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