THE
CHRONIC STRESS OF POVERTY
It is way past 7pm, and I have just returned
to the Blue House after a day at a Medical Clinic, in an isolated part of this
country, For the entire day, while feeling elated at the work we are doing, one
becomes aware of the stress that Poverty alone can put one through.
By the forward vision of some of their
ancestors, the clinic services are one of the few bright spots in their life.
First of all, they are treated with respect, plus all the services are offered
free, including all the medications and investigations.
Is there a big line outside my door in the
clinic? No.
The priority of my patients is the Poverty
they face rather than the sociocultural, patient oriented specialist service
that I can offer in conjunction with some dedicated nurses.
A woman, who is barely in her forties, says
I am going to be a Grandmother for the fifth time! Her son, who is sixteen, has
made a girl pregnant, third in a series! Near my office is a big open jar of
condoms any one can pick and choose and all the family planning services are
offered free of charge!
Why then a sixteen year old, going around
getting girls pregnant? How old are these girls, fourteen in this case!
She is a pleasant looking woman; I have
known her for most of my time here in this isolated village. I was in the
hospital recently, she says calmly, I was shooting up a drug and something went
wrong and my whole arm was infected! She does not flinch as she gives me
details of her life. She was thrown out of the temporary shelter of her own
daughter’s house, before that she was thrown out by her own mother. She cannot
remember the last time she was gainfully employed.
Please don’t judge this woman, she could be
your sister or mother of your children, but the circumstances are different,
she lives in poverty and in an isolated village where there is no access to
almost anything except a clinic where she is welcomed by a doctor and a nurse
she has known for a while. By the laws of this country I cannot prescribe
narcotic medications, so that is not why she is coming to see us.
A little respite from the problems of the
day, and night. A place she knows she
has friends, someone who would receive her with a smile, would not judge her,
treat her as a human being, medically help her, before she disappears into the
dark hole of desperation and suffering with no end.
I spend as much time as she wants; get her
the medications, the e nurse making all the necessary arrangements for further
treatment for her failing kidneys.
I don’t wish to discuss nutrition with you,
I tell another patient, because I would cry at the end. They have no fresh food
available and donations arrive in cans and all their attempts at being self-sufficient
have been squashed by many government programs of help.
A school teacher arrives, at least she has a
job, and the majority of my patients does not or cannot get jobs. Stress at
work is driving up her blood pressure and we spend time talking about how to
deal with stress. She is actually worse off than people who do not work, since
her income precludes her getting assistance with food.
A pharmacist comes to reconcile the
medications and we find that most of them are on medications prescribed by
different providers, majority of the patients deny taking any of the medications
on any regular basis. A great help indeed since we see the influence of much
peddled drugs on the providers they had seen elsewhere.
Two nursing students arrive and they cheer
me up a bit, as I tell them about the importance of a Nurse in such a situation
and the socio cultural aspects of suffering and ill health. The students are from middle class white
families and for them these patients could as well be from Mars!
Another drives 90 miles having failed to get
much attention at the nearby veterans facility and the entire hour is spent on
convincing him the necessity to coordinate his medical care. After many a
telephone calls we are able to get him a regular supply of his medications, but
it may be already too late, as his kidneys were failing. He says to me proudly,
if I live another 15 years, I would become the longest living member in my
family, Poor people live way less years than the middle class white people in
this country, in the case of my patients, the difference is close to 20 years!
Because of the nature of our patients, we
can accommodate only about 8 or 9 patients in the course of a long day. Towards
the evening I was getting emotionally drained. I had just travelled 4500 miles
by air and 100 miles by car to get to this isolated spot.
I was happy to be here.
And I told the pharmacist who had come to
help, as you have seen, these people need more than just medications, they need
counselling, they need respect, they need comfort, they need friendship , the
old fashioned friendship with tenderness, a non-judgmental look at their face
and try to make them smile.
The highlight of the day was telling a young
man that the Testosterone injections he has been receiving are not medically
necessary. His face just brightened up as he thought he was suffering from some
incurable illness. I had requested that the laboratory tests be sent to a
reputable laboratory in California which returned normal values for this young
man who had been given testosterone injections because he had complained of
tiredness, and a laboratory value showed him to have low testosterone values.
The smile on his face was priceless!
I did enjoy my Cuba Libre…now to catch up on
some medical literature while the silence of this village is so conducive.
Soon I would leave to join my Cuban
Colleagues who work tirelessly along the Amazon River to bring preventive
medical care to isolated communities, but these people, with whom I was today,
whom I have known for a while now, would be in my heart.
You may wish to guess which country this clinic
is located?
It is in the richest country on earth, The
United States of America.
