Upstream Doctors

Upstream Doctors

Three friends are strolling in the woods by a broad, rushing river when they see a child being swept downstream in the water. Aghast, they rush to pull a flailing toddler from the surging current.

Then they see another child.

Then another.

And then another.

The water is full of children.

One friend races to scoop up kids right before the river surges into a steep drop ending in jagged rocks. The second friend grabs a long stick to give several children something to hold onto while he pulls them from the river. The third dives into the water and begins swimming upstream. When her friends ask her where she is going, she replies, “I’m going to find out who is throwing all these children into the water.”

This oft-used public health parable becomes the titular analogy in Dr. Rishi Manchanda’s book Upstream Doctors, and he deployed it when he spoke at MAHEC and Mission Hospital’s 2015 Spirit of Dr. Martin Luther King, Jr. Award Program on Thursday, January 22nd.

During his speech and his popular TED Talk (see link below), Manchanda cites the case of Veronica, a patient whose excruciating headaches repeatedly brought  her to the emergency room, threatened her ability to work, put stress on her family, and finally pulled her to the clinic in South Central Los Angeles where she met Manchanda and his team. After a medical assistant asked about her home, Dr. Manchanda noticed signs of her chronic allergies (see the allergic salute), and a community health worker helped Veronica eliminate the mold in her apartment that was making her sick, her symptoms decreased by 90% in two months. Veronica no longer went to the ER; she didn’t miss work, and she could care for her family whose health also improved.

And this wasn’t just a big deal for Veronica. It marked a larger shift as well. With Veronica’s case, the clinic established a system that made her wellness replicable, that meant other patients would find solutions, too.

Manchanda is one of a growing number of physicians and other public health experts emphasizing the importance of social determinants of health. They argue that doctors ought to address the origins of their patients’ problems, not just the illness their problems produce. We can prevent children from being flung into the water, and we can clean moldy buildings.

Social factors, instantiated in the mold invading Veronica’s home, account for over 60% of all premature deaths in the United States.

In Dr. Manchanda’s neighborhood, substandard housing and food insecurity shape his patients health. In Western NC where I live and work, among many other issues, we struggle with food insecurity and transportation.

Zip code, as it turns out, matters more than genetic code.

Upstream Doctors

Dr. Manchanda talks about his parents’ immigration to the US and the world’s “inescapable network of mutuality,” a phrase taken from Dr. Martin Luther King, Jr.

Manchanda hooks listeners with memorable stories and persuades us with hard data, but in this speech he went one step further and tied his cause to the drive for equality championed by Dr. King.

A quote printed on the program bulletin read:

“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”

Dr. Martin Luther King, Jr. – Second National Convention of the Medical Committee for Human Rights – Chicago, March 25, 1966

Manchanda contended, we can’t set health care right without addressing social determinants of health, but we also can’t do it without recognizing health care as a right.

Watch Dr. Rishi Manchanda’s TED Talk here.

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