Cultivating primary prevention: the mechanised agricultural approach.
Just the other day I was fortunate enough to visit one of our local grain farmers on their land. All over our corner of the Eyre Peninsula, hard working farmers are driving neat patterns in their combine harvesters (headers) collecting wheat, barley and other crops. Interestingly enough, our patient numbers have fallen steadily during this time. It seems that most of the community is too busy harvesting to be sick! Subsequently one afternoon, I only had two patients right after lunch. An early day! I’d spoken earlier in the year with a patient about visiting his farm and seeing what goes on around harvest time. After half hour driving east of town, I arrived to be greeted by a gargantuan green machine. There had been plenty of them parked in an empty lot next to the medical centre over the year, but when switched on and heading towards you, they are a different beast altogether!
Obviously things have changed a lot since the humble scythe, kyphosis and a headscarf. These days, the operator sits in air-conditioned comfort with a pre determined track and auto steering. The on board computers can tell the farmer the current yield of the crop and let him calculate (with SMS prices popping up continuously) how well they have done for each field. Looking out through the huge unobstructed windshield, you are able to see everything happening. From being plucked from the ground to being stored in the back of the header, a piece of grain has an amazing journey. When the comb at the front cuts the head of wheat, it is fed into the header by some conveyer belts. Inside, the stalk and the head are agitated so that the grain can fall below and be placed in the hopper for further use. The stalk and left over husks are then spat out the back into the field.
It got me thinking. Could we apply this same principle to primary health care and prevention? Watching the header bear down on me first and then seeing the wheat collected into the machine to get sorted gave me an idea. Often general practitioners, community nurses and health promoters have difficulty encouraging the public to connect and participate in health prevention strategies. One simple reason for this reluctance to attend may be that these approaches rely on self-directed changes. Eating less sugars/salt/saturated fats, exercising more, cutting out smoking and reducing alcohol. Stopping all the things that people can enjoy. But these are also all essential elements in reducing serious preventable health issues such as diabetes and CVS disease.
I propose this. Rather than relying on self-presentation, family members nagging or proactive health workers, we construct a transportable health prevention vehicle. “But Gerry!” I hear you exclaim, “such schemes exist already.” Ah yes they do (Harold et al), but never before like this. The Combine Health Harvester (CHH) will function in a similar way to the headers currently out in the fields surrounding our medical practice. Gathering then triaging the wheat from the chaff. The process by which the harvester can increase health officer access to patients with poor health lifestyles and then do something about it follows:
- Unsuspecting patients scooped off the street by scoop
- Channelled into the back of the harvester
- There, a BMI, blood glucose, blood pressure, and SNAP history taken, nicely.
- If enough risk factors exist, the patient will be kept inside the harvester for delivery to the local clinic.
- If the patient is healthy, they will be deposited back onto the street. Then left to continue their daily business with a healthy lifestyle pamphlet in hand.
Once dropped at the clinic, the patients assessed being at high risk can be tested further and referred to specialist care if needed. The technology and policy for the harvesting and patient education are already here. We just, in the words of the machine itself, need to combine them. Now just to pacify those civil libertarians….
DISCLAIMER: This blog post is intended to be taken entirely as parody and humour. If it has not been, then perhaps you’d better go outside and get some sun. Our capture methods in Wudinna are currently much more crude than stated and will be refined in time. Thank you for your patients (sic).