New Orleans In organizing the process of strengthening weak ties to build the strong welds of solidarity can be very personal, tediously time consuming and therefore prohibitively expensive, and involve huge scale human engineering in order to create deep organizations, which is partly why organizers use other tools like actions and demonstrations to achieve scale and create polarization. There’s no better or more intensive process than home visits, the door-to-door work that was the ACORN hallmark.
For a long time I have found it fascinating the way similar systems have been successfully adapted in developing countries to provide health care, particularly preventive care. In Lima and elsewhere many of our organizers were originally salud promodores or health promoters, similar to home health aides doing outreach. In fact when I was consulting with Casa de Maryland they had an excellent program working among immigrant populations in the suburban counties outside of Washington, DC. The role of barefoot doctors, who were home health organizers after the Chinese revolution, was well regarded and carefully studied in my generation as both hopeful and inspirational. The huge explosive growth of home health workers in the USA was more about cost saving than prevention or intervention, but there’s no doubt that when the service worked it allowed better health and independence for millions.
It wasn’t surprising to that Dr. Aaron Shirley, a veteran doctor and civil rights activist in Mississippi, would be attracted to these kinds of programs in dealing with the persistent, scandalous, and tragic heath care crises in Mississippi, but the New York Times Magazine feature advocating a move to an Iranian model of health houses or mini-clinics serviced by promodores of sorts was fascinating.
The Iranians built ‘health houses’ to minister to 1500 people who lived within at most an hour’s walking distance. Each house is a 1000-square foot hut equipped with examination rooms and sleeping quarters and staffed by community health workers – one man and one or more women who have been given basic training in preventive health care. They advise on nutrition and family planning, take blood pressure, keep track of who needs prenatal care, provide immunization and monitor environmental conditions like water quality. Crucially, in order to gain trust, the health workers come from the villages they serve.
All of that seems to make enormous good, common sense. The article drifts a little towards the direction of being a solicitation for government or private funds for the $3 million the Mississippi organizers and advocates want to build 15 such “health houses” over three years, but it makes me wonder why this wouldn’t be a vital system in not only rural areas, but also cities, and why with some energy and ingenuity and community support versions of this couldn’t be created by community organizations using the talents all around them. Given the costs of health care, the shrinking of the safety net, and the fact that it’s life-or-death if we don’t start embracing preventive care and create a real ground-level health care system, it seems like it’s worth some thought and work for community organizations to adapt something similar and do so PDQ.