortunately the very next morning I had to go pal around with Doug/ Kevin et al.
So thank you, I suppose, for disturbing my personal quiet, reflective peace!
A Modest Proposal* on Diabetes Detection and Control
Self Management of Early and Silent Diabetes or Pre-Diabetes
Colonet is an inland town of about 2500 in Baja California. I have gone there four times with my daughter Amy and the Los Gatos Methodist Church to build small houses. They have now built more than 40, generally during Easter vacations so school children can participate. There are two doctors offices and two pharmacies in the tiny town but it serves a wide local area; ‘universal care’ is available at a government clinic staffed – in a common South American way –by a recent medical school graduate who must pay back year for year of medical school by staffing several remote rural clinics; he is there only a few hours each week, so people line up at 4 AM for one of the few openings. Otherwise they must see a private doctor at about US$35 a visit. For those who have a job, the average daily income is about US $10 per day, but work is not available year round. The nearest hospital is 60 Km distant.
It may seem surprising, but the area is highly agriculturally productive. The largest tomato grower in the world is nearby. The Driscol strawberries we buy here are grown in the region. Why? It sits between the ocean and the Sierra de San Pedro mountain range that reaches up 10000 feet to suck in winter rain, allowing for irrigation like a tiny San Fernando Valley; water and sun and hard work make it productive. Migrant workers, often speaking no Spanish, invade for harvests. This year it rained a great deal and the area is lush with small blossoming plants and green with bushy growth.
The local Christian Church has been very helpful in building the small homes. They often help people to acquire a tiny plot of land, which is a required, as well as someone in the family with a job. The pastor’s wife has diabetes as does her mother and their four year old daughter; they assisted in preparing for a series of evening diabetes screening clinics during my week there. The disease is so common that among the first 20 people screened ( excluding the pastor’s family) 9 had diabetes or pre-diabetes. Below is the translation from Spanish of the written introduction and information that was given to people who attended the screenings. Of course, the problem is obvious: When you find a person with diabetes, under these circumstances what do you do? I believe self management is the only realistic, timely, and practical option. To make that sort of thing work, it is best for small groups of people with diabetes to work together over time to solve problems like Where to find medications and supplies most reasonably; How to measure and keep track of glucose levels; How to safely adjust medication in view of the results. The pastor has an internet connection. It is a long and twisted road, but one that otherwise most Colonet people with diabetes travel alone. What follows below is information provided at the screening clinics, addressing the screening process, the general nature of the disease, glucose self monitoring, and possibilities for self treatment. It is translated and redacted from a Spanish blog.
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RAPID SCREENING FOR DIABETES AND PRE-DIABETES
Blood glucose is measured about two hours after a sugar or starch rich meal.
Diabetes Positive Screening test:
- Any blood glucose level above 200 mg/dL at any time, including the
- Challenge test: Blood glucose above 200 mg/dL 2 hours after a sweet or starchy meal
- After 10 hour fast: any blood sugar over 125 mg/dL
PreDiabetes Positive Screening test:
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- after a 10 hour fast: blood sugar 100-125 mg/dL
- 2 hours after sweet or starchy meal blood sugar 140-199 mg/dL
Conversions between mmol/dL and mg/ dL here
Screening tests are highly suggestive but not diagnostic. When positive, reconfirm whenever possible, with a qualified laboratory and physician.
These screening tests are valid at all ages.
Diabetes has serious complications, all caused by elevated levels of blood Glucose (sugar). In early years the disease is silent. One feels fine while high glucose levels destroy the most delicate but critical circulation in the kidneys, retina of the eyes, feet, and elsewhere.Fortunately we live in a time when prevention of that damage can be effective, and simple. But only those who have or who discover their disease can successfully treat it; especially those with the most common kind: silent diabetes. To do that the disease must be revealed… diabetes diagnosed if present,. , and then controlled by:
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- Using a personal glucose monitor to keep track of blood glucose levels
- Measuring and recording glucose levels
- Learning to manage the illness… i contend that is best done as a member of a small group who regularly share their experiences and information.
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Some may wonder why it is essential or practical to self control and self manage this particular illness. Although it can best be done with the help of a physician, only the person who has this disease can do so. Physicians cannot hang around 24/7. The time a physician can actually help most is after the disease had done so much damage that a foot has to be cut off, or a kidney replaced: too late for prevention. A competent physician welcomes self management of early or silent disease. All this may seem complicated, but it becomes quite natural quickly when the diabetic can:
- measure, blood glucose, record the result, and then
- use the results to manage and control the disease
- share results and experience with others who have diabetes for: a) interpretation of results; b) finding sources for test strips, medications or professional advice;c) understand medications and ways to manage it. For example, glucose monitoring is crucial, but very expensive. However, an hour drive away is a large international chain store where costs for glucose monitoring supplies are: ( US$): Monitor $ 9.00; 100 test strips $17.88; one time cost of lancing device $5.84; 100 lancet needles, $1.84 Total $34.24 , adequate for about 6 months monitoring– $0.19/day! By comparison, costs where test strips alone are $ .50-.75 each, are many times that depending on how many strips are required.
The personal glucometer (glucose measuring device or meter) is inexpensive, accurate and lasts for years. One must learn to use it, use it regularly and record results and circumstances affecting each test. . At first it is advisable to measure glucose levels often in order to better understand the illness. Yet because test strip use can often gradually be reduced to as little as 5 or six times weekly, plus anytime a concern arises. For example, one might suspect, for whatever reason, a blood glucose is low, and eat “just in case.” That should not be done: measure, don’t guess!
The blood glucose monitoring record: ( for one month…the first of 30 spaces appear) below)
| Date mo/day | Time 24 hr | Level before meal | 2 hours later | Useful details like: what was eaten, an unusual event like illness, or any other comment |
How food affects blood glucose:
Carbohydrates fats and proteins can all be converted to glucose…which is vital to the human body even if too much is harmful. Some carbohydrates convert to glucose very quickly and therefore are a problem for people with diabetes:
Fast: processed or refined bleached grains like white wheat flour, and white rice; processed fruit sugars (fructose) like corn sugar and beet or cane sugar; starchy vegetables like potatoes and some sweet fruits like peaches, apples, bananas, oranges.
Slow: beans, seeds like most nuts, peas, lentils, meat, fish, chicken, cream is less fast than milk because less lactose, milk sugar.
Take control of your diabetes when it is silent and serious irreversible complications are most easily prevented.
You are the only person who can control your disease!
Note 1) Insufficient insulin was discovered to be present in diabetes nearly 100 years ago. Insulin is made in the pancreas; in the most common sort, Type 2 diabetes, the pancreas still can make some insulin, but not enough to meet the body needs; so glucose accumulates. The disease usually gets worse with time– especially if not controlled well. In type 1 diabetes almost no insulin is produced, and that is a different but related illness.
Note 2) Fasting blood sugar— after not eating for about 10 hours– can be deceptive in Type 2 diabetes because the pancreas has been resting (usually overnight) making enough insulin to keep blood glucose levels normal or nearly so.
Note 3) Hemoglobin A1C test: Red blood cells are not alive. They were grown in the bone marrow, and when growth is complete, they are delivered to the blood where they act as tiny carriers of Oxygen. That Oxygen is delivered to the tissues, and the empty red blood cells are sent back for more. They live about 90 days and are then discarded. But when they were being formed they took in the amount of glucose that was in the blood at that time. Therefore, the average glucose level in those red blood cells is a measure of the average blood glucose during the previous 90 days. Problem: both high blood sugars and low blood sugars can be seen in early type 2 diabetes because the pancreas can over react to high blood sugars and therefore over-produce while trying to catch up at night. So an average of high and low glucose can be deceptively normal. Conclusion: a challenge test, similar to the old glucose tolerance test, is superior to looking at averages or fasting blood glucose level. This screening test is significant because it offers a fast, and economical screening that can be done by anyone with a glucose meter.
Note 4) The personal glucose meter was pioneered by Richard K Bernstein, an engineer with severe diabetes working on a glucose monitor for physician offices. His diabetes became so advanced he began to control his own blood glucose very tightly and began to improve; then he did his own study among students, which suggested a personal glucose monitor was the key to diabetes control. What happened is classic:The study results were rejected by the academic medical profession. So he went to medical school and began to practice immediately as a diabetes specialist. His book –The Diabetes Solution- is largely viewable on line
Dr. Bernstein completely recovered on a very low carbohydrate high protein diet and tight glucose control; he suggests an average blood glucose of 81 mg/dL; he is alive, and lively, over 80 years old. He participates regularly in Teleseminar Webcasts. The March 29 2017 event can be seen here.
* A Modest Proposal is a 1729 satire by Jonathon Swift: ‘For preventing the Children of Poor People From being a Burthen to Their Parents or Country, and For making them Beneficial to the Publick’. He outrageously suggests newborns be harvested for food to reduce the numbers of poor and also feed the rest. Perhaps the only bearing of Swift’s satire to this little essay is the focus on the millions of poor we seem willing to sacrifice to diabetes, even though it’s cruel, and irrational. and avoidable.
By working together outside a system that tends to sacrifice the good to the perfect, and by self managing their own disease, people can at least greatly improve their lives and well being. Yet for our world’s millions of unsuspecting pre-diabetic and diabetic people, only those who discover their disease early and begin to self control it can easily limit its ravages. I believe that worldwide– and even in the USA– there are tens of millions who could benefit from a similar process until something more academically perfect comes along.
Even privileged, idealistic and committed people can become insensitive, intolerant, and dismissive, based on disagreement about dogma, about the meaning of ideas and words. Words are, after all, only symbols; like metaphors they represent things or ideas usually unseen. When we hear or read a word, we rewrite it in our own minds. We interpret and give it our own personal twist. When one half of our nation cannot stand to hear or see the other half, because of ideas or words, it would seem wise to ask ourselves Why do Words Hurt? Why are we so willing to wound one another? Or to put another way, Why so terribly thin skinned? Who ever said ‘sticks and stones will break my bones but words will never hurt me’ was from another era; like Swift.
It seems to me more appropriate to think about deeds rather than only words. So in Colonet this year, I wore a baseball cap with a silent modest proposal written on the face to imply that :
We are in this together. In this place, this nation, this world. We should try to ‘read’, or value one another for what we DO, not what we appear to BE: Not color of skin or political affiliation; or religion; or citizenship, or age, sexuality or gender— but rather, our behavior; our acts; and judge ourselves and others as reasonably as our acts allow.
“THNIK”
