Be thankful if you do.
I got an e-mail last night from Dr. Ralph Freidin of Lexington, Mass., a primary care doctor who participated in last Saturday's free clinic. He's written an article about his experience. He's seen above in a brief clip taken at the clinic.
What, he asks, is wrong with a country that cares so little about the small person. Why so much talk about the cost of reform and not the cost of failure to act?
Suffering in Silence in Little Rock
They began to line up about 45 minutes before the doors to the one-day health clinic opened. The event, organized by the National Association of Free Clinics, was going to provide free medical care to anyone wanting to be seen as long as they did not have any health insurance.
Perhaps because I have had 40 years of experience practicing medicine, I was assigned to be the person to look for anyone in the line who needed urgent care. As the line grew I made my way through introducing myself and asking how we could help them today.
In the first hour of speaking to over a hundred people, (ten percent of all those seen) I saw five middle aged men with untreated hypertension all with diastolic pressures of over 100. Standard medical practice is to treat a diastolic pressure greater than the low 80’s. Two of these people had not seen a doctor in more than two years and the others had not seen a doctor at all. Either they did not have the cash or the insurance. The two who had been to the doctor were not taking medication because they could not afford it.
Sitting in a wheel chair in the midst of the crowd was a middle-aged man with below knee amputation who hoped that we would be able to help him obtain prosthesis. He had some medical insurance but it had just denied his request sinking his hopes to be able to walk again so that he could return to his job as plumber and support his family.
There was a woman who had cancer treatment two years ago but was unable to continue with her care again because she did not have insurance. But it was not her cancer that was her concern today of. Her face was grimacing with the pain of a terrible toothache that she had been suffering with for the past two weeks. Again - no insurance, no physician, no medication.
Then I spotted a woman off to the side of the line wearing a trench coat to cover her emaciated frame. She did not have an appointment but had had three grand mal seizures in the past two weeks. A week ago she had been seen in a local emergency room where she was told that anti seizure medications was “OK” and then discharged without arrangement for any follow up. In addition to her uncontrolled seizures, she had terrible dental pain such that she could not eat. I could only see the roots of her teeth. There was not an intact tooth visible.
Leaning on the railing was a woman panting after walking a half a block to get in line. She had no asthma medication and had not had any in more than six months. Behind her was a thirties year old man who had already been given a wheelchair because he was having difficulty breathing. In a soft voice he said that he had just been discharged from the intensive care unit of a local hospital where he had been treated for swollen ankles and shortness of breath. He was not sure what was wrong with him but for the past month he had been having chest pains every time he walked more than a few yards, he was sleeping propped up on pillows, and his ankles had begun to swell. When he was discharged he was given a list of medications that he could not afford, did not understand and arrangements for his continued care had not been made. About an hour after I had brought this gentleman to the front of the line he was being attended by an ambulance crew on his way back to the emergency room with a possible heart attack.
Looking further down the line I saw a young man avoiding any eye contact. His slouched posture told me he did not want to talk but had something very heavy on his mind. Later I heard that there had been three young people who had plans for suicide that had been foiled. I was quite sure that he was one of them.
I knew that I was Little Rock, Arkansas, in middle America. I had seen the Little Rock School District written on the school buses when I visited the Central High School. But I did not feel I was in America - at least not the America of the 21st century that I knew.
It was an emotionally overwhelming day. Sure I had seen patients with these illnesses before but the last time was in my first year of medical school, 40 years ago.
I feel as embarrassed by my profession as I did when I read the hysterical fear generating campaign to block the passage of Medicare in 1965. OK, this time the American Medical Association says that it supports health reform, but I did not see them in Little Rock at the free clinic. Nor were the politicians who brag that a ‘public option’ is something they cannot vote for because they must first think of what is in the best interest of the people of their state. When I juxtapose my experience in the Free Clinic to these self-righteous proclamations, I hear the clarion of hypocrisy. No self respecting educated person could possibly believe that without the impetus of a public option will a private insurance company will ever write policies to alleviate the amount of suffering of so many people I witnessed last Saturday in Little Rock.
What is it with my profession? What is it with those who set policy in an agriculturally rich but morally poor midwestern state? What is it with our county that gives so little value to the ‘small person’?
It is not a question how much reforming our healthcare will cost, it is a question how much it will cost not to fix it. It is a question of equality. It is a question of how we as a nation value our neighbor. It is a question of whether the general public will allow another segment of our citizenry to be marginalized. It is a question of how we see ourselves.
I am convinced that if the Declaration of Independence were written today ‘the pursuit of happiness’ would include access to basic health care.
Saturday November 21, 2009
Ralph B Freidin, MD