Sarah “Jo” Baker MD is still important.

Dr. Baker was one of the first women to graduate from an American Medical School. That was in 1898. She tried private practice for a year, but the country was not ready for women doctors so she gave it up after a year and got a job with the New York City Public Health Department. Her area of the city was Hell’s Kitchen and the massive influx of Irish immigrants created an environment that favored epidemics. Typhoid fever and cholera were the ones she had to cope with. Both are caused by bacteria and are spread by fecal oral transmission. Typhoid Mary exemplifies this problem: she was a cook and wherever she worked typhoid broke out in the family. Dr. Baker was actually the person who knew and identified Typhoid Mary–twice–and finally was influential enough that Mary was put away in protective custody.

In order to cope with these epidemics Dr. Baker began a hand washing education program at the local high schools. It was often the older daughters who took care of changing diapers in their infant siblings, which helped spread the illness the infants who were much more vulnerable. Washing hands interrupts the transmission of the bugs that cause it. It was a good idea, and it worked. It worked so well, as she relates in her biography, Fighting for Life, that “thirty-odd Brooklyn doctors [wrote to the Mayor], protesting bitterly against …[her work]…because it was ruining medical practices by its results in keeping babies well, and demanding that it be abolished in the interests of the medical profession.” (p. 157)

The reason she is still important today is that we have not changed our system. It is still an “illness care” system where doctors, hospitals, pharmaceutical companies, and anyone else in the healthcare family, are rewarded only when people are sick. Something is inherently wrong with that, but we are not going to fix it until we see it. In order to see it we need to change our paradigm or model.

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*Insurance is designed to pay for the unexpected crisis. Health insurance started that way in the U.S. but gradually, because the companies we work for were paying for it and getting a better tax break, it morphed into paying for it all. That means we have less interest in getting the ounce of prevention than if we were paying for some of those costs. Children we talk to about the dangers of drugs just say they’ll get a brain transplant if they burn theirs out. That’s why we think that Health Savings Accounts should be promoted by the government more; they put the individual back in a position of responsibility in making more choices in their health care. With Health Savings Accounts an ounce of prevention is worth a pound of cure.


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