Health guru preaches personal responsibility
HUNTINGTON, W.Va. -- He's a mild-mannered man, small, soft-spoken and serene. Behind the quiet demeanor beats the heart of fierce warrior in the battle for better health in rural Appalachia and underserved areas abroad.
That's Richard Crespo, a professor in the Department of Family and Community Health at Marshall University's Joan C. Edwards School of Medicine, a nationally recognized force in community health.
Inspired years ago by the high infant death rate he encountered in the mountains of Ecuador, he preaches a grassroots approach to better health built on disease prevention and instilling good health habits in childhood.
His arsenal includes rural and school-based health centers, diabetes coalitions, student dental screenings, peer-to-peer prenatal care and creative touch-screen projects to combat childhood obesity.
A self-help guru, he believes fervently in a simple premise: Healthy people take care of themselves.
"My parents were missionaries. My father is from Puerto Rico, and my mother is from the United States. I grew up nine years in Colombia, South America; four years in the States and four years in Puerto Rico.
"I was 6 when we came to the States the first time. When I was 10, it was back to Colombia for junior high. My parents left the mission field about the time I was in high school, so I went to high school in Puerto Rico.
"I wanted to be like my dad. Mission work was the predominant thing. Living internationally gave me a perspective about living elsewhere that I wouldn't have had if I had just grown up in the States.
"Colombia was a relatively poor country when I lived there. I saw a lot of poverty, people living simply with almost no conveniences. I clearly saw the need.
"I got my master's in community resource development and my Ph.D. in curriculum research and development at Michigan State and applied all that to the health field.
"I got my master's in '76 and got a job with an organization that did community work internationally. In 1979, through that organization, I went to Ecuador and opened an office for them to do community health work.
"For the most part, I worked with indigenous organizations. Ecuador has a sizeable indigenous population. At that time, it was highly segregated. The indigenous people lived in discreet areas. There were no Hispanics or Latinos.
"Like discrimination anywhere, they had limited resources, limited access to government services and minimal education and health care.
"When I first came to Ecuador, I worked with the indigenous people living in the mountains in harsh climate areas. On my visits, I asked typical things -- the family name, the number of children. It was in their culture to say, 'three live children and four dead.'
"I would say, 'Oh, that's too bad. I'm so sorry.' But hearing this from person after person, I discovered that was the norm. Approximately half their children died between childbirth and 1 year of age. Typically, they did not name their children until the child got to be 1 year of age and they knew the child would live.
"We organized some community health work, got preventive things going and sanitation -- clean water was the most important thing. We improved birthing practices and nutrition and set up childhood immunizations and helped them get better access to government health centers.
"Three years later, I asked community health workers how many children under 2 had died that year. They said none. One guy raised his hand and said they had one child die. He was hit as he was playing along the road.
"I lived in Ecuador five years and during that time, I got my Ph.D. I moved to the home office of MAP (Medical Assistance Programs) International in Georgia for another three years, and that gave me contacts with people and places around the world.
"One of the things I did in the home office was put on workshops on implementing community health programs. A couple of faculty members attended from Marshall, and I was invited here to lead a weekend seminar.
"My position here is a research and service appointment as opposed to teaching. I don't teach any classes. I came to Marshall in 1991.
"The Centers for Disease Control had a program to organize community groups to do community health work similar to what I had done. The context was different in the United States, but it was the same idea of getting people in the community involved in healthy eating and physical activity and availing themselves of preventive services. My experience lent itself to working with organizations here trying to do similar things.
"Some of first places I worked were in Fayette County and Lincoln County. This department has a strong relationship with Lincoln Primary Care, so I helped them organize a number of community programs.
"One of the first areas was in prenatal care. About 50 percent of the women in prenatal care smoked. There was a great lack of understanding in how to take care of themselves during pregnancy. The things we told them in the clinic environment were hard to remember at home.
"So we had a nurse in Family Care train a couple of the women in the prenatal class to be prenatal care health workers. They would make home visits to other pregnant women and give them advice and helped them get their visits with health care providers. That was a fun project, getting peers working with peers.
"About that time West Virginia, with Benedum Foundation support, was beginning to establish school-based health centers in rural areas.
"You've got to start early getting people engaged in taking responsibility for their own health. People who are healthy aren't healthy because they are going to the doctor. They're healthy because they're taking care of themselves.
"We have a lot of chronic disease, a lot of diabetes, but West Virginia is not any worse than anywhere else. Well, we do like to say, 'Thank God for Mississippi.'
"Wherever you have the combination of low income and low education and limited access to health care, you are going to have a lot of problems with chronic diseases.
"If you compare people who live in those conditions, whether in New York or Texas or Mississippi or West Virginia, problems are going to be the same. Proportionally, West Virginia just has more people in those circumstances.
"One of the things we're involved in is the relationship between health and school performance. We're working with 10 school-based health centers, and they're identifying a core of sixth-graders who are overweight and inviting them to participate in an obesity prevention project.
"Working with school health centers, we have developed a touch-screen program that invites students to do a basic health assessment based on eating five servings of fruits and vegetables a day, two hours or less of screen time a day outside of school, one hour or more of vigorous activity and no sugary drinks. Those behaviors have been shown to lead to healthy weight.
"Then they are invited to do an action plan on the touch screen. At first, we had the survey and the action plan on paper and no kid would fill it out. The moment we put it on the screen, we barely have to ask them to do it.
"Oral health tends to be a neglected part of health care. Kids and families are even less likely go to the dentist than to a doctor. So with support from the Benedum Foundation and the Appalachian Regional Commission, we established a program to give a community group a small grant to organize an annual screening of children's oral health in schools. A dental hygienist comes to screen students' teeth and recommends follow-up care if indicated.
"It's the same concept of school-based health centers, taking health care to where the kids are instead of expecting kids to go where health care is.
"Another area is diabetes coalitions. We've helped 66 diabetes coalitions get going in nine Appalachian states. It's a matter of helping people make their own plans, the sense by people in the community that this is their project, not Marshall's. All we do is help them with training and tools.
"I'm able to help a lot of people and that is gratifying. I'm very satisfied with the trajectory I've had in my life and can't imagine doing anything differently.
"I still go abroad but a little less than what I used to. Last October, I was in Guatemala working with pastors and leaders from the Nazarene church, helping them think through an integrated way to minister socially, physically and spiritually to the people in their communities. In January, I was in Honduras training new community health workers.
"I'm a tree farmer. I have 12 acres north of Proctorville where I grow hardwood trees. Because of my travel, I can't have a garden, so I plant trees. It's something I can use my land for that doesn't need daily attention." Reach Sandy Wells at firstname.lastname@example.org or 304-348-5173.