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From FountainofLight.net Books
This is an excerpt of Jim Hightower's new book, Swim Against the Current, followed by an interview with the author. HEALTHY HEALTH CARE Who would've thought that in the moral morass of what is now called the health "industry," the flower of social responsibility could still bloom? The industry is controlled by insurance middlemen, HMO chains, and rip-off drug makers -- all putting profits over patients. The industry's lobbyists impose public policies that leave forty-seven million of our fellow Americans with no health plan whatsoever, while tens of millions more hold miserly plans that provide very little balm in times of need. The industry has created such a screwed-up system that we Americans spend more each year on health care ($6,280 per capita) than people in any other country, yet the treatment we get ranks a pathetic thirty-seventh in the world. But there's good news: rising from the grassroots in every area of the country, health professionals and businesses are bringing an enterprising spirit to this dysfunctional system, reaching communities of people who've been shut out, and showing the way to put the "care" back into health care. Charlie Alfero is one of these people. Working with both private and public health institutions in New Mexico for nearly thirty years, he is some combination of agitator and administrator, adept at figuring out how to get quality care delivered to rural outposts that the corporatized medical system has largely abandoned. Moreover, he sees health care as key to reviving the economic health of those areas. Charlie's outpost is Hidalgo County. Where? Look at the bottom left corner of a map of the "Land of Enchantment" and you'll see a boot heel. That's Hidalgo, a remote but picturesque stretch of the Old West that was once crossed by the Butterfield Stagecoach line, then the Southern Pacific railroad, and now I-10. The boot heel is a long way from any city -- Tucson is 150 miles west, El Paso 150 miles east, and Albuquerque 300 miles north. It has been a hard-hit area. Copper companies used the place up before pulling out in the 1970s and 1980s, leaving Hidalgo mostly a ranching economy. Some six thousand people live there, with a lot of poverty among them. The local hospital closed in 1979. The last doctor left in 1983, and the county was unable to entice another one to move in. There was an obvious need and demand for health services, but Hidalgo is hardly the sort of lucrative market that such profit-hungry chains as Hospital Corporation of America are willing to consider. The county's leaders realized they would have to put something together for themselves. So in 1994, they asked the state rural health office to send some experts to Lordsburg, the county seat, to help guide them. One who came was Charlie Alfero. Years previously, he had attended a small college up the road in a neighboring county, and he was glad for the chance to revisit a region he loved. Alfero had been working with the rural outreach program of the state university's medical school, and he remembered from his earlier time in the boot heel that despite economic difficulties, the people of the area shared strong egalitarian values. He felt that they might do big things. He arrived with a vision: the people there could create a health commons of their own design -- a community complex that would provide one-stop service for medical, dental, and mental health care, with family support services and economic development built in. Most of Hidalgo's residents have lived in the county all of their lives and have an attachment to the area and to one another. "We stick together; we help each other in times of need," said Irene Galven, now the city clerk. It was this sense of community, the residents' willingness to throw in on projects to benefit everyone, that inspired Alfero to throw in with them. It was not a simple project. For nearly four years, Charlie made the six-hundred-mile round-trip commute each week from his home in Albuquerque to Lordsburg to work with eager locals to establish Hidalgo Medical Services (HMS), get it on its feet financially, and get it moving -- one small step at a time. * On July 1, 1995, HMS opened its doors in one wing of the old hospital, offering health services two days a week. Four doctors from Silver City (fifty-five miles from Lordsburg) rotated to the clinic, each doing one day every two weeks. * In the fall of 1996, HMS was able to add a full-time nurse practitioner, meaning that Hidalgo County had daily medical service for the first time in thirteen years. * In the spring of 1997, HMS's proposal for rural outreach was funded by two small but crucial federal programs, the Community Health Center and the Office of Rural Health Policy, thus allowing the clinic to expand its services and hire a full-time family physician. * In 1998, for the first time in county history, dentistry was made available on a part-time basis. Also, with the clinic becoming a viable enterprise (it now occupied about 60 percent of the old hospital), Charlie Alfero left Albuquerque to become the CEO of HMS. From the start, Charlie understood that the key to success would be building broad support -- enthusiasm, even -- throughout the county and gaining the trust of all involved. In addition to board members who could bring a bit of clout to the cause (hometown bankers, lawyers, local officials, and certain retired professionals), he enlisted some of the clinic's patients to serve (today, 100 percent of the board members are patients). He preached the democratic ethic that the larger community had to be invested in HMS, literally making it theirs and recognizing that "each person's success helps strengthen the whole." Alfero took public involvement a step further by bringing ordinary residents inside to serve as a direct, integral, and very effective part of the health delivery system itself. They were enlisted to be promatoras de salud(promoters of health). These community outreach workers, trained in the management of such chronic diseases as diabetes (a huge problem in this region), literally spread the reach of HMS, traveling out to smaller settlements and isolated ranches and bringing medical help, information, news, connection, and ... well, care. "I think I've always been a promatora," declared Elva Quimby, a fiftyish former cosmetologist. "I just thrive on helping people." Step-by-step, service was expanded, gaining the attention and the support of health professionals and funders outside of the boot heel. A little more capital was raised, another nurse or physician arrived, and before long HMS had become not only a strong medical center, but also the largest economic engine in the county. Alfero contended that if the strongest local asset is a health clinic, go with it! Why try to get some out-of-state conglomerate to reopen the copper smelter when you've got a clean, community-supported enterprise creating jobs, generating small business growth, and making people healthier? A dozen years after opening its doors, HMS has become the health commons it was envisioned to be. On its tenth anniversary, it opened the doors of its new twenty-two-thousand-square-foot clinic in Lordsburg, a modern, full-service facility with nine exam rooms, lab and X-ray rooms, a dental clinic with six chairs, and offices to deal with mental health problems, substance abuse, and family support needs. It has a staff numbering more than 140, operating on a budget of more than $10 million a year. In addition to Lordsburg, HMS now has clinics in six other communities in two counties, including one in Silver City, where it originally had to go to find doctors who were willing to come to Hidalgo twice a week. "I didn't deliver health care," Alfero noted. "I'm not even a doctor. I just gave people an idea, pointed them in a direction, and they built this themselves. People who rely on external forces to determine their future are going to find a bad future. The people in this area are showing what health care can be if we invest in people, not in the layers of intermediaries looking to make money off a top-heavy system. Our country needs more clinics like this." For the interview with the author go here. ****** Fair Use Notice: There is no attempt here to usurp any copyright but only to distribute useful and educational information to a non profit audience. © Copyright 2000-2008 by Fountain of Light |
