<div>Very nice. we could learn a few lessons about health care from Cuba as well.</div>
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<div class="gmail_quote">On Mon, Mar 22, 2010 at 2:09 PM, Robert Naiman <span dir="ltr"><<a href="mailto:naiman.uiuc@gmail.com">naiman.uiuc@gmail.com</a>></span> wrote:</div>
<div class="gmail_quote"><br> </div>
<blockquote style="BORDER-LEFT: #ccc 1px solid; MARGIN: 0px 0px 0px 0.8ex; PADDING-LEFT: 1ex" class="gmail_quote"><a href="http://www.timesonline.co.uk/tol/news/world/middle_east/article6962844.ece" target="_blank">http://www.timesonline.co.uk/tol/news/world/middle_east/article6962844.ece</a><br>
<br>Sunday Times<br>December 20, 2009<br>Deep South calls in Iran to cure its health blues<br>In ground-breaking project, one of America’s poorest communities is<br>turning to the Middle East to try to resolve its crisis<br>
Christina Lamb<br><br>AS Marie Pryor shuffles along a Mississippi roadside collecting<br>discarded drink cans to sell for a few cents, her breath comes in<br>short puffs caused by a congenital heart defect. The same condition<br>
caused her granddaughter’s death earlier this year.<br><br>The last place on earth she would look for help is Iran, a country<br>widely regarded in America as the enemy. The US and Iran have not had<br>diplomatic relations for 30 years and the two governments trade daily<br>
insults over Iran’s nuclear programme. Last week Tehran charged three<br>American hikers with espionage after they apparently strayed across<br>the border.<br><br>But with Congress acrimoniously debating the reform of healthcare, it<br>
is to Iran that one of America’s poorest communities is turning to try<br>to resolve its own health crisis.<br><br>A US doctor and a development consultant visited Iran in May to study<br>a primary healthcare system that has cut infant mortality by more than<br>
two-thirds since the Islamic revolution in 1979.<br><br>Then, in October, five top Iranian doctors, including a senior<br>official at the health ministry in Tehran, were quietly brought to<br>Mississippi to advise on how the system could be implemented there.<br>
<br>The Mississippi Delta has some of the worst health statistics in the<br>country, including infant mortality rates for non-whites at Third<br>World levels.<br><br>“It’s time to look for a new model,” said Dr Aaron Shirley, one of the<br>
state’s leading health campaigners.<br><br>“Forty years ago, when I was a resident at Jackson hospital, I was in<br>charge of admitting sick babies and was astonished at all the children<br>coming in from the delta with diarrhoea, meningitis, pneumonia.<br>
<br>“After years of health research and expenditure of millions of<br>dollars, nothing much has changed.”<br><br>As the House of Representatives and Senate weigh the cost of President<br>Barack Obama’s health reforms, Shirley points out that good primary<br>
care prevents people from ending up in hospital in the first place.<br><br>Besides, nowhere is the need for reform more acute than in<br>Mississippi. The southern state has the highest levels of child<br>obesity, hypertension and teenage pregnancy in the US. More than 20%<br>
of its people have no health insurance.<br><br>Baptist Town, where Pryor lives, is typical. A rundown suburb of<br>Greenwood, the collapse of the cotton industry has led to massive<br>unemployment. The local stores are a pawn shop, Juanita’s Beauty Salon<br>
and Bail Bonding, and an office offering “payday and title loans”.<br><br>Pryor’s son Kenneth and daughter-in-law Lizzie, who live with her, are<br>both out of work and their only daughter died from her heart condition<br>
at the age of 26. With no local clinics or transport, they go to the<br>hospital’s accident and emergency department if they need a doctor.<br><br>The idea of looking for solutions in Iran emerged when James Miller, a<br>
consultant based in Mississippi, was called in to advise a rural<br>hospital in financial difficulty. He was shocked to find that the<br>state had the third highest medical expenditure per capita, but came<br>last in terms of outcome.<br>
<br>Miller, managing director of Oxford International Development Group,<br>remembered a conference in Europe where Iranian officials had<br>explained how their country had revolutionised its healthcare system.<br><br>Facing shortages of money and trained doctors at the start of the<br>
Iran-Iraq war in 1980, the new government launched a system based on<br>community “health houses”, each serving about 1,500 people.<br><br>Locals were trained as health workers known as behvarz, who would<br>travel their area, dispensing advice about healthy eating, sanitation<br>
and contraception as well as monitoring blood pressure and conditions<br>such as diabetes.<br><br>It was a stunning success, reducing child mortality rates by 69% and<br>maternal mortality in rural areas from 300 per 100,000 births to 30.<br>
There are now 17,000 health houses in Iran, covering more than 90% of<br>its rural population of 23m.<br><br>Miller contacted Shirley, who is seen as a community health pioneer in<br>Mississippi and had recently converted a deserted shopping centre in<br>
Jackson into a “medical mall” for the poor.<br><br>“I thought if the Iranians could do it with a fraction of resources we<br>have, then why shouldn’t we?” said Shirley.<br><br>An Iranian doctor helped them make contact with Shiraz University,<br>
which manages more than 1,000 health houses and trains healthcare<br>workers.<br><br>Shirley and Miller visited Iran in May and were astonished to be<br>welcomed with open arms. When they went to remote villages to see the<br>
health houses, the Iranians were equally amazed.<br><br>“They told us this is a miracle,” said Miller. “Not only were<br>Americans coming here, but also they were learning from us rather than<br>telling us what to do.”<br>
<br>One villager exclaimed: “We always knew rain fell down but never knew<br>it could fall up.”<br><br>They signed an agreement with Shiraz University to form the<br>Mississippi/Islamic Republic of Iran rural health project and applied<br>
to the US Treasury for a special licence for “Iranian transactions”.<br><br>The next step was to win over communities in Mississippi. They started<br>with Greenwood, where Shirley had already been in talks about setting<br>
up a local clinic.<br><br>Community leaders were shocked when he advised using Iran as a model.<br>“To be honest, I wasn’t overwhelmed with the idea of copying Iran,”<br>said Larry Griggs, the local fire chief. “It’s not exactly one of the<br>
most favourable countries to the US.”<br><br>They also had to overcome the legacy of distrust between blacks in the<br>American south and public health officials after a series of scandals<br>over medical experiments. The most notorious was the Tuskegee<br>
experiment between 1932 and 1972, in which 399 impoverished, black,<br>illiterate farmers were left to suffer from syphilis even though<br>penicillin was available. More than 100 died.<br><br>To sell the Iranian idea, Miller promoted it as “a healthcare model<br>
just like the Beetle”, pointing out that the popular Volkswagen Beetle<br>had been conceived by the Nazi regime to show “good things can come<br>out of somewhere not very popular in the world right now”.<br><br>The Iranian experts who came to Mississippi included two of the<br>
programme’s architects, Dr Hossein Malekafzali, a former minister who<br>is professor of public health at Tehran University, and Dr Kamal<br>Shadpour, the initiative’s co-ordinator in the health ministry.<br><br>The Greenwood community was convinced and leased a defunct car<br>
showroom for $1 a month for the first Mississippi health house, which<br>is due to open next month. Fifteen Delta communities have expressed<br>interest and Harvard’s School of Public Health will monitor the<br>project.<br>
<br>Paula Gutlove, deputy director of the Institute for Resource and<br>Security Studies, a US think tank, said there was a positive shock<br>value to using an Iranian model. “The exotic nature of working with<br>Iran makes it intriguing to potential funders and sponsors,” she said.<br>
<br>The first candidates from the Mississippi Delta are expected to be<br>trained as health assistants in Iran this spring. If it works, Shirley<br>hopes to extend the programme to the rest of the US. “Just as<br>Mississippi was ground zero in the civil rights movement, so it can be<br>
for health,” he said.<br><br>Nonetheless, the Iranian connection poses a problem. Knowing that many<br>Americans might be outraged, they have not spoken about the project.<br>Even the governor of Mississippi is unaware of it. “We’ve been<br>
deliberately working under the radar,” said Shirley.<br><br>The programme chimes with Obama’s policy of engagement and his support<br>of so-called “smart diplomacy”, using links between scientists as a<br>way of breaking down barriers between countries. Following his speech<br>
in Cairo last June, aimed at reaching out to the Islamic world, the<br>president has appointed three science envoys who will head to the<br>Middle East next month.<br><br>“The Iranians are a proud people with 5,000 years of history and huge<br>
contributions to science and medicine,” said a State Department<br>official.<br><br>“A project like the Mississippi one is incredibly powerful as it<br>appeals to that Iranian concept of history. It’s a great way to keep<br>
the door open between the two countries.”<br><br>Gutlove points out that similar meetings between American and Soviet<br>scientists in the 1980s helped pave the way for the end of the cold<br>war. “What we did in the 1980s created lasting relationships which cut<br>
across the divide,” she said.<br><br>“It’s a win-win project,” said Shirley. “Not only do we finally have a<br>way of addressing disparities in Mississippi, but also building<br>relations between peoples.”<br><br><br><br>
--<br>Robert Naiman<br>Policy Director<br>Just Foreign Policy<br><a href="http://www.justforeignpolicy.org/" target="_blank">www.justforeignpolicy.org</a><br><a href="mailto:naiman@justforeignpolicy.org">naiman@justforeignpolicy.org</a><br>
<br>6 minute video: highlights of the House Afghanistan debate<br><a href="http://www.justforeignpolicy.org/act/endthewar" target="_blank">http://www.justforeignpolicy.org/act/endthewar</a><br><br></blockquote>
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