As I struggle to maintain seiza (traditional Japanese style of sitting) and eat comfortably from the ground-level table, my attention is refocused on the 87-year-old man in front of me. Despite having double cancer of the stomach and lung, he dances jovially with his compatriots, all of whom are around the same age. What makes this scene even more interesting is that I’m the only one younger than 30 in a room full of nearly centenarians contemplating what made them so full of vigor and life.
Nearly three years ago, I had the opportunity as a family medicine resident to complete my global health project in southern Japan. In the small community of Kaita, I was tasked to employ the principles of family medicine and reinvigorate a community to leave it better than how I found it. The problem was I found such a great community full of elders with so much camaraderie and shared wholeness in that I didn’t see any problems. However, the idea behind my project was not to pose a research question and answer it, but it was instead asking the community what it needs.
This line of thinking is community-oriented primary care, a system-based approach that aims to ascertain the needs of the group from the members themselves and implement sustainable changes. The community-oriented primary care model consists of four stages: 1. Define the community; 2. identify health problems; 3. develop an intervention; and 4. monitor the intervention.
In the Kaita community-oriented primary care project, we focused on the elderly community and through my initial meetings I found behind a vibrant youthful community of elders, there were also frail elderly living alone and often not coming to the hospital for care until things were too late. Upon further community research, there appeared to be a sense of mistrust between the aging and the hospital in the region.
Even further beneath this was a reluctance to ask for help. I found this to be a cultural theme on my visits to Japan as people don’t like to inconvenience the collective whole. After realizing the problem, we performed focused questions among the community and came up with a transportation service for patients in need, which overall increased utilization of services and preventive care. The results are still ongoing.
As a doctor in a new community now amid a global pandemic, the principles of community-oriented primary care hold even a deeper meaning for me now. I find myself working with different groups from medical students to the elderly at the Osher Lifelong Learning Center at the University of Texas Medical Branch.
The common glue that holds communities together is curiosity and connection. Especially in these times of stress, we can lend an ear to those around us and help them work through their anxieties by just listening. I find myself “doing” all the time as a physician, but through the community-oriented primary care model and global health, sometimes all it takes is an attitude of curiosity to help foster a positive change.