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The Role of CAM in Public Health

In an open letter to Dr. Malek, I describe the potential role of CAM in the public health strategy of developing nations:

Dear Dr. Malek,

Thank you very much for your reply! You bring up a number of excellent points regarding the difficulties in broadcasting a program devoted to CAM's role in the public health system. Indeed, given the breadth of CAM modalities, it would be an unwieldy topic to tackle, and you are correct about there being marked differences in philosophical/theoretical underpinnings of each tradition (although strangely enough, most of these traditions are not incongruous with one another - there are, in fact, a number of common themes celebrated by all CAM modalities).

My idea, however, was not to single out any particular CAM modality to be trumpeted as a boon to public health initiatives, but rather to demonstrate that CAM providers collectively could play a significant role in the public health strategy of developing nations. There are 4 principle reasons why I believe CAM should be promoted alongside more traditional Western methods of treatment for those living in Third World poverty:

1) Low Cost Treatment - I recall you mentioning in program #61 (Medical Personnel Shortages in the Global South) that many MD's shy away from work in developing countries because they do not have access to the tests, medicines, or other tools they have become accustomed to using here at home. Although many CAM providers take full advantage of blood panels, urinalysis, and x-ray/MRI, etc., they do not necessarily share the other technological limitations (or in the case of drugs - cost limitations) of practitioners in the allopathic tradition. The very essence of CAM delivery promotes the use of manual medicine alongside a solid grounding in the scientific and philosophical basis of human health and disease; that is, physically working with nothing more than one's hands and knowledge to deliver care to those in need. It is no secret that conservative care is a vastly less expensive means of rendering treatment to the general public (and in this instance, to Third World populations). In this spirit, CAM represents a sustainable approach to long-term service to such vulnerable populations.

2) Preventive Public Health - CAM practitioners have long been champions of preventive public health measures; that is, the field is punctuated by a desire to address the underlying cause of disease while focusing efforts on eliminating the true source of the problem. Western medicine plays a VERY important role in taking care of those who are further along down the path of illness, but many of these illnesses could be avoided entirely given the general up-regulation of individual health in developing nations.

3) Manual Societies - As a student of chiropractic, I view the world through the eyes of a manual medicine practitioner. When I think about the importance of manual medicine on a global scale, I am immediately transported back to the Third World where the arduous strain of life's activities on the body is obvious and the implications of treatment profound. When a worker in North America misses a day of work due to low back pain or a headache, they might be forced to use one of their sick days. When a worker in, say, India, misses a day of work due to low back pain or a headache, their family doesn't eat. Providing a low cost, effective treatment to help alleviate this worker's pain would be tantamount to a life-saving experience. The demand for conservative care in this setting is present, but thus far the supply has been found wanting.

4) Culturally Appropriate Health Care - CAM providers such as Homeopaths, Naturopathic Doctors, or practitioners of Chinese Medicine already have a grounding in the medical traditions of Third World communities. For example, the traditional Tibetan medical practice of "Amchi" or the Ayurvedic tradition which is still so prevalent in India and other parts of Asia are not unfamiliar topics to many CAM professionals. A sound knowledge of traditional healing methods along with the desire to deliver culturally appropriate treatment (while still applying the very best of Western health care knowledge) leaves CAM providers in a great position to lend their efforts and expertise to the field of Third World public health.

I also agree with you on the topic of a poor general grounding in evidence-based approaches in both the allopathic and CAM professions, although I don't feel that this a particularly large stumbling block in providing effective treatment for those in need. Although more research is beginning to mount in the support of CAM strategies, CAM professions struggle mightily for a very small slice of the overall research budget allocated to the health professions. The volume of research produced is directly proportional to the level of funding received. In addition to this, the CAM professions do not enjoy the extraordinary funding from pharmaceutical companies that our allopathic cousins enjoy.

In terms of discussing an evidence-based approach to health care, I support the approach of Dr. David Suzuki, eminent Canadian researcher and environmental activist, who points out the inadequacies of a reductionist approach to understanding both the human organism and the world we occupy. If we truly consider human beings to be "wholograms," that is, more than just the sum of their component parts, trying to study and understand the body on a reductionist basis will be an inaccurate reflection of the true function of the organism. The process of reductionism is what science and research have largely been engaged in for the past 100 years. Without making a judgment call on the merits of this approach, I will simply say that randomized control trials, while the gold standard of our modern health care research approach, have serious flaws and limitations as well.

I apologize for the lengthy email Dr. Malek. I just wanted to provide some insight into possible CAM topics which could be addressed on Public Health Radio. Sadly, in terms of possible guests for the program, I do not have any names to offer you. Unlike the fine allopathic tradition of non-profit organizations dedicated to alleviating the suffering of the world's economically disadvantaged (e.g. Doctors Without Borders, Physicians for Human Rights, etc.), CAM has not fully realized it's potential in the realm of Third World public health (which in my mind, is all the more reason to stir up some excitement within the healthcare community!).

There are no doubt many dedicated individuals out there in the field of alternative healthcare who are currently battling the injustices of structural violence - they simply don't belong to any umbrella organization which would make their presence strongly known. I will put some more thought and effort into tracking down some sources if you think such a program would have merit. In fact, I do know of one such individual who is currently serving in an administrative role at my chiropractic college: Dr. Lester Lamm served as a chiropractor in Nepal for a number of years prior to returning to America to practice. He is a flamboyant individual, an animated storyteller, and a gifted speaker. He would actually be a perfect fit for the program now that I think about it. If you are interested, I could bring the idea to his attention. He would be in a better position than I to know of others in conservative care with a vested interest in this topic who could also contribute.

Thanks again for your time Dr. Malek,

Sincerely,

Martin Hughes

Dr. Malek Responds!

After tuning in to several Public Health Radio programs, I wrote Dr. Malek about the possibility of broadcasting a program discussing the potential role of complementary alternative medicine (CAM) in the continuum of public health strategies in the developing world. Dr. Malek responds to my queries:

Martin,

Thanks for the positive feedback on Public Health Radio. No problem creating a link to your website.

I've thought of attempting to do a show on Complementary and Alternative Medicine, and may eventually air a show on the topic. But there are several obstacles:

1) The main obstacle is that the various alternative traditions have as little in common with each other as they do with traditional Western medicine - historically, in terms of their theoretical underpinnings and also in their approaches to various clinical problems. This means the topic is actually quite huge - far too large for even several shows to do each modality justice (e.g. Chinese herbal medicine, Native American medicine)

2) There is little scientific basis for what I recommend in the vast majority of clinical situations I face. Based on what I've seen and read thus far, this is true for at least as high a proportion of CAM - probably a much higher proportion.

3) Public Health Radio primarily uses a public health model: looking at the health of specific populations (Haitians, Afghanis, etc.), public health vectors/threats (factory farms, polio, hypertension, the commercialization of medical research), and the delivery of the small number of proven effective interventions (polio vaccine, pap smears).

So I prefer to start with public health problems, rather than treatment modalities, and therefore I don't generally air programs on new drugs or other treatments. This doesn't mean they're not important, but that topic would more appropriately run on medical shows.

What were your thoughts on this? Who did you have in mind as a possible guest?

Marvin Malek

Public Health Radio

For the past five years, Dr. Marvin Malek, an M.D. from Montpelier, VT, has been producing a monthly radio program entitled Public Health Radio, which is available for all to listen to on the program's website, publichealthradio.org.

The hour-long program runs the gamut on public health issues, discussing both domestic and international health dilemmas and triumphs with key interviewees in the field of public health. Topics include landmines and their victims, the effects of urban design on public health, and women's reproductive health in the developing world, just to name a few.

It will take me some time to sift through the 64 programs already available to the public, but a few of my early favourites include programs #16, 38, and 51. Program #16 consists of an interview with my own hero in public health, Dr. Paul Farmer, who discusses the delivery of healthcare to his patients in Haiti's Central Plateau and the broader implications of wealthy nations intervening in the affairs of developing countries. Program #38 discusses Canada's health care system as a model for the U.S. to emulate (which is always an interesting and controversial topic). Finally, program #51 addresses the ever-increasing impact of factory farming on public health issues.

Dr. Malek is to be commended for his dedicated efforts in bringing important health issues to the attention of the general public. Please visit his site if you get a moment and listen a few of his broadcasts - the topics are well worth a look.

The Illuminati of Tibet

Photo contributed by: Tamdin Wangdu, Founder of the Tibetan Village Project (TVP). This photo was taken during TVP's 2005 Cultural Immersion trip to Tibet. Check out TVP's website to find out more about the 2006 TVP Cultural Immersion trip leaving for Tibet in mid-June.

An Evening for Tibet

One of the coolest things about living in Portland is being able to ride the MAX light rail line out to the airport to meet guests at PDX. A five minute walk from my house brings me to the nearest MAX line hub. From there, it is a 20 minute cruise out to the airport in north Portland to meet the newly arrived.

I recently had the occasion to make the airport run a few weeks back. It's rare that I get visitors coming in to Portland, so when a friend or family member does come to town to visit, it's a big deal. In this particular case, I had not previously met my guest. We had exchanged one phone call and many emails, but I had never met Tamdin Wangdu in person.

Let's back up several months to the moment where my friend Jess Barr and myself decided to host a fundraising and awareness party for the organization I will be volunteering with this coming September - the Tibetan Village Project (TVP). My thought process was thus: if I am going to be spending time volunteering with an organization, it would be a good idea to form an intimate connection with the causes they support, and what better way to create this intimacy than by hosting a fundraising and awareness party on their behalf?

It took Tamdin all of about 5 seconds to respond to my suggestion, indicating that he himself would be able to join us from his base of operations in Westminster, Colorado, for what we were dubbing "An Evening for Tibet" - a fundraising party sponsored by the newly formed Portland TVP Friendship Circle.

Tamdin had recently received a speaking grant which allowed him to reach a broader audience across the U.S. by helping to cover his travel costs. So with the promise of the Founder and President of TVP joining us for the event, my team of willing volunteers and I set about preparing for the event in earnest.

By the time Tamdin arrived in Portland on May 5th, 2006, all of the critical components of the party had been taken care of and we were left with only some simple fine tuning to pull everything together. I met up with Tamdin at PDX early in the morning on the 5th. We immediately hit it off, discussing all aspects of grassroots/NGO work in Tibet. It was quite easy to recognize Tamdin as one of those rare individuals who possess a genuine authenticity - the type of person you can learn volumes from just by being in their presence. Add to that natural presence his compelling and inspiring personal story, and you begin to understand where the man's motivation comes from. He is like a live version of the energizer bunny, always thinking, planning, and acting selflessly on behalf of his charges back home in Tibet.

We spent the rest of the morning of the 5th shopping for print/calligraphy frames for the party's silent auction while discussing TVP's work in Tibet. Later in the day we met up with Steph, a good friend and super-volunteer, who chauffeured us around to the local grocery stores who managed to hook us up with an utter bounty of food donations. In the evening, we prepared some of the food for the following day, slicing up potatoes, peppers, and other veggies. Before retiring for the evening, Tamdin and I prepared a quick meal consisting of donated red bell peppers and boiled potatoes. And then something really funny happened: Tamdin had an extra potato that he was too full to eat, so I suggested he take it home with him to eat later when he got hungry. I don't think he actually wanted to eat it, but instead of offending me by throwing it in the compost bin, he carried the potato around with him all weekend! In fact, just the other day I found the small boiled potato tucked away in a little nook outside of my house, on the way out of the garden (three weeks after the party!). Tamdin must have left the potato there just before he left for his departure flight on the Sunday evening after the party. That's just the type of guy Tamdin is.

Everything came together beautifully on the day of the party, May 6th, 2006. The venue, Jess Barr's house, was transformed into a Tibetan stronghold fortified with prayer flags, mantra banners, and incense. The kegs were situated in a strategic location in the backyard, which also happened to be the staging area for our incredible musicians, Bright Red Paper and the Hank Hirsh Quintet, who freely volunteered their time and talents to enrich our lives with their music and generally make the evening a magical experience.

While the kitchen crew was busy preparing the mountain of food that would sate the appetites of our guests, Tamdin and I put together the silent auction display. Tamdin had brought with him from Colorado about 20-25 authentic Tibetan handicrafts made by Tibetan artists themselves through the Artisan Training Center in Lhasa, a cooperative initiative sponsored by TVP to train Tibetans in the traditional weaving arts (as a form of cultural preservation and a real source of livelihood for Tibetan villagers). Tamdin also brought with him a number of his own calligraphies - beautiful, purposeful brush strokes promoting the great tradition of Tibetan calligraphy as an artistic medium. These calligraphies proved to be very popular with bidders during the silent auction.

Just as the last batch of food was coming out of the oven, the Hank Hirsh Quintet rolled into town and began jamming in Jess' backyard. As the smooth jazz sounds wafted down the driveway to the level of the street, our guests began showing up. Despite the weather not being optimal (i.e. overcast and cool), the rain held off and we were able to move ahead with our plan for an indoor/outdoor event.

The parade of guests never amounted to a torrent, but rather, was sustainable and consistent. I would be lying if I said I wasn't a little disappointed by the general turnout, as only about 1/4 to 1/3 of the numbers I expected to show up actually showed up (particularly disappointing because everybody had a formal invitation in their hands at least one month before the date of the party). Thankfully, the success of an event like this is not based on how many people step through the door or by how much money people donate. Rather, success is measured in terms of the impact the event has on people when they witness others digging in their heals for a worthy cause - taking a stand for something that is right, something that has deep meaning and significance for people living very different lives than our own. Besides, the people who showed up at the party truly wanted to be there and that created an infectious energy we all drew from.

The highlight of the evening was Tamdin's powerpoint presentation on the work of grassroots organizations such as TVP in rural Tibet. We brought the projection screen and projector indoors for a more intimate setting to listen to Tamdin speak. All in attendance were moved by Tamdin's personal story of hardship and struggle on behalf of his fellow Tibetans. The presentation made it obvious just how far a little assistance goes in a place like rural Tibet; that is, how sustainable and culturally appropriate development can preserve cultural identity/self-esteem while providing locally relevant educational opportunities for youth and effective healthcare for communities.

Following Tamdin's presentation, guests headed upstairs to the parlour to listen to the chill musical stylings of Portland's very own Bright Red Paper who filled the house with song. Just as Bright Red Paper was winding down their set, an impromptu drum circle broke out in the parlour. What's a party without a late night impromptu drum circle? I couldn't imagine!

When the dust had settled and the last dish had been washed, all of us who worked so hard to make the evening a success breathed a collective sigh of relief. We had done it. Despite a lower turnout than expected, we had succeeded in making the evening a special event, and Tamdin's presentation really brought the purpose of the party into clear focus for all of our guests. With a deep sense of satisfaction, we all retired to bed.

Sunday May 7th, 2006, saw Tamdin back out on the speaking circuit. Tamdin was the guest of honour at a speaking engagement with the Portland Tibetan Community hosted at the Northwest Tibetan Cultural Association headquarters here in town. The Tibetan community opened their hearts to Tamdin and TVP by providing some very generous donations towards TVP's educational projects. All told, Tamdin and TVP left Portland with over $2600 USD in donations. Our party raised $1500 USD and the Tibetan Community donated the remaining $1100 USD.

A recent letter from Tamdin identifies how these funds will be distributed to support of TVP's projects:

I had the opportunity speak with our project people in Tibet last night and they are thrilled (as am I) to hear about our productive weekend in Portland last week (with regard to both the spirit of volunteerism and acts of compassion). The Tibetan Village Project raised $2642. Of that, $1560 was from the event at Jess’ house through donations at the door and the silent auction. The remaining $1,082 came from donations and sales during my presentation hosted by the Portland Tibetan Community. Here is where the money will be used:

$1560 for Mobile Clinic: The mobile clinic program of the Tibetan Village Project provides additional resources to our village-based clinics, and travels to villages that don't have doctors in residence. The mobile clinic unit consists of two doctors, a pharmacist, two hygienists, and a supporting vehicle which provide basic, yet critical, medical treatment and prevention through health education. Depending on the location of the village, road conditions, and number of patients, each mobile clinic visit usually takes from one to three days and can benefit about 275 patients at no charge.

For the months of June and July, the mobile clinic that your team has sponsored will travel to remote villages throughout Tibet. We expect to benefit about 300-400 villagers during these two visits. Those patients who are critically ill will receive medical treatment and the remaining villagers will participate in our health education session. Please click here to view photos of our medical work.

$1082 for School Supplies: Through sales and the generous donations from the Portland Tibetan Community, Tibetan Village Project raised $1082 on May 7th, 2006. This money will be used to purchase textbooks, notebooks, pens and pencils, and bags for school-age children. Depending on each school’s need, we expect to reach at least 200–300 students. Tamdin and TVP’s other volunteers will come back from Tibet in mid July with photos and stories to share. Please see photos of our kids that we have helped in the past.

On behalf of the Tibetan Village Project and the people we serve, I would like to thank you all from bottom of my heart. I look forward to staying in touch and keeping you posted on project progress.

Sincerely,

Tamdin

I would like to take this opportunity to personally thank a number of individuals who were swept up in the spirit of volunteerism and graciously gave their time to help with this event.

First, I would like to acknowledge Ms. Stephanie Abbott for successfully soliciting food donations from local grocers, distributing advertisements for the party, and essentially owning the kitchen on the day of the party. Steph, I can't thank you enough for your help - you truly are my hero. In terms of the food preparation, a big thank you also goes out to Ecole and Marcy for their dedicated help in the kitchen.

Second, I would like to recognize the contributions of Ms. Tenzin Kalsing for welcoming Tamdin to Portland with open arms and introducing him to the 300 member strong Portland Tibetan Community. Tenzin also provided decorations for the house, which helped to create a very festive atmosphere. Tenzin also spent a significant amount of time at the door greeting guests and collecting donations. Thank you so much for your help and advice Tenzin - we couldn't have done it without you! Maybe next time you will even let us take a picture of you!

Third, I would like to thank Ms. Jess Barr for the generous use of her house as the party venue. It is not an easy thing to open up your house to 70-80 people, and I feel blessed to have such an accommodating friend. Jess also put in some serious effort to get our kegs donated, but this proved to be a more difficult task than originally anticipated. Jess also performed myriad other duties which flew just under the radar - the unheralded tasks which are essential for the smooth functioning of such an event, but which are not high profile or glamorous. Thanks again kiddo!

Finally, I would like to acknowledge the contributions of our artists Bright Red Paper and the Hank Hirsh Quintet. I can't say enough about the spirit of generosity exemplified by these cats. My hope is that they enjoyed the event as much as we enjoyed their music. Also, I would like to thank Mr. K. Austin Hackett and his associate Peter for collecting some priceless video footage of the event. I will cherish those images and what they represent for a long time to come.

Before Tamdin left Portland on Sunday May 7th, 2006, I had the opportunity to sit down and conduct a one-on-one hour-long recorded interview with topics ranging from health and human rights to the future of the international NGO movement. This interview marked the beginning of a documentary film project aimed at promoting volunteerism as a fulfilling and sustainable lifelong vocation. This is the direction I want to see humanity move, and therefore, this is what I will promote in my own work.

If anybody is interested in purchasing one of Tamdin's original calligraphies, please send me an email at: mdhughes862 [at] hotmail [dot] com. Also, be sure to check out a brand new Photo Album feature in the sidebar, where you can find pictures from the recent TVP fundraiser.