Dr. Aaron Shirley has devoted his career to serving the rural poor in the Mississippi Delta, but now the 77-year-old pediatrician believes the key to reducing the nation’s highest infant mortality rates lies in a surprising place: the Islamic Republic of Iran.
Never mind that America and Iran broke diplomatic relations after militants seized the U.S. Embassy in Tehran in 1979, or that the White House is seeking new United Nations sanctions to punish the regime for its nuclear development program.
In May, Shirley and two colleagues flew to Iran for 10 days to study a low-cost rural healthcare delivery system that, according to the World Health Organization, has helped cut infant deaths by 70% over the last three decades.
In October, four top Iranian doctors, including an official from Iran’s Ministry of Health, visited Mississippi for a week. They spoke at a conference in Jackson, the state capital, and toured the Delta.
“Sometimes communication was not easy,” Dr. Hossein Malekafzali, a professor in the School of Public Health at Tehran University, recalled in a phone interview. “But they can understand our system and translate it to Mississippi.”
Iran and healthcare are politically toxic topics in Washington these days. But Shirley and a colleague are to go to Capitol Hill today to seek funding to open an Iranian-style “health house” in Baptist Town, an impoverished neighborhood on the edge of Greenwood, and in 14 other Delta communities.
“We played black gospel and blues for those Iranians,” said Sylvester Hoover, 52, owner of Baptist Town’s only business, a one-room grocery, laundromat and barbecue grill. “They were just hugging us they were so excited. They loved it.”
Tensions between the United States and Iran dominate daily headlines, but both governments have given quiet support to the little-known initiative in the Delta.
In Tehran, the Foreign and Health ministries approved a memorandum of agreement to authorize collaboration between Shiraz University of Medical Sciences and Shirley’s team, which includes Jackson State University.
In Washington, the Treasury Department granted the Mississippians a license to ensure they were not violating sanctions on Iran. The National Institutes of Health also signaled its approval.
A posting on the NIH website notes that the “remarkable success of Iran’s health house concept . . . is providing hope and inspiration to officials in the Mississippi Delta.”
Iran has 17,000 health houses, essentially rural medical outposts staffed by community health workers. The proposed Mississippi version calls for training nurses’ aides in each community, and then sending them door to door to help with basic needs, such as taking blood pressure and improving sanitation. The health workers would refer patients to clinics or hospitals for more advanced care and follow up with home visits.
“The community health workers will know who has diabetes, who has high blood pressure, who is 10 or 12 years old and pregnant,” Shirley said. “They will know it because they live in the neighborhood and see them at church or the corner store.”
Over the years, the federal government has poured tens of millions of dollars into primary healthcare research and delivery programs in the Delta, but the effect has been limited.
“The system is broken,” Shirley said in frustration. “It’s time to try something new.”
Mississippi ranks at or near the bottom of most healthcare indexes. Obesity is rife among children, and teenage pregnancies, hypertension and diabetes are all too common. The state suffers the nation’s worst infant mortality rate -- about 50% higher than the national average -- and the lowest life expectancy.
The uninsured mostly go to hospital emergency rooms for basic care, from colds to toothaches. Better preventive care could ease that traffic and lower costs, so local hospital administrators are receptive to a new system.
“People will be skeptical at first because of Iran,” said Paula Lang, chief nursing officer at the 34-bed Patients’ Choice Medical Center of Humphreys County in Belzoni, which is slated to get a health house. “But I think they will embrace the concept when they see how it works.”
Jennifer Tate Hibbler, payroll administrator at the Greenwood Leflore Hospital, the largest in the area, said health workers could help with problems such as identifying children about to quit school because their families couldn’t afford glasses.
“I was a senior in high school before I saw a dentist,” she said. “Our community definitely needs this.”
Shirley’s group is seeking $30 million in federal funds for a three-year pilot project and has lined up support from Rep. Bennie Thompson (D-Miss.), who represents the area. But Thompson said colleagues facing reelection could balk at backing anything tied to Iran.
“It’s fine with me,” Thompson said. “To be honest, anything that can improve deplorable health conditions in the Delta, I’m going to support. Even ideas that are foreign to a lot of people.”
The proposal to emulate Iran came from James Miller, a medical services consultant in Oxford, Miss. He first heard of the Iranian health houses several years ago at a conference in Germany.
“I realized this was a model that worked,” Miller said. “Plus the Iranian model seemed most transferable to the Delta situation.”
He took the concept to Shirley, who has a much-deserved reputation for challenging the status quo in Mississippi.
Raised in poverty, Shirley became the state’s first black pediatrician in 1965. He endured police brutality as a civil rights activist, helped create the state’s largest community health center and won a MacArthur “genius” award in 1993. He now heads a nonprofit group that turned a former shopping mall into a medical center for Jackson’s poor.
Going to Tehran didn’t faze him. “I felt safer in Iran than I felt in Mississippi in the 1960s,” he said with a laugh.
An Iranian American professor at Jackson State University, Dr. Mohammad Shahbazi, reached out to Shiraz University of Medical Sciences in southwest Iran. The university agreed to sponsor a visit, and Iranian authorities approved visas for the three Americans.
“When we went, all we received were open arms and ‘How can we help you?’ ” Miller said. “They were just amazed that Americans would come and ask for their help.”
The Iranians who were brought to Mississippi got a shocking view of rural American poverty when they arrived in Baptist Town.
The blighted warren of muddy streets, weed-filled lots and about 500 shotgun shacks -- each has three rooms in a line so a shotgun fired through the front door supposedly would exit the back door -- is isolated between two railroads and a bayou.
The all-black community boasts a proud history as a front line in the civil rights struggle and a cradle of the Delta blues. The local cemetery is one of three that claims to be a final resting place for Robert Johnson, the blues legend who died in 1938.
But unemployment is widespread. There is no school, medical clinic nor community center, and many occupied houses look as decrepit as those that are abandoned.
In one, retired cotton worker Erleen Smith, 80, huddled on a folding chair by a space heater as a frigid draft blew through her ill-fitting door on a recent afternoon. She had lit all four burners on the kitchen stove to help fight the cold.
She grabbed a pill for her blood pressure, swigging it down with water from a jelly jar. Old vinyl records hung on the wall as the only decoration. She can’t afford a TV, but friends stop by to check in and chat.
Told about the proposed health house, she shrugged.
“I ain’t never heard of Iran,” she said. “But we could sure use somebody’s help.”