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Having completed all of the stoves one day ahead of schedule (with the exception of a required repair) we raised money among ourselves, purchased and installed an institutional stove for the elementary school. The kindergarten children and teachers would have otherwise remained exposed to the smoke from the large open fire used for their meals. The sun smiled on us today and we were able to spend all of our remaining time in outdoor activities with the community. The elementary school children were involved in song and dance, Aimee and I broke out into a spontaneous Cumbia (a Latin American dance) unfamiliar to the children or their watchful mothers who all seemed to find it amusing.The closing ceremony was a long series of long speeches by religious and civic dignitaries. This must be the same the world over. Finally however, we were presented with gifts of local crafts. That part of the ceremony was touching and unexpected.At the conclusion we had a very nice meal prepared in part on one of the new stoves we had installed the day before. There was plenty of pride to go around, both on the part of the women who prepared the meals, and those of us who built the stove.The remainder of the day raised many more questions than answers and at my end of the dinner table there were intense discussions. Are we making a difference? If so, how and when will we know? Is there adequate monitoring of the metrics of success? Some of us discussed an unintended consequence of the march toward prosperity in this village. Snacks in small bags are now becoming widely available. Although there is an effort to teach oral hygiene, it appears that tooth decay may be rapidly encroaching on a population that seems to have had excellent teeth, in fact I was told that the decay is much less an insure in the poorer villages. Very young children have rotted primary teeth and among young adults I saw a striking contrast of an occasional individual with perfect looking dentition among peers with almost no healthy teeth.So...questions, not answers. The "triple aim" concept is gaining currency among those discussing needed change in the American healthcare system. The first aim is "improve the health of populations." It seems to me we once called that "public health" and with this experience it seems a bit pretentious for the medical care delivery system, built around treatment and rescue to think it will reinvent itself as a vehicle for improving population health. Our brethren in public health services have thus far been kind enough not to remind us too stridently that this emperor has no clothes.
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