MakeWork and Old Hotels

Social Safety Nets

Homeless

Old Hotels provide shelter for all comers without qualification (unless there is a restraint order against an ex-husband whose wife lives in the Old Hotel, or similar situations). It is a goal of all platform programs not to compete with private enterprise, so no effort will be spent making Old Hotels luxurious. Safe and attractive, but not luxurious. In some climates, they are not air-conditioned. If the carpet is in bad shape, and there is good hardwood flooring or ceramic tile underneath, the carpet will be removed. The important thing is to run such places with humanity, preserve their natural beauty and make them welcoming communities to all who need them, run by people on MakeWork.

By the way, how can an Old Hotel always have an open door, no matter how many show up on a given night? Most travelers will stay in dormitories with triple bunk beds. The rooms will mostly be reserved for permanent residents. If the dormitories fill up, cots and sleeping bags will be brought out. An Old Hotel will redirect some travelers to nearby Old Hotels, but the system as a whole will never turn people away.

Guaranteed Employment

One kind of MakeWork is tending to community orchards and gardens and vineyards and berry brambles and asparagus beds to provide fresh fruits and vegetables to nearby Soup Kitchens in season. Nothing is served out of season, except for crops that go into the cellar, i.e. potatoes, onions, garlic, beets, squash, apples and pears. An overflow of fresh cabbage is turned to sauerkraut. An overflow of fresh tomatoes is made into tomato stock, suitable for soups or sauces, or sun-dried. Nothing is purchased at a supermarket. Corn on the cob is served on the day it is picked, and likewise with tomatoes and melons.

MakeWork is sometimes Make-An-Entrepreneur. In particular, with the cars gone, I wish to re-introduce the pushcarts to city streets, as the easiest way for a person to become his own boss. MakeWork can help and try not to meddle. I can imagine pushcarts that make handmade shoes to a last made from a cast of a person's foot and ankle. Hand-tailored clothes could be done with pushcarts, i.e. measurements could be taken and materials chosen. People too disabled to be on the streets could work in the sewing shops that make the clothes. Most of us have trouble finding clothes or shoes that really fit "off the rack." It also sometimes happens that a particular style that we like is discontinued. The MakeWork artisan can duplicate anything, or design an original to the customer's specifications. These are just a few examples of the kind of unmet needs which MakeWork could satisfy.

The first requirement of both the Soup Kitchens and the food pushcarts is that no one is made sick by eating there! Workers must scrub up like surgeons, put on clean clothes and a hairnet, wear surgical masks and rubber gloves and use tongs to handle food. We must rule out any possibility of Salmonella or E. Coli or viruses being spread from raw food to the finished product, or from a worker to the finished product. Thus, all workers must be carefully checked for infectious diseases before being allowed in the kitchen or behind the serving line. Soup Kitchens should confine themselves to foods thoroughly cooked, such as soups, chilies, baked goods, casseroles, or pickled items.

No One Should Go Hungry

Except for farm fed catfish, no meat or seafood is served, as a way of reducing competition with ordinary restaurants. Soup kitchens are cafeterias. Bags of raw coffee beans are not expensive at the dock, so I suggest that each soup kitchen roast, grind and brew their own coffee. Barley and hops are not expensive either, so I suggest a micro-brewery for every soup kitchen, with a limit of one liter per customer per day. This is a hearty and robust brew. No wine, and no milk, and no more milk subsidies. (Infants should be breast-fed, and the rest of us can get calcium in many ways, from tofu, for instance).

Eggs are pickled on intensive five acre farms, given out as MakeWork. The eggs are delivered in five gallon jars. Cheese is cut from a large wheel of cheddar. Catfish are steamed, skinned and deboned at the catfish farm. So the Soup Kitchens get catfish in cooked, sterilized, boneless pieces each about the size of a lamb chop, to be dried and smoked, barbecued, batter fried, deep fat fried, broiled with dill and lemon juice, pickled like Herring, or served as is with malt vinegar.

Low Cost Housing

The parts for the Underground Village that come out of a factory are all doubly curved, stackable pieces of heavy PVC. This is the same plastic chosen nowadays for waste systems because of its durability. Some of the ideas that have gone into space-station design are applicable here. Many of the surfaces discovered by soap-bubble research are double curved and stackable, and can be combined to form strong structures. They need to be strong to support the tons of dirt we are going to cover them with. They need to be air-tight and water-tight to prevent soil microbes from entering the living space, because most of these soil bacteria produce diarrhea.

But why put them underground at all? To avoid both heating and air-conditioning expenses. Normal underground temperature is about sixty degrees, about the temperature of a typical British summer. So neither heating nor air-conditioning is required. Just sweaters by day and blankets by night. Each home is a ring or a stacked ring of rooms around a central atrium which goes all the way to the surface. The homes themselves are linked to a large central space, with more atria and skylights.

This central space is just like a mall, and the rooms facing the mall can become a Mom and Pop store or workshop of some kind. Each room has an individual skylight above, reflecting the sun to a large diffuse surface. Naturally, the amount of light could be controlled. On the wall away from the central family atrium, each room has a camera obscura, i.e. a large piece of ground glass displaying a scene from the surface above, a scene which may be changed by turning the surface mirror or tilting it. This has the psychological effect of looking out a window. The central atrium is roofed with a flat transparent lid of lightweight, flexible but hard material, i.e. not easily scratched. Such a material may not yet exist. In winter, it seals the atrium, which becomes a closed ecology. In summer, it may be raised a foot or so to allow ventilation. What do we put in our atria? Waterfalls, and orchids, and every botanical delight known to man. After all, an atria is just a kind of recessed greenhouse.

Affordable Universal Health Care

Just what do we want from our medical care system? Most Medicare expenses are incurred in the last months of a person's life, when the prognosis is terminal. Western scientific medicine does little to comfort or ease the patient or the family through this terminal phase. Patients become habituated to opiates, which then lose their pain-killing power. Western medicine denies death, and fears it, fights it to the bitter end.

Do we want our lives to be dragged out for another year or two, in agony, sometimes out of our heads, with tubes running down our nose and needles in every arm, at vast expense, as if death were the enemy? And do we want life to be prolonged in nursing homes, when we no longer recognize relatives or have any idea where we are? Do we want to try to preserve one and two pound newborns, knowing that fifty percent will die and fifty percent of those that live will be permanently brain damaged, when all it takes to prevent underweight birth is a little proper nutrition and prenatal care by the mother? Our answer to all these questions may depend on our metaphysics.

In Seven Facts I provide evidence for immortality, and many already know this --- those familiar with the literature on Near Death Experience or Ian Stevenson's studies of young children who spontaneously recall former lifetimes. Death is a wonderful experience, nothing to be feared. It is not the end, only the beginning of another phase in our infinite journey.

If we strive to make an honest terminal prognosis as early as possible, we can stop treating the disease and begin treating the person, with palliatives in hospices or at home, and with alternative therapies, such as Chinese Herbalism, acupuncture, Tai Chi or the remedies of Edgar Cayce. Hospices should have books, videos and roundtable discussions about Near Death Experience and other witnesses to immortality and the actual act of dying.

Hospitals should not be places to die. Half the beds now are filled with terminal cancer patients, for whom our expensive care is doing nothing but running up the bill and prolonging the agony. Death is not the enemy. For those in agony, or those in a vegetative state, death is a friend.

As for mentally and physically incompetent (and incontinent) individuals presently sent to nursing homes, offer them Dr. Kervorkian's Doctor Assisted Suicide as an option. His method is very similar to execution by lethal injection and produces an easy and certain death, which is not true of most methods of suicide. Everyone should have a Living Will, created with the help and advice of a doctor, setting forth the conditions in which the patient would rather die in peace than suffer. Dying in peace, or dying when ready, can mean "no resuscitation," or "turning off the respirator," or "shutting off the feeding tubes," and in some cases it means Dr. Kervorkian. This is the humane treatment for patients. It is also the only way we can afford medical care for those who can use it, for those who have many good years left of life.

The Free Clinics are bound to be controversial, because I propose staffing them entirely with MTs, instead of MDs. Medical Technicians have one year of training and a salary of $20 - $50,000. Many of them come from the ranks of emergency room nurses or surgical scrub nurses. MDs have eight years of training and an income of $200,000 and up.

Using optical fiber and video, there will be MDs "standing over the MT's shoulder," so to speak, whenever he or she needs help. This will be particularly true of trauma cases, remotely overseen by a trauma surgeon. Surgery in the Free Clinics will normally be laparotomy, under minor anesthesia. If a procedure cannot be done that way, the patient is sent by helicopter to the hospital trauma center, after stabilization. But if that is not possible, the MT may have to plunge in with scalpel and rib-spreader, following the instructions of the remote trauma surgeon.

Much of the training of MTs will go into learning how to use all the high technology to be found in all Free Clinics. He or she will practice the laparotomy techniques for removing diseased or damaged organs and tumors. He or she will learn how to set fractures, close cuts with superglue and butterfly bandages and all the routine stuff. The MT will spend no time learning diagnosis, and will learn anatomy from plastic bodies one can take apart, name, and put back together. MTs will not dissect a cadaver, because a scalpel will be a little used tool in the practice of an MT.

Diagnosis will be done by computer programs written by Doctors and researchers at the Mayo clinic, or similar places, or by the MD "looking over the shoulder" of the MT. As input, we have the results from the standard tests run every time, e.g. temperature, BP, heart rate, respiration, urine analysis, and a statement of complaints, if any. The programs will ask a series of questions, which the MT relays to the patient. Sometimes the program requires additional tests, such as throat cultures, MRI scan, PET scan after drinking radioactive antibodies or a plain old x-ray, or immediate transport to the hospital.

There is one Free Clinic per ward, with the MTs living in that ward, and every Free Clinic is open all the time. This is always the closest and best place to go with trauma, heart attacks, poisoning, drowning, sudden high fevers in children, and all those things that go wrong in the middle of the night.

The Free Clinics should have two pieces of high technology that have so far been expensive. I propose to put them on an assembly line and bring their costs down and their quality up. One of these is the general purpose MRI, PET, and CT scanner for telling where there is a tumor or infection. These could be inexpensive if they used powerful permanent magnets, like those made by the Russians.

To tell what, laboratories presently have an array of devices for separating and identifying molecules or fragments of molecules in the blood or urine. New techniques have been developed to identify molecules, so far used to identify molecules in a Martian meteorite. (See the May 1997 issue of Discover magazine, "The Light on Life," by James Shreeve, p. 50 ff. about the work of Richard Zare with lasers.)

Clearly this work has a medical application. Most diseases can be identified by molecules excreted in the urine. Antibodies to viruses, bacteria, parasites and cancers can be used to identify diseases. Computerized systems can count red cells and white cells on a microscope slide. Combining all such systems so they can work automatically on a single drop of blood or urine, and then mass-producing the equipment to do it, that is the challenge.

Preventions (e.g. vaccination) or early interventions are much cheaper than crisis surgery. For instance, we now know that a program of counseled exercise, diet (ten percent fat), and meditation can reverse the effects of arteriosclerosis. Doctors should look for early signs of heart disease and treat it vigorously with such programs, run by nurse-practitioners. What shall we do with a heart patient told to enter one of these diet-exercise-meditation programs and give up smoking, who does neither? Shall the taxpayers pay for coronary bypass operations or heart transplants for such a person? I don't think so.

The Free Clinic system has three tiers. At the top are the Mayo Clinics and other hospitals with demonstrated expertise at a particular treatment. In the middle is the Free Clinic, where everyone is an MT. Everything is done by MTs, from mopping the floor to greeting patients or keeping electronic charts updated. The Free Clinics are places of gleaming tile and a fanatic emphasis on antisepsis. Today, one out of three hospital patients picks up a bug during their stay, often one resistant to all antibiotics.

The Free Clinics and associated hospitals must be designed so that all surfaces can be sterilized daily, and the air system must filter out all viruses, fungal spores, dust particles and bacteria. However, we may want to follow sterilization with spraying surfaces with a mixture of benign bacteria that can out-compete deadly varieties. Otherwise, our elaborate efforts may just create bacteria that are antiseptic proof, just as we are gradually creating antibiotic-proof bacteria. How do we avoid that? Perhaps by spraying the antiseptic field with benign bacteria!

On the bottom tier are nurse-practitioners, trained and supported by the local Free Clinic. These include midwives, since by far the best place to have a baby is at home. No nasty disease-resistant bugs lurking at home, and no baby-stealers either. Skilled midwives can even turn the baby to the correct position before birth, if they are in the wrong presentation. Home births have only about 1/3 the neonatal mortality rate or maternal complications as hospital births. If you don't believe this statistic, read the book Spiritual Midwifery, which I also recommend for all couples about to have natural childbirth at home with a midwife. This book is published by a Tennessee commune called The Farm, and they compare neo-natal mortality with those for Tennessee hospitals and several other groups of hospitals. My own children were born at home with standard pre-natal care, and with the assistance of an experienced midwife, and me as Lamaze partner.

The Free Clinics make housecalls, if there is a relative or companion that can provide some basic care, such as meals, bedpans, diapers, dressings, and sponge baths. Visiting nurses, portable monitors and drug injection systems, could allow many people to go home.

Quality medical care is not always cheap. Where a large expenditure is worth it, as for the MRI-PET-CT machine, I'm all for mass-producing it, or redesigning it so that it uses permanent magnets.

Often the best medicine is conservative. For instance, no one believes our health is better than Sweden's because we do ten times as many births by C-section. No, this is an indictment, taking a routine procedure (birth) and turning it into hazardous major surgery. Why do American ObGyns do this? Because they are afraid of being sued? Or because they can charge thousands instead of hundreds?

Service-for-fee provides a strong economic incentive to cut, to prescribe, to conduct tests, i.e. to do something rather than nothing. The MTs and MDs in the Free Clinic system are all on salary. They have no financial incentive to do more than is necessary. If you will recall from the Justice chapter, there are no torts in the new law. No suits for damages. No mal-practice suits, or suits of any kind.

Conclusion

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