Why is so much of the health care system set up for consumer failure?
My doctor referred me to see another doctor. She made an e-referral, "shared" my e- Medical records, and told me all I had to do was set up an appointment. Technology is great, I thought happily. I had no idea that I was about to enter the scheduling Twilight Zone.
Consider this sentence in a message left on my voice-mail hours after I initially called to set up an appointment:
"Then we'll mail you a questionnaire and when you fill it out and mail it back we will review it and then call you to make an appointment. So call back and let me know if I should send it."
First of all, you'll mail a what? I'm not taking the Pepsi Challenge. I'm going to see a doctor. Second of all, I had already called and left a message in the "scheduling" box. Which I was only allowed to do after I did an intake over the phone with someone from Registration. Clearly, I want an appointment. Send the questionnaire if that's a real thing. Why do I need to call back a third time?
Surely I had misunderstood the voice-mail.
The next day when I called I was told the questionnaire had not even been sent to me yet since they had not heard from me. I asked why I needed to fill out a questionnaire and was told "so we can determine which practitioner you should see." At this point I reiterated that my doctor had submitted a referral for a specific doctor in their practice. "That is the practitioner I should see," I pointed out. The secretary told me I still needed to answer the questions and mail it back. There is no way to fill out the form online. I need to receive it, fill it out, mail it back, and wait for it to be reviewed before I can schedule an appointment.
This is insanity to me. In an age where robots perform surgeries, where computers can play Jeopardy, and where I can have ice cream delivered to my door UNTIL 4AM and pay for it with a credit card, why am I watching my mailbox? Don't they know I am rarely home? That I have two jobs? That I just ran out of stamps? Am I being referred to see Dr. Quinn, Medicine Woman? *
As I stood in the hallway at work, trying to let the anger go, it made me think of my patients.
- If I can barely navigate this ridiculous back and forth of voice mails, phone calls and paperwork, how hard must it be for someone without a home? A phone? A voice mailbox? A mail box? Even if a homeless man or woman has a mailing address (and many do), often it is not accessible to them 24/7.
- Add on the fact that seeking help for anything other than acute injury is not going to be a priority for someone on the street, and you have a real barrier to compliance for appointments related to chronic life threatening problems such as diabetes, cancer and AIDs.
- Forget appointments to screen for early signs of disease, such as yearly pap smears for females or colonoscopies for people over the age of 50.
- Plus, when I finally get an appointment I am likely to write it down somewhere, be able to take a (paid) day off from my job and I will drive my car to see the doctor. A homeless man or woman is likely to forget the appointment, or just blow it off due to lack of transportation or the need to be somewhere else at that time (taking care of an infant, standing in line for a bed or food) or in some sad cases, abusing substances to mask physical or emotional pain).
That's why Healthcare For the Homeless programs are so important nation-wide. It's not about cheaper access to services or free care. It's about access to services at all. It's about organizations that can offer rides to the disabled war veterans to get to appointments, or who will help an illiterate woman fill out pages and pages of complicated forms in order to get social security benefits. It's about teams of people who will meet with folks who have been through too much trauma to deal with the type of rejection sometimes faced by patients waiting for care. Just think, I've had to call this woman's office three times so far since my PCP made the referral for me. People with mental health issues, social phobias and histories of being abused probably would not have made the second call, if they made the first one at all.
So as I continue to try to get in touch with Dr. Mike** I am thankful for the structures in place in my life that I often take for granted that will assist in me eventually getting an appointment. And I vow, not for the first time, to do my best every day to address every patient issue that I can, or to put the patient in direct touch with someone who can help them. It can't always happen. Things get busy. Patients get blown off. Especially ones with minor complaints. We triage, we prioritize. But I can try my best.
Because unless I create the care I wish to receive, the system is going to stay broken.
In the meantime, Nurse Sassy Lionheart suggested I just get on my horse and gallop the questionnaire back to the office. You know, to speed things up.
----------------------------------------------------------------------------
* Gosh I hope so. And I hope Sully is there. mmmm.. Joe Lando circa 1996.. That helps. No more anger. Only wild and free "courtship feelings." ****
** Not her real name, obv, but I am assuming she, like the real Dr. Mike, will be bold, outspoken and have all kind of new ideas she learned at the Women's Medical College of Pennsylvania.***
*** If not, this was so not worth it.
**** No disrespect, of course, to Joe Lando's current wife and children. I am glad it worked out for you all.
Showing posts with label homeless. Show all posts
Showing posts with label homeless. Show all posts
Thursday, February 17, 2011
Tuesday, February 15, 2011
Housing for Labor
My role as a provider of health services to homeless men and women does not end the cycle of homelessness. My mission is to provide the best quality health care I can offer to people during a vulnerable time in their lives, whether their non-housed status is chronic or temporary.
Still, my hope for all of my patients is for them to attain safe, stable housing situations. Housing is a huge part of homeless healthcare.
There are many different reasons people become displaced or homeless. Which is why there is no good, solve-all resolution for the problem. But there may be a few approaches that will work on large pockets of homelessness in the US.
An interesting article came my way via Twitter yesterday from the National Coalition for the Homeless.
The full article can be found here. In case you don't have time to read it I'll sum it all up:
In San Jose, there is a community of otherwise homeless people who live intermittently in a tent city near Coyote Creek. They are often asked to clear out. The city organizes a clean up effort (for example, in conjunction with the county jail). Then... they move back in.
But if the US Environmental Protection Agency funds a grant proposed by the city's Environmental Services Department, the Santa Clara Valley Water District and a non profit called Destination: Home, then the creek dwellers may be able to do the clean up work themselves this time, earning housing and job training in the process.
Since my visit to St. Mungo's Nightingale House in London last spring, I have often thought about how important job training and social services are for ending the cycle of homelessness.
The Downtown Streets team, mentioned in the article, has used a similar model to get men and women off the streets of Gilroy, Palo Alto and Daytona Beach in Florida.
Again, because homelessness has so many different causes, the same treatment isn't going to work for all of them. What about elders who can not work? Those who are homeless due to illness or physical disabilities?
Well done, San Jose!
Still, my hope for all of my patients is for them to attain safe, stable housing situations. Housing is a huge part of homeless healthcare.
There are many different reasons people become displaced or homeless. Which is why there is no good, solve-all resolution for the problem. But there may be a few approaches that will work on large pockets of homelessness in the US.
An interesting article came my way via Twitter yesterday from the National Coalition for the Homeless.
The full article can be found here. In case you don't have time to read it I'll sum it all up:
In San Jose, there is a community of otherwise homeless people who live intermittently in a tent city near Coyote Creek. They are often asked to clear out. The city organizes a clean up effort (for example, in conjunction with the county jail). Then... they move back in.
But if the US Environmental Protection Agency funds a grant proposed by the city's Environmental Services Department, the Santa Clara Valley Water District and a non profit called Destination: Home, then the creek dwellers may be able to do the clean up work themselves this time, earning housing and job training in the process.
Since my visit to St. Mungo's Nightingale House in London last spring, I have often thought about how important job training and social services are for ending the cycle of homelessness.
The Downtown Streets team, mentioned in the article, has used a similar model to get men and women off the streets of Gilroy, Palo Alto and Daytona Beach in Florida.
Again, because homelessness has so many different causes, the same treatment isn't going to work for all of them. What about elders who can not work? Those who are homeless due to illness or physical disabilities?
And I think this is an important thing to note. It's easy to reject ideas because we can see that they don't hold the entire solution within their limits. But when a problem is as multifaceted as homelessness... an entire toolbox full of approaches is going to be absolutely necessary.Both Richardson and Liccardo say they are fully aware that the program will not end the problem of chronic homelessness, especially for the severely drug addicted and mentally ill."We don't pretend that we can save everyone,'' Liccardo said. "But this could be an effective tool in the toolbox."
Well done, San Jose!
Tuesday, January 11, 2011
The Boots Aren't The Woman - Part Two
Thinking about this lady's boots from The North Face reminded me of something that upsets me a lot when I see or hear it, so I'm going to climb on my tiny soap box for a minute.
I have seen a handful of tweets and status updates in the past few years voicing amusement or outright annoyance at behaviors or appearances that are out of line with how people would like to view the homeless in our communities. Some examples: "the guy asking for money at the bus stop had nicer sneakers than I do!" and "I just saw a homeless guy on a CELL PHONE!" I've heard similar complaints or commentary from friends of friends or new acquaintances.
It's something I'd like to address here for just one second.
I have seen a handful of tweets and status updates in the past few years voicing amusement or outright annoyance at behaviors or appearances that are out of line with how people would like to view the homeless in our communities. Some examples: "the guy asking for money at the bus stop had nicer sneakers than I do!" and "I just saw a homeless guy on a CELL PHONE!" I've heard similar complaints or commentary from friends of friends or new acquaintances.
It's something I'd like to address here for just one second.
People who do not have homes are not required to fit your expectations of what homelessness looks like.
I understand that many people's immediate reactions to seeing signs of stability in a person who has their hand out for scraps is to conclude a disparity. The perceived duality can be off putting. Perhaps some people feel they are being "tricked" into providing for this person who is merely pretending to be impoverished, or who is just too lazy to get an actual job. That might make me angry too. I understand.
But let me offer you some thoughts that may help you to understand why I think it is so offensive to pass judgment on someone's level of need based on their appearance.
1. Everyone loves to donate stuff. Homeless men and women are often recipients of hand outs. Those really nice sneakers that your local pan handler is wearing may very well have come from your neighbor's closet. Or were donated by the family of someone recently deceased. Or were collected in a church clothing drive. For society to want every single homeless man and woman on the street to dress like a Dickens' character all in rags is a little bit silly considering the amount of people who like to donate their stuff to the "less fortunate."
2. Gifts are for everyone. The lady in the first part of this post received boots, really nice boots, from her mother. Her mother can NOT buy her a house, a clean bill of health, freedom from addiction, or the mental capacity for managing her life. But she can buy her a pair of boots to prevent immersion foot or frostbite. Homeless men and women do not have homes, but it doesn't mean they don't have families, or loved ones. Or in some cases - concerned sponsors. For Christmas, for example, this year every single patient at the respite facility where I work was visited by Santa Claus and given one brand new item of clothing and a brand new L.L. Bean backpack. It breaks my heart to think that anyone, seeing someone panhandling while wearing that brand new backpack might think "this person doesn't need help, look at that backpack." The bag was free. The person is still trapped in the cycle of street life.
3. Low income is still income. I know you know. But it bears reminding that some homeless men and woman may be the recipient of some form of disability check or veterans checks. They have as much right to spend their money they way they want as you or I do. If that means skipping lunch until they get a used walk-man so be it. Seriously. They could be using their money to buy things like cigarettes, food, or to pay for a track phone*. There are so many barriers to housing for many members of our society that it would take an entire different post to explain why buying day to day necessities/whims is more practical than going without those things.
I desperately want to break down any argument that if someone is wearing a nice piece of clothing, or carrying a nice purse, or eating a cheeseburger while they are out stemming that they must be manipulating you out of your money. Not because I want you to give them your money. In fact, I do not condone giving cash to panhandlers.** However, I can't sit by silently while I witness stereotypes being propagated about the members of our community who do not have stable housing. Lack of understanding about why people are homeless, or what homelessness looks like is a major barrier to finding an end to the problem.
Our sympathy for the poor should not be limited by some implicit requirement for poor people to look and act the way the middle class expects them to. This is the attitude which keeps the class divide alive and well. If we truly want to end suffering for our fellow humans, we will not require people to prove their pain to us before we offer relief.
So the next time you see someone sleeping outside of the train station, or holding out a cup in the park and they're wearing a super nice coat or they have a brand name back pack let your reaction be thankful and hopeful. Be thankful that in some small way this fellow human being is being taken care of. And be hopeful that if it's you out in the cold someday, someone will give you a super nice coat too. Let's not any of us deny human comforts to anyone, simply because we think they should be wearing their trauma more prominently on their sleeves.
-----------------------------------------------------------------------
* The phone thing is also a whole other entry that is partially written out already in reply to someone who once asked me why a homeless person needs to use the phone at all.
**There is a list of things I do condone giving out to panhandlers, which I will be posting soon and will link back to here.
Tuesday, January 4, 2011
The Boots Aren't The Woman - Part One
"It's my nurse!" I recognize her voice before I turned around, even though she is stuffing a donut into her mouth with fingers red from exposure to the cold.
"I'm living in an apartment with this guy near -------- .," she tells me after I asked.
"Is it safe?" is my first question.
"No," she says without pausing. "Not really, but it's what I've got for now."
Her voice lowers to whisper and she reminds me of the health condition combo that currently excludes her from staying in any shelter. "It's not their fault," she says with resignation in her voice, "but it's not my fault either. Either way, I can't sleep in the cold so I'm in with him for the winter."
She adds, "we're not having sex or anything like that. He's just a loser."
I nod to assure her that I'm hearing her, wondering what she is editing for my benefit.
"I went to [a shelter] cuz they say I got mail. I thought it was from my Mom, but it's just bills."
I shake my head sadly, but she laughs and repeats the line like a punchline to a great joke, "just bills!"
"She did by me these boots though. My Mom did," she points down and I see that she is wearing North Face Boots. I am relieved. Two fewer frostbitten feet in the ER this winter.
"My family that's how they buy me. Clothes. They buy my love with clothes," she is half joking but her lip trembles.
"No. That's how they protect you from freezing to death out here," I point out. "They do love you." Her face breaks into a smile, although her mouth is still shaking. "Yeah, I know," she answers, and busies herself with the donut wrapper, which needs to be folded up.
On the way home I am struck thinking about her coat and boots. I have really similar boots, just as new as hers, actually. My mother bought them for me for Christmas. Incidentally, my mother also bought my new puffy down coat because she was sick of watching me layer sweatshirts underneath my denim jacket all winter long.
I wonder about her mother, whom I have never met and probably will never meet. I can not begin to imagine how different her situation must be from my own. Her mother sends her checks to the shelter. I take my mother out for lunch on Fridays. And yet...I can't get the image of boots and coats out of my head.
Boots and coats, carefully chosen and paid for. Laid into boxes, or folded into bags. Gifts from women who otherwise might have nothing in common except that they can't stand the thought of their daughters being cold or wet if they have anything to do about it.
"I'm living in an apartment with this guy near -------- .," she tells me after I asked.
"Is it safe?" is my first question.
"No," she says without pausing. "Not really, but it's what I've got for now."
Her voice lowers to whisper and she reminds me of the health condition combo that currently excludes her from staying in any shelter. "It's not their fault," she says with resignation in her voice, "but it's not my fault either. Either way, I can't sleep in the cold so I'm in with him for the winter."
She adds, "we're not having sex or anything like that. He's just a loser."
I nod to assure her that I'm hearing her, wondering what she is editing for my benefit.
"I went to [a shelter] cuz they say I got mail. I thought it was from my Mom, but it's just bills."
I shake my head sadly, but she laughs and repeats the line like a punchline to a great joke, "just bills!"
"She did by me these boots though. My Mom did," she points down and I see that she is wearing North Face Boots. I am relieved. Two fewer frostbitten feet in the ER this winter.
"My family that's how they buy me. Clothes. They buy my love with clothes," she is half joking but her lip trembles.
"No. That's how they protect you from freezing to death out here," I point out. "They do love you." Her face breaks into a smile, although her mouth is still shaking. "Yeah, I know," she answers, and busies herself with the donut wrapper, which needs to be folded up.
She looks good, better than she did when I saw her last. Sober, I think to myself, with a bit of surprise. She has a little bit of makeup on, just foundation and some mascara. She got glasses somewhere and they frame her face well. She's wearing a wool coat, a knit cap and the boots. All, I imagine, gifts from her mother and brother.
On the way home I am struck thinking about her coat and boots. I have really similar boots, just as new as hers, actually. My mother bought them for me for Christmas. Incidentally, my mother also bought my new puffy down coat because she was sick of watching me layer sweatshirts underneath my denim jacket all winter long.
I wonder about her mother, whom I have never met and probably will never meet. I can not begin to imagine how different her situation must be from my own. Her mother sends her checks to the shelter. I take my mother out for lunch on Fridays. And yet...I can't get the image of boots and coats out of my head.
Boots and coats, carefully chosen and paid for. Laid into boxes, or folded into bags. Gifts from women who otherwise might have nothing in common except that they can't stand the thought of their daughters being cold or wet if they have anything to do about it.
Wednesday, August 11, 2010
a letter
Today a letter was delivered to the nurses' station. It was addressed to "the nurses and aides" on our floor. The letter was a thank you note for the care we provided to a patient at the end of his life who passed away in the early morning. He had been sick for a long time and chose to be with us for his death, which he knew was coming.
It sounds like typical end of life fare, maybe. The kind of letter you might expect from a family member or close friend of the deceased after a long hospital or hospice stay. But it wasn't. It was from another patient. What is even more amazing is that the two men were randomly assigned roommates. But the second man immediately took to assisting the sicker patient and then at the end, keeping silent vigil at his bedside.
A third, younger homeless man had also been taking care of the man before he passed. The third man had met the older man when they were both patients. Once the younger man was discharged, he continued to call and visit daily until the end.
"It's not friendly anymore," the younger homeless man had once said to me. "It's hard on the streets. Mean. But you see the oldtimers and they're all family. Our generation doesn't have that."
But it seems like at least some of them do. And maybe, just maybe it's never too late to make a family.
It sounds like typical end of life fare, maybe. The kind of letter you might expect from a family member or close friend of the deceased after a long hospital or hospice stay. But it wasn't. It was from another patient. What is even more amazing is that the two men were randomly assigned roommates. But the second man immediately took to assisting the sicker patient and then at the end, keeping silent vigil at his bedside.
A third, younger homeless man had also been taking care of the man before he passed. The third man had met the older man when they were both patients. Once the younger man was discharged, he continued to call and visit daily until the end.
"It's not friendly anymore," the younger homeless man had once said to me. "It's hard on the streets. Mean. But you see the oldtimers and they're all family. Our generation doesn't have that."
But it seems like at least some of them do. And maybe, just maybe it's never too late to make a family.
Tuesday, May 25, 2010
... only thirty two
Here is a video that was made about BHCHP.
It has a lot of focus on the building I work, and features a ton of my coworkers and patients.
And the song throughout it, which is an original piece by a patient... well, you'll just have to listen for yourself.
I love my job.
It has a lot of focus on the building I work, and features a ton of my coworkers and patients.
And the song throughout it, which is an original piece by a patient... well, you'll just have to listen for yourself.
I love my job.
Thursday, May 6, 2010
Rx: feline
"Sam*, can you at least take your antibiotics?"
"I'm not takin' any of 'em. Why should I? You weren't here."
He's had so many head injuries, that he's now a kid trapped in an adult body. His face is scarred and his body is scarred and his liver is scarred, and his heart hurts. Not his real heart. Sam's lonely.
"Sam, another patient needed me," I faltered, weighing HIPPA against his anger.
"It was an emergency, I didn't know how long I would be in the other room when I went in."
"I don't care. You were supposed to be here. You weren't. I'm gonna go smoke."
He doesn't understand waiting in line, or being told he can't do what he wants to do. What he wants to do is drink a lot of alcohol and smoke cigarettes and eat cinnamon buns until his glucose level is unreadable on the glucometer. He tells me the higher the number, the better. "Like basket ball scores."
Before they reach a certain stage in both their mental and emotional development children are unable to think abstractly enough to put themselves into another person's shoes, or to plan for the future, or to delay gratification.
Sam is a little like that. Unable to understand why a nurse would not be on time, or why he shouldn't cuss out the doctors, or why he should care about his blood pressure.
Just like a child, retarded emotional development doesn't mean Sam is a bad person. It just means he is where he is. Unlike a child, however, he's not going to progress. His brain is damaged. He may be able to learn behavioral modification - but he's not ever going to reach the next stage. He's stuck.
So whenever Sam is my patient I take my time to remember that and treat him accordingly.
"Hey Sam, you look nice today. I'm sorry I wasn't here for you earlier. Can you take your medications now?"
"No. I'm going to sleep."
Usually it's me who is called in to reason with Sam, some other nurse at her wit's end. Today, I'm the bad guy. Because another patient was vomiting and I was late with Sam's medication cup.
I'm putting out fires. Vomiting, hypotension, dressing changes, patients with frightening hallucinations. Pharmacy's on the phone asking about prescriptions never sent. Due to a "boil water" alert I'm rationing bottled water. I have three patients with persistent elevated temperatures possibly related to their illnesses but much more likely caused by dehydration. I am watching everything.
As I run around, Sam is in the background of everything I do. Standing in the hall. Sitting in the clinic. Riding the elevator. He takes his meds from me, quietly, an hour after refusing them. He says little all day.
Then, as I'm leaving, he's telling a respite aide:
"I had three cats," he said, "named Mud, Mud Junior and Mud the third."
His eyes glow with excitement as he continues, "and I used to feed those cats better than I fed me. King crab. Shrimp. They loved that stuff. I'd go buy it for them."
It is the first time I see Sam smile all day, talking about his cats and how he took care of them. How he loved them and they loved him.
He notices me listening and waves cheerfully, the morning forgotten.
I leave the building deep in thought, wondering how one would word a prescription for a cat.
----------------------------------------------------------------------------------------
*names, diagnoses, and situations have been changed to protect the privacy of patients and staff involved
"I'm not takin' any of 'em. Why should I? You weren't here."
He's had so many head injuries, that he's now a kid trapped in an adult body. His face is scarred and his body is scarred and his liver is scarred, and his heart hurts. Not his real heart. Sam's lonely.
"Sam, another patient needed me," I faltered, weighing HIPPA against his anger.
"It was an emergency, I didn't know how long I would be in the other room when I went in."
"I don't care. You were supposed to be here. You weren't. I'm gonna go smoke."
He doesn't understand waiting in line, or being told he can't do what he wants to do. What he wants to do is drink a lot of alcohol and smoke cigarettes and eat cinnamon buns until his glucose level is unreadable on the glucometer. He tells me the higher the number, the better. "Like basket ball scores."
Before they reach a certain stage in both their mental and emotional development children are unable to think abstractly enough to put themselves into another person's shoes, or to plan for the future, or to delay gratification.
Sam is a little like that. Unable to understand why a nurse would not be on time, or why he shouldn't cuss out the doctors, or why he should care about his blood pressure.
Just like a child, retarded emotional development doesn't mean Sam is a bad person. It just means he is where he is. Unlike a child, however, he's not going to progress. His brain is damaged. He may be able to learn behavioral modification - but he's not ever going to reach the next stage. He's stuck.
So whenever Sam is my patient I take my time to remember that and treat him accordingly.
"Hey Sam, you look nice today. I'm sorry I wasn't here for you earlier. Can you take your medications now?"
"No. I'm going to sleep."
Usually it's me who is called in to reason with Sam, some other nurse at her wit's end. Today, I'm the bad guy. Because another patient was vomiting and I was late with Sam's medication cup.
I'm putting out fires. Vomiting, hypotension, dressing changes, patients with frightening hallucinations. Pharmacy's on the phone asking about prescriptions never sent. Due to a "boil water" alert I'm rationing bottled water. I have three patients with persistent elevated temperatures possibly related to their illnesses but much more likely caused by dehydration. I am watching everything.
As I run around, Sam is in the background of everything I do. Standing in the hall. Sitting in the clinic. Riding the elevator. He takes his meds from me, quietly, an hour after refusing them. He says little all day.
Then, as I'm leaving, he's telling a respite aide:
"I had three cats," he said, "named Mud, Mud Junior and Mud the third."
His eyes glow with excitement as he continues, "and I used to feed those cats better than I fed me. King crab. Shrimp. They loved that stuff. I'd go buy it for them."
It is the first time I see Sam smile all day, talking about his cats and how he took care of them. How he loved them and they loved him.
He notices me listening and waves cheerfully, the morning forgotten.
I leave the building deep in thought, wondering how one would word a prescription for a cat.
----------------------------------------------------------------------------------------
*names, diagnoses, and situations have been changed to protect the privacy of patients and staff involved
Monday, January 11, 2010
..if you just smile
Tom's of Maine is one of my favorite companies because I have loved their products for years and I love their commitment to community. As many of you may already know from talking to me or browsing through Facebook, right now Tom's is getting ready to grant five different clinics a $20,000 sponsorship. And they have decided to let communities vote to determine the recipients.
You can go onto their website every day from now until March 12th and vote for up to five different clinics.
Annnd... (here's where I come in) the dental clinic of Boston Healthcare for the Homeless is one of the clinics in the running. Specifically, they are being considered for their initiative to create more support for HIV/AIDS and Diabetic patients.
As of right now they have two locations (Pine Street and Jean Yawkey Place) where our patient population can easily access comprehensive dental services from cleanings to denture fittings.
If our dental clinic is awarded the sponsorship they'll be able to hire a new dental assistant who will be specifically working to provide fluoride treatments and oral hygiene education to patients with HIV, AIDS, and diabetes who are at risk for serious health complications otherwise.
This paradigm shift towards primary preventative healthcare would be huge in stopping very avoidable oral health issues from snowballing into major medical problems.
Please. Please. Please. Take the time to go vote for BHCHP. And maybe a couple other clinics whose ideas you like, too. And remember you can vote every day, for up to five different places.
This kind of financial support in the hands of the dedicated programs listed on the Tom's website can only lead to good things happening for quality, accessible care.
Monday, November 30, 2009
I don't want any of it to go to waste
7am: "Those are mine!" The security guard is staring suspiciously at the bags of men's clothes
at the door. "Well, not mine," I qualify. "But I left them there when I went to park my car." The guard laughs and we grab up all the bags of shirts and shoes and rush them inside.
11am: "Thank you. Thank you, all of you, for working today," It's the program wide Director of Nursing, and he's standing beside the BMH director, and she is holding a bag of chocolates out to us, over and over again. Barry hugs all of us before he leaves. Sarah snaps a photo of the turkey family made out of rubber gloves and tells us again how thankful she is for us.
12:30pm: "You're going to town on those peas, huh?" The man laughs. I am sitting in the activity room with a plate of food on my lap. I am surrounded by patients and we are watching House. I realize with somewhat of a start how natural these traditions have begun to feel. One of my patients approaches me shyly and asks if she can wrap up her leftovers. "I don't want any of it to go to waste," she explains.
4:30pm: "Michelle's here! Michelle's here!" I feel as though I've entered a dream. My Aunt and Uncle's new house is three years old, but that's how long it's been since I've spent a Thanksgiving with my family. Light bounces off colored glass, and I don't know where to look first. My family, larger somehow than I expected turns toward me, smiling. I feel dirty and tired looking in my scrubs. I feel like I don't belong here, and although my day was easy, tears threaten my cheeks. Then somehow my mother's arms are around me and Ralph is taking my coat and Rosina is pouring a glass of wine and Auntie Mame is asking questions and I am not crying at all.
"Do you want one?" asks my small cousin chewing on a caramel. He is looking at his little brother. Sam nods.
"You can't have one," Nicholas says, without a hint of malice. He looks at me apologetically, "they're too chewy. - But you can have something else, Sam."
And when my tiny cousin, now old enough to speak but still a stranger to me, looks at me as if to ask if this is all ok, I nod. And he smiles shyly and nods back.
at the door. "Well, not mine," I qualify. "But I left them there when I went to park my car." The guard laughs and we grab up all the bags of shirts and shoes and rush them inside.
11am: "Thank you. Thank you, all of you, for working today," It's the program wide Director of Nursing, and he's standing beside the BMH director, and she is holding a bag of chocolates out to us, over and over again. Barry hugs all of us before he leaves. Sarah snaps a photo of the turkey family made out of rubber gloves and tells us again how thankful she is for us.
12:30pm: "You're going to town on those peas, huh?" The man laughs. I am sitting in the activity room with a plate of food on my lap. I am surrounded by patients and we are watching House. I realize with somewhat of a start how natural these traditions have begun to feel. One of my patients approaches me shyly and asks if she can wrap up her leftovers. "I don't want any of it to go to waste," she explains.
4:30pm: "Michelle's here! Michelle's here!" I feel as though I've entered a dream. My Aunt and Uncle's new house is three years old, but that's how long it's been since I've spent a Thanksgiving with my family. Light bounces off colored glass, and I don't know where to look first. My family, larger somehow than I expected turns toward me, smiling. I feel dirty and tired looking in my scrubs. I feel like I don't belong here, and although my day was easy, tears threaten my cheeks. Then somehow my mother's arms are around me and Ralph is taking my coat and Rosina is pouring a glass of wine and Auntie Mame is asking questions and I am not crying at all.
"Do you want one?" asks my small cousin chewing on a caramel. He is looking at his little brother. Sam nods.
"You can't have one," Nicholas says, without a hint of malice. He looks at me apologetically, "they're too chewy. - But you can have something else, Sam."
And when my tiny cousin, now old enough to speak but still a stranger to me, looks at me as if to ask if this is all ok, I nod. And he smiles shyly and nods back.
Monday, October 5, 2009
Meet Gwen
Gwen is an American Girl.
When I was growing up the American Girl series was a staple of my bookshelf.
My favorite book was Molly Saves the Day, which was about summer camp and an epic Capture the Flag game. I owned the entire Kirsten series as well as the Felicity series and a few Samantha books*. I remember the glossy catalogs that came to our house full of dolls and accessories; but I was never very interested. I just liked the stories.
Now, the American Girl company is much much bigger. I went to visit the American Girl Place in Chicago a few years ago, and ate in their restaurant. We were provided with dolls to sit with us at the table as we sipped pink lemonade. I was astounded as we toured the rest of the building to find out that you can now pay to have your doll's hair done, or get her ears pierced.
Perhaps it is because of the huge expanse of the corporation that a great deal of controversy surrounds Gwen, a pretty blond doll who is... homeless.
Apparently Gwen has been around since January, but a recent NY Post story has brought the doll new attention. My favorite back-and-forth debate has been taking place in the comments section of the article posted by ParentDish.com.
Parents are debating everything from whether or not the company should be donating money to homeless shelters for every sale of the doll, to the nature of what homelessness is.
Personally I don't care to comment on whether or not Gwen should be more "raggedy," or whether she's "truly" homeless according to the details of the book she appears in.
I think $95 is an outrageous amount of money to spend on a doll whether it's "homeless," or not which might be why I never owned a Molly. The irony that no homeless child could probably ever own such an expensive toy is just a bit of added insult.
However, The American Girl corporation isn't marketing Gwen as "homeless," they are just marketing her as a character from one of the books. They are not obligated to give money to a homeless shelter or healthcare program from "Gwen" sales any more than they are obligated to donate money to the African American History Museum every time they sell an Addy doll. It's just not logical.
As for the social implications of the very existence of the doll, I haven't made up my mind yet.
One one hand, the book "Chrissa Stands Strong," (and by extension, the Chrissa and Gwen dolls) teach young girls that they should reach out to everyone across gender, race and class lines. On the other hand, do they send the message, as one reader pointed out, that we should just accept that some people have and some have not? Do they dull the thirst for justice that we should be instilling in our youth by saying 'it's not so bad that Gwen is homeless'?
I don't have these answers, but I suspect that more good than harm comes from inspiring young girls to reach out and help others. And although the message is a tad moralizing and overly-simplistic, it's not a bad message, and it is certainly a great jumping off point for discussion in the home about bigger and more complex issues.
So if parents are really worried about the message is sends to pay $95 for a doll who represents a character who wouldn't be able to afford a school lunch, then they should be trying in other ways to instill a sense of social justice in their children. Talk with your children about their ideas and opinions. Have your kids come with you to buy a toy for a gift drive at church or temple or the Y. Or let them pick out the cans from your pantry for food donations. Bring them with you when you drop off gently used clothing at Salvation Army.
But don't blame a toy company for doing just what they set out to do.
When I was growing up the American Girl series was a staple of my bookshelf.
My favorite book was Molly Saves the Day, which was about summer camp and an epic Capture the Flag game. I owned the entire Kirsten series as well as the Felicity series and a few Samantha books*. I remember the glossy catalogs that came to our house full of dolls and accessories; but I was never very interested. I just liked the stories.
Now, the American Girl company is much much bigger. I went to visit the American Girl Place in Chicago a few years ago, and ate in their restaurant. We were provided with dolls to sit with us at the table as we sipped pink lemonade. I was astounded as we toured the rest of the building to find out that you can now pay to have your doll's hair done, or get her ears pierced.
Perhaps it is because of the huge expanse of the corporation that a great deal of controversy surrounds Gwen, a pretty blond doll who is... homeless.
Apparently Gwen has been around since January, but a recent NY Post story has brought the doll new attention. My favorite back-and-forth debate has been taking place in the comments section of the article posted by ParentDish.com.
Parents are debating everything from whether or not the company should be donating money to homeless shelters for every sale of the doll, to the nature of what homelessness is.
Personally I don't care to comment on whether or not Gwen should be more "raggedy," or whether she's "truly" homeless according to the details of the book she appears in.
I think $95 is an outrageous amount of money to spend on a doll whether it's "homeless," or not which might be why I never owned a Molly. The irony that no homeless child could probably ever own such an expensive toy is just a bit of added insult.
However, The American Girl corporation isn't marketing Gwen as "homeless," they are just marketing her as a character from one of the books. They are not obligated to give money to a homeless shelter or healthcare program from "Gwen" sales any more than they are obligated to donate money to the African American History Museum every time they sell an Addy doll. It's just not logical.
As for the social implications of the very existence of the doll, I haven't made up my mind yet.
One one hand, the book "Chrissa Stands Strong," (and by extension, the Chrissa and Gwen dolls) teach young girls that they should reach out to everyone across gender, race and class lines. On the other hand, do they send the message, as one reader pointed out, that we should just accept that some people have and some have not? Do they dull the thirst for justice that we should be instilling in our youth by saying 'it's not so bad that Gwen is homeless'?
I don't have these answers, but I suspect that more good than harm comes from inspiring young girls to reach out and help others. And although the message is a tad moralizing and overly-simplistic, it's not a bad message, and it is certainly a great jumping off point for discussion in the home about bigger and more complex issues.
So if parents are really worried about the message is sends to pay $95 for a doll who represents a character who wouldn't be able to afford a school lunch, then they should be trying in other ways to instill a sense of social justice in their children. Talk with your children about their ideas and opinions. Have your kids come with you to buy a toy for a gift drive at church or temple or the Y. Or let them pick out the cans from your pantry for food donations. Bring them with you when you drop off gently used clothing at Salvation Army.
But don't blame a toy company for doing just what they set out to do.
Tuesday, September 29, 2009
Mark 9:40 : Revisiting Brianna Karp
On Sept. 11th I posted about Brianna Karp and her "New Face of Homelessness." I received a lot of feedback about my opinions, both in person and in writing.
The one that caused me the most distress was this one, from Matt.
Reading this makes me very sad indeed.
She does not hold all the answers and neither do you or I but she is a deeply caring and courageous woman who wishes to help all those who are experiencing homelessness. I know this for a fact.
She should be both encouraged and supported by those who claim to have similar goals, not attacked for any shortcomings she may have.
"The vast majority of homeless individuals....want to work, and look for work"
Somehow you turned that into:
"And to intimate that only white, formerly middle class people are willing to work "and look for work," is offensive. It was an innocent mistake on her part, but offensive."
That is a massive leap for which I can see no grounds whatsoever. She 'intimated' nothing. Now THAT is offensive.
I choose to believe that your heart is in the right place too so instead of whining at her, how about getting behind her and helping her make the most of what I'm sure you will agree is a huge opportunity to do some real good?
Firstly, I would like to publicly apologize if I have come across as having all the answers. Because I know that I don't. I would like to apologize to Bri and to any of her friends and loved ones who think this was some sort of attack on her, because it wasn't meant to be. As I said in my post, I agree with the sentiment of her heart being in the right place. I would never hope that my words would take away from her courage or her caring or the fact that she is using her position to do positive things in the world.
The things I said were not meant to be malicious, but if they were interpreted that way then there is something wrong with the way I presented them. And so I will try again.
Bri never says that only white, formerly middle class people want to work or look for work. So it was unfair of me to say that in my post.
She does say that the overwhelming percentage of homeless people are drug free, have no mental illness and are formerly middle class. She reports that this vast majority of homeless people are the ones who would like to join the work force. I apologize for adding the qualifier of "white;" it was inspired by her sentiment that "most homeless people are like me and manage to blend in relatively well. " It was not, as I see now, entirely relevant to the point at hand. Nor was it helpful in my argument. My issue was and is with the line in the sand being drawn between "bums" and "non bums." I think the rest of my original post covers how I feel about that.
But I think Matt's real point was that the issue is moot anyway. The real point is that if I truly am an advocate for the homeless, as I claim to be, why am I wasting time finding fault with someone else who claims the same?
I think it's because over the past two years I have become very sensitive towards the marginalization of any of the people I work with. To draw a line between types of homeless people is hurtful because some concepts are not mutually exclusive, and it paints an unflattering picture of many homeless individuals.
Sometimes love can make us blind. I saw Brianna's piece as a threat to my patients getting public support and in my haste to defend them I neglected to acknowledge that Brianna was simply also looking to gain public support for a group of people in need.
My post did not successfully express any gratitude towards Ms. Karp, which I definitely owe to her along with my apology. My point in my post was not to whine at Brianna, but rather to expound on her idea; to say, yes, yes you're right! And you are beautiful. You are homeless and strong, and there are others like you. And you are speaking up for them. Becoming their voice where they had none before. Please, don't stop....but please also don't forget those who have a different story.
I applaud Brianna for the work she does, and for the positive example she sets for people in every walk of life. As I continue my own advocacy for human rights, I know that anyone working under the banner of ending human suffering is on the same side that I'm on.
I'm glad Matt posted because it made me continue to revisit my old ideas. I don't think we should ever stop what I see as a necessary and ongoing peaceful dialogue that can take place amongst us all regarding the nature of our work. This dialogue should empower us and inspire us to move forward.
So with all of this in mind, I reiterate these hopes:
That all people without homes, not just those who fall into certain socially acceptable criteria, will have access to the assistance they require to live the lives they dream of for themselves.
That all human beings will recognize themselves in the joys and sufferings of others and be moved to help those in need of aid.
And that all those working for peace, justice and love may be united over common goals instead of divided over differences in their work.
Thank you, Matt for reminding me of that last one.
The one that caused me the most distress was this one, from Matt.
Reading this makes me very sad indeed.
She does not hold all the answers and neither do you or I but she is a deeply caring and courageous woman who wishes to help all those who are experiencing homelessness. I know this for a fact.
She should be both encouraged and supported by those who claim to have similar goals, not attacked for any shortcomings she may have.
"The vast majority of homeless individuals....want to work, and look for work"
Somehow you turned that into:
"And to intimate that only white, formerly middle class people are willing to work "and look for work," is offensive. It was an innocent mistake on her part, but offensive."
That is a massive leap for which I can see no grounds whatsoever. She 'intimated' nothing. Now THAT is offensive.
I choose to believe that your heart is in the right place too so instead of whining at her, how about getting behind her and helping her make the most of what I'm sure you will agree is a huge opportunity to do some real good?
Firstly, I would like to publicly apologize if I have come across as having all the answers. Because I know that I don't. I would like to apologize to Bri and to any of her friends and loved ones who think this was some sort of attack on her, because it wasn't meant to be. As I said in my post, I agree with the sentiment of her heart being in the right place. I would never hope that my words would take away from her courage or her caring or the fact that she is using her position to do positive things in the world.
The things I said were not meant to be malicious, but if they were interpreted that way then there is something wrong with the way I presented them. And so I will try again.
Bri never says that only white, formerly middle class people want to work or look for work. So it was unfair of me to say that in my post.
She does say that the overwhelming percentage of homeless people are drug free, have no mental illness and are formerly middle class. She reports that this vast majority of homeless people are the ones who would like to join the work force. I apologize for adding the qualifier of "white;" it was inspired by her sentiment that "most homeless people are like me and manage to blend in relatively well. " It was not, as I see now, entirely relevant to the point at hand. Nor was it helpful in my argument. My issue was and is with the line in the sand being drawn between "bums" and "non bums." I think the rest of my original post covers how I feel about that.
But I think Matt's real point was that the issue is moot anyway. The real point is that if I truly am an advocate for the homeless, as I claim to be, why am I wasting time finding fault with someone else who claims the same?
I think it's because over the past two years I have become very sensitive towards the marginalization of any of the people I work with. To draw a line between types of homeless people is hurtful because some concepts are not mutually exclusive, and it paints an unflattering picture of many homeless individuals.
Sometimes love can make us blind. I saw Brianna's piece as a threat to my patients getting public support and in my haste to defend them I neglected to acknowledge that Brianna was simply also looking to gain public support for a group of people in need.
My post did not successfully express any gratitude towards Ms. Karp, which I definitely owe to her along with my apology. My point in my post was not to whine at Brianna, but rather to expound on her idea; to say, yes, yes you're right! And you are beautiful. You are homeless and strong, and there are others like you. And you are speaking up for them. Becoming their voice where they had none before. Please, don't stop....but please also don't forget those who have a different story.
I applaud Brianna for the work she does, and for the positive example she sets for people in every walk of life. As I continue my own advocacy for human rights, I know that anyone working under the banner of ending human suffering is on the same side that I'm on.
I'm glad Matt posted because it made me continue to revisit my old ideas. I don't think we should ever stop what I see as a necessary and ongoing peaceful dialogue that can take place amongst us all regarding the nature of our work. This dialogue should empower us and inspire us to move forward.
So with all of this in mind, I reiterate these hopes:
That all people without homes, not just those who fall into certain socially acceptable criteria, will have access to the assistance they require to live the lives they dream of for themselves.
That all human beings will recognize themselves in the joys and sufferings of others and be moved to help those in need of aid.
And that all those working for peace, justice and love may be united over common goals instead of divided over differences in their work.
Thank you, Matt for reminding me of that last one.
Friday, September 11, 2009
The New Face of Homelessness?
Liz. C recently sent me an article that ran on Jezebel.com entitled "Elle's "New face of Homelessness:" White and Formerly Middle Class. "
The article is a soft critique of 24 year old Brianna Karp's blog piece for Elle entitled "The New Face of Homelessness."
The more I read about Brianna, the more intrigued I became. I even found her blog, and other blog pieces about her.
Bri, apparently homeless after a string of temporary jobs and exhausting her savings to fix her car, was chosen to intern at Elle, and to write her own blog column. In her first go, she wanted to break down the typically negative stereotypes of homeless individuals.
She writes:
I believe it is very important to reverse the prevalent negative attitudes and common stereotypes of homelessness, such as its perceived definition. Its legal definition is “an individual who lacks a fixed, regular, and adequate nighttime residence, or a person who resides in a shelter, welfare hotel, transitional program, or place not ordinarily used as regular sleeping accommodations, such as streets, cars, movie theatres, abandoned buildings, etc." It also includes children and youths "who are sharing the housing of other persons due to loss of housing, economic hardship, or similar reason".
Now, as many of you know, I am personally very committed to educating the public about homelessness in order to dispel Myths About the Homeless. There's nothing wrong with her piece so far.
But what happens next is where her good intentions go awry:
She goes on here (I added the bold for emphasis):
The vast majority of homeless individuals are not on drugs, do not have mental problems, want to work, and look for work. The "new face of homelessness" the last couple of years is the middle-class recession victim with a stable history, who would never have previously been pinpointed as a likely candidate for homelessness. The stereotypical "bum" is actually a very small fraction of the homeless population; the overwhelming percentage of homeless people are like me and manage to blend in relatively well.
The point she is trying to make is one I have pointed out to friends as well. On a bus or a train, at your job, you have no idea who may be homeless and "passing." Or there could be children who go to school with your children who go home to a car or a motel at the end of the day.
But to say that there is a "new face of homelessness," and in doing so to effectively brush aside individuals who were born poor, or mentally ill, or who are elderly, or immigrants (legal or otherwise), or victims of domestic or sexual abuse, or, yes even drug addicts or former convicts is absurd. And to intimate that only white, formerly middle class people are willing to work "and look for work," is offensive. It was an innocent mistake on her part, but offensive.
She seems to realize how her words may have come across so she adds "even those that do fit the negative stereotypes are no less deserving of help; if anything, they are far more in need of it than the majority."
But the damage has been done. She has created a dichotomy in which homeless people are either "bums:" people who fit the negative stereotypes; or part of the "new face" of homelessness: people who aren't stereotypical. Although she graciously admits that everyone is deserving of help, she continues to reinforce the stereotypes by playing to them at all.
But if you get to know the homeless you'll know that even those who resemble "the homeless" the way we see homeless people mercilessly and consistently portrayed in media, aren't necessarily people who "fit" the negative stereotypes. Not every elderly white man with a beard is an alcoholic. Not every young hispanic pan handler with tattoos is an ex gang member. You can't tell anyone's story just by looking at them.
Every single person without a home is first and foremost a human. Whether they were formerly middle class or not. Although Bri makes it clear that she isn't like "the stereotypical bum," she actually is. And so am I. And so are you. Because we are all human. We think, and feel. We hope and want. And we have setbacks, some more major than others.
Brianna means well, but ends up shooting herself in the foot with the "us" and "them" talk.
Hortense at Jezebel.com writes, "her heart is clearly in a good place, and hopefully her column will reflect more than just the magazine's slightly off-putting attempt to attach a "new face" to a sad and ongoing issue."
Megan Sweas of U.S Catholic, is even more gracious and commented directly to Brianna on her blog: "I'm glad you are introducing us all to the "new face of homelessness," but I hope you also address the issues faced by those who have long been homeless, especially the criminalization of homelessness that you mentioned."
I agree completely, and I will be watching with interest to see what she puts out there next.
The article is a soft critique of 24 year old Brianna Karp's blog piece for Elle entitled "The New Face of Homelessness."
The more I read about Brianna, the more intrigued I became. I even found her blog, and other blog pieces about her.
Bri, apparently homeless after a string of temporary jobs and exhausting her savings to fix her car, was chosen to intern at Elle, and to write her own blog column. In her first go, she wanted to break down the typically negative stereotypes of homeless individuals.
She writes:
I believe it is very important to reverse the prevalent negative attitudes and common stereotypes of homelessness, such as its perceived definition. Its legal definition is “an individual who lacks a fixed, regular, and adequate nighttime residence, or a person who resides in a shelter, welfare hotel, transitional program, or place not ordinarily used as regular sleeping accommodations, such as streets, cars, movie theatres, abandoned buildings, etc." It also includes children and youths "who are sharing the housing of other persons due to loss of housing, economic hardship, or similar reason".
Now, as many of you know, I am personally very committed to educating the public about homelessness in order to dispel Myths About the Homeless. There's nothing wrong with her piece so far.
But what happens next is where her good intentions go awry:
She goes on here (I added the bold for emphasis):
The vast majority of homeless individuals are not on drugs, do not have mental problems, want to work, and look for work. The "new face of homelessness" the last couple of years is the middle-class recession victim with a stable history, who would never have previously been pinpointed as a likely candidate for homelessness. The stereotypical "bum" is actually a very small fraction of the homeless population; the overwhelming percentage of homeless people are like me and manage to blend in relatively well.
The point she is trying to make is one I have pointed out to friends as well. On a bus or a train, at your job, you have no idea who may be homeless and "passing." Or there could be children who go to school with your children who go home to a car or a motel at the end of the day.
But to say that there is a "new face of homelessness," and in doing so to effectively brush aside individuals who were born poor, or mentally ill, or who are elderly, or immigrants (legal or otherwise), or victims of domestic or sexual abuse, or, yes even drug addicts or former convicts is absurd. And to intimate that only white, formerly middle class people are willing to work "and look for work," is offensive. It was an innocent mistake on her part, but offensive.
She seems to realize how her words may have come across so she adds "even those that do fit the negative stereotypes are no less deserving of help; if anything, they are far more in need of it than the majority."
But the damage has been done. She has created a dichotomy in which homeless people are either "bums:" people who fit the negative stereotypes; or part of the "new face" of homelessness: people who aren't stereotypical. Although she graciously admits that everyone is deserving of help, she continues to reinforce the stereotypes by playing to them at all.
But if you get to know the homeless you'll know that even those who resemble "the homeless" the way we see homeless people mercilessly and consistently portrayed in media, aren't necessarily people who "fit" the negative stereotypes. Not every elderly white man with a beard is an alcoholic. Not every young hispanic pan handler with tattoos is an ex gang member. You can't tell anyone's story just by looking at them.
Every single person without a home is first and foremost a human. Whether they were formerly middle class or not. Although Bri makes it clear that she isn't like "the stereotypical bum," she actually is. And so am I. And so are you. Because we are all human. We think, and feel. We hope and want. And we have setbacks, some more major than others.
Brianna means well, but ends up shooting herself in the foot with the "us" and "them" talk.
Hortense at Jezebel.com writes, "her heart is clearly in a good place, and hopefully her column will reflect more than just the magazine's slightly off-putting attempt to attach a "new face" to a sad and ongoing issue."
Megan Sweas of U.S Catholic, is even more gracious and commented directly to Brianna on her blog: "I'm glad you are introducing us all to the "new face of homelessness," but I hope you also address the issues faced by those who have long been homeless, especially the criminalization of homelessness that you mentioned."
I agree completely, and I will be watching with interest to see what she puts out there next.
Thursday, September 10, 2009
Healthcare on the Brain
On 8/31 cuts were made to Commonwealth Care causing 31,000 legal immigrants to lose health care coverage.
On October 1st they will be enrolled in CeltiCare, but in the meantime they are being covered by Health Safety Net.
The problem is that there is a myriad of services not covered by Health Safety Net including outpatient non-urgent services. Which means chemotherapy, dialysis, and other important therapies can not be paid for. In many cases, this will mean termination of therapies until Oct. 1.
Fortunately for the percentage of my patients that these changes effect, they have someone to go to bat for them. Administrators at BHCHP are willing to work with the Office of Medicaid and Commonwealth Care to try to cover treatments on a case by case basis until the transition period is over.
Hopefully they will be successful. It's one more reason why I love where I work, the fact that people are consistently ready to go above and beyond to advocate for every person's right to health care.
I worry about the people who don't have anyone to advocate for them. The young, or elderly or non English speaking or mentally impaired legal immigrants who are not part of our system. I hope their doctors are also speaking up for them. Everyone has a right to the care that they need.
And without getting any more political, that's all I have to say about that.
On October 1st they will be enrolled in CeltiCare, but in the meantime they are being covered by Health Safety Net.
The problem is that there is a myriad of services not covered by Health Safety Net including outpatient non-urgent services. Which means chemotherapy, dialysis, and other important therapies can not be paid for. In many cases, this will mean termination of therapies until Oct. 1.
Fortunately for the percentage of my patients that these changes effect, they have someone to go to bat for them. Administrators at BHCHP are willing to work with the Office of Medicaid and Commonwealth Care to try to cover treatments on a case by case basis until the transition period is over.
Hopefully they will be successful. It's one more reason why I love where I work, the fact that people are consistently ready to go above and beyond to advocate for every person's right to health care.
I worry about the people who don't have anyone to advocate for them. The young, or elderly or non English speaking or mentally impaired legal immigrants who are not part of our system. I hope their doctors are also speaking up for them. Everyone has a right to the care that they need.
And without getting any more political, that's all I have to say about that.
Sunday, August 9, 2009
I am a Respite Nurse
"She works at a homeless hospital..."
"You work in a nursing home, right?"
"How did you get involved at the shelter?"
A lot of people are a bit unsure of what I do. And I don't blame them. I had never heard of "respite" nursing before I applied for my current job. And I went to four years of nursing school.
Even the EMTs who respond to our 911 calls (wait - don't you work in a hospital, why are you calling 911?) are unsure of where they are. ("What kind of shelter is this?").
This video is new, I have never posted it before. But it explains what respite nursing is, and more specifically shows you exactly where I work (and who I work with!) every day.
Although I had never heard of respite care before, after two years, I am a very strong supporter of it. I would like to see more programs like this one form all over the country. I think that educating the public on what we do is an important first step in gaining future support for respite programs.
http://www.nhchc.org/Respite/
"You work in a nursing home, right?"
"How did you get involved at the shelter?"
A lot of people are a bit unsure of what I do. And I don't blame them. I had never heard of "respite" nursing before I applied for my current job. And I went to four years of nursing school.
Even the EMTs who respond to our 911 calls (wait - don't you work in a hospital, why are you calling 911?) are unsure of where they are. ("What kind of shelter is this?").
This video is new, I have never posted it before. But it explains what respite nursing is, and more specifically shows you exactly where I work (and who I work with!) every day.
Although I had never heard of respite care before, after two years, I am a very strong supporter of it. I would like to see more programs like this one form all over the country. I think that educating the public on what we do is an important first step in gaining future support for respite programs.
http://www.nhchc.org/Respite/
Tuesday, June 9, 2009
Urine Trouble #2
Scrolling through the comments, I could not believe the number of people who don't even know Debbie making the most rude and crude criticisms imaginable. Some people accused her of trying to get her name in the paper. Which is funny since Debbie turns bright red whenever she's the center of attention and shakes when she has to give employee recognition speeches once a year. One person said that "Thornton is the type of person.." who would get upset if someone said a church steeple was "erected." That one was also funny since Debbie no doubt, like most nurses, left behind the prim and proper at the door a long time ago. Nursing is no place to be coy or prudish. Professional, yes. In denial about bodily functions? No.
It was hard to see so many strangers rip Debbie to shreds on the internet so casually. As they sipped their morning coffee they typed noxious generalizations about a woman they don't know. Either stealing from their desk jobs by surfing the net at work, or sitting at home in their underwear they judged Debbie soundly with definitives about what kind of person she is and whether or not she should be in the profession she's in.
And they weren't just rude to Debbie, even some of the people who backed her up said things about the MBTA that were unfounded and hateful. Debbie doesn't think that all MBTA drivers are "lazy," or "stupid," and she certainly didn't imply, as one commenter did, that the man was "intoxicated." Why the hate? Then, when people couldn't agree about a point, they turned on each other - the jurors in this imaginary trial devouring one another before a verdict could be reached.
How quick we all are to judge. In some cases it's a good thing, it's why our brains are hardwired to do it in the first place. Is that berry poisonous? Will the man approaching me on the street strike me dead or wave hello? But we've done something wrong when we can sit at home and hang people with mere keystrokes. Especially people like Debbie, a nurse who has spent her life taking care of other people, and most recently in her career, people for whom few others have any pity, any compassion or any time.
Then again, most educated people know that the rumblings of idiots in the comments section of Boston.com articles mean very little. They are rendered immediately useless by the casual access of the authors. And isn't my blog, by definition a bit of the same? In condemning those rude commentators aren't I exercising the same right they were?
In the end, we should be thankful that we're allowed to call to report things that we believe are wrong. And... we should be thankful that people are allowed to argue in a public forum over whether or not it was really wrong. Because we could be living in a police state. We could be living in a country like China right now. We could be in any number of small dictatorships all over the world but instead we're here.
Thankfully Debbie was able to laugh about the majority of the comments as we scrolled down the list in her office this morning before work. She's a very strong woman, a great leader, definitely not a prude or a "peeping Jane," and will not be quitting the medical field any time soon. Or definitely not before it becomes legal to just pee anywhere you want, no matter what you're doing or who's around.
Sorry, Boston.
It was hard to see so many strangers rip Debbie to shreds on the internet so casually. As they sipped their morning coffee they typed noxious generalizations about a woman they don't know. Either stealing from their desk jobs by surfing the net at work, or sitting at home in their underwear they judged Debbie soundly with definitives about what kind of person she is and whether or not she should be in the profession she's in.
And they weren't just rude to Debbie, even some of the people who backed her up said things about the MBTA that were unfounded and hateful. Debbie doesn't think that all MBTA drivers are "lazy," or "stupid," and she certainly didn't imply, as one commenter did, that the man was "intoxicated." Why the hate? Then, when people couldn't agree about a point, they turned on each other - the jurors in this imaginary trial devouring one another before a verdict could be reached.
How quick we all are to judge. In some cases it's a good thing, it's why our brains are hardwired to do it in the first place. Is that berry poisonous? Will the man approaching me on the street strike me dead or wave hello? But we've done something wrong when we can sit at home and hang people with mere keystrokes. Especially people like Debbie, a nurse who has spent her life taking care of other people, and most recently in her career, people for whom few others have any pity, any compassion or any time.
Then again, most educated people know that the rumblings of idiots in the comments section of Boston.com articles mean very little. They are rendered immediately useless by the casual access of the authors. And isn't my blog, by definition a bit of the same? In condemning those rude commentators aren't I exercising the same right they were?
In the end, we should be thankful that we're allowed to call to report things that we believe are wrong. And... we should be thankful that people are allowed to argue in a public forum over whether or not it was really wrong. Because we could be living in a police state. We could be living in a country like China right now. We could be in any number of small dictatorships all over the world but instead we're here.
Thankfully Debbie was able to laugh about the majority of the comments as we scrolled down the list in her office this morning before work. She's a very strong woman, a great leader, definitely not a prude or a "peeping Jane," and will not be quitting the medical field any time soon. Or definitely not before it becomes legal to just pee anywhere you want, no matter what you're doing or who's around.
Sorry, Boston.
Urine Trouble - #1
The DON was in the news last night, but not for anything that had to do with our work.
I usually refer to her as the DON, but in this Globe article her full name is stated, so I guess we can all be candid from here on in. I'm not going to get to my point until the last paragraph or so, so settle in for a long winded ride on this one.
Debbie is in the news because she reported a bus driver in Boston for getting off the bus and urinating on a city street.
At first I wasn't sure why this was newsworthy, but one glance at the comments section of either the article linked above or this one, will explain everything.
People are furious. And they are either furious at the man... or in many cases, at Debbie. In fact, the article was mostly about Debbie, and the comments are ALL about Debbie.
The criticisms of Debbie range from making no sense at all...
"Leave it to a nurse to complain," writes reindeergirl.
"Seriously, Ms. Thornton you work in nursing. You should know better."
... to personal attacks:
"Thornton..I hope someday you have to go so bad you can't wait and you embarrass yourself in front of everyone.....you are a snob!"
"Thornton you really need to focus on yourself. I'm blown away by how inconsiderate you are. I hope at your job you aren’t given normal bathroom breaks. Wow..."
Some people even tried to drag the homeless into it:
"She works with the homeless and is complaining about this?
If one of her clients were arrested or disciplined for the same behavior I bet it would be quite a different story." *
And more than one person stated straight out that she shouldn't be allowed to be a nurse. This is one of them:
"This could happen to anyone including you ms. thornton. Maybe you should resign from the medical field because the compassion you show here should never be allowed in a hospital or a medical facility."
I promised myself I'd get right down to the point I was trying to make, but I want to rip on this one for a minute.
First of all, Debbie is in her forties and has never gotten out of a car in downtown Boston, dropped trou, squatted and peed. So "this could happen to anyone even you," is a little silly.
Then the other half, "maybe you should resign from the medical field..." Seriously? Since Debbie is a nurse she has to be okay with public urination? What if your nurse in the hospital relieved himself in a potted plant because he couldn't make it to the staff bathroom? How compassionate would you feel? Would you argue that maybe your nurse has a bladder problem and invite him to pee on your flowers every day? Would you be okay with someone saying "well he did his job, so let him alone?"
Compassion is good and fine, and has it's place but if nurses ruled only with compassion without any thought to best practice, boundaries, or greater community good then everyone who said they had a little back pain would be high on vicodins, no one would have to pay for health care and there'd be no beds left in the hospitals because people would just be living there treating the CNAs as hired help. Compassion doesn't mean letting everything all go to hell in a handbasket.**
Now listen. If you don't agree with what Debbie did, that's fine. I know a lot of people would have looked the other way.
They're thinking "the guy is human! When you gotta go, you gotta go!"
But why take out your outrage about the human condition in working class America on Debbie? Get outraged about the long hours for MBTA drivers. Or about the general rush of American life which made the man feel like he couldn't pull over for a more legal or legitimate bathroom break.
There are also a number of people who side with Debbie on the issue, most of those comments for some reason are left on the second article, whereas the more scathing quips are on the first.
The people who agree with Debbie point out that the bus driver was in uniform, abandoned his post, and didn't explain anything to the worried passengers.
"I agree with person who reported this; an unscheduled stop for an emergency is one thing, an unscheduled stop to urinate in public is quite another. It is an incredible display of disrespect to have a bus with people on it wait while you urinate in a public place."
Others chimed in that if the bus driver had explained what was going on, it would have been more excusable. Still others mentioned the fact that the man, in fact was breaking a law.
And friends, you can argue til the sun goes down about whether or not it's a stupid law but it is still a law and the law is that you can NOT urinate in public here. I think plenty of laws are stupid***, but they're still laws. And if we're going to have laws, we need to either uphold them or protest them until they are no longer laws. Otherwise they're just suggestions.
I'm not going to tell you how I feel about the issue with the bus driver because that's moot. I don't even want to talk about whether or not a bystander should report public urination. I want to talk about people.
(See next post)
------------------------------------------
* Actually when homeless men or women urinate in the street it's because they are intoxicated or mentally impaired. Most people without homes when sober and right minded are actual hyper vigilant about dignity and privacy because of the social stigma they already face. (Sigh).
** Or a puddle of urine.
*** Plenty.
I usually refer to her as the DON, but in this Globe article her full name is stated, so I guess we can all be candid from here on in. I'm not going to get to my point until the last paragraph or so, so settle in for a long winded ride on this one.
Debbie is in the news because she reported a bus driver in Boston for getting off the bus and urinating on a city street.
At first I wasn't sure why this was newsworthy, but one glance at the comments section of either the article linked above or this one, will explain everything.
People are furious. And they are either furious at the man... or in many cases, at Debbie. In fact, the article was mostly about Debbie, and the comments are ALL about Debbie.
The criticisms of Debbie range from making no sense at all...
"Leave it to a nurse to complain," writes reindeergirl.
"Seriously, Ms. Thornton you work in nursing. You should know better."
... to personal attacks:
"Thornton..I hope someday you have to go so bad you can't wait and you embarrass yourself in front of everyone.....you are a snob!"
"Thornton you really need to focus on yourself. I'm blown away by how inconsiderate you are. I hope at your job you aren’t given normal bathroom breaks. Wow..."
Some people even tried to drag the homeless into it:
"She works with the homeless and is complaining about this?
If one of her clients were arrested or disciplined for the same behavior I bet it would be quite a different story." *
And more than one person stated straight out that she shouldn't be allowed to be a nurse. This is one of them:
"This could happen to anyone including you ms. thornton. Maybe you should resign from the medical field because the compassion you show here should never be allowed in a hospital or a medical facility."
I promised myself I'd get right down to the point I was trying to make, but I want to rip on this one for a minute.
First of all, Debbie is in her forties and has never gotten out of a car in downtown Boston, dropped trou, squatted and peed. So "this could happen to anyone even you," is a little silly.
Then the other half, "maybe you should resign from the medical field..." Seriously? Since Debbie is a nurse she has to be okay with public urination? What if your nurse in the hospital relieved himself in a potted plant because he couldn't make it to the staff bathroom? How compassionate would you feel? Would you argue that maybe your nurse has a bladder problem and invite him to pee on your flowers every day? Would you be okay with someone saying "well he did his job, so let him alone?"
Compassion is good and fine, and has it's place but if nurses ruled only with compassion without any thought to best practice, boundaries, or greater community good then everyone who said they had a little back pain would be high on vicodins, no one would have to pay for health care and there'd be no beds left in the hospitals because people would just be living there treating the CNAs as hired help. Compassion doesn't mean letting everything all go to hell in a handbasket.**
Now listen. If you don't agree with what Debbie did, that's fine. I know a lot of people would have looked the other way.
They're thinking "the guy is human! When you gotta go, you gotta go!"
But why take out your outrage about the human condition in working class America on Debbie? Get outraged about the long hours for MBTA drivers. Or about the general rush of American life which made the man feel like he couldn't pull over for a more legal or legitimate bathroom break.
There are also a number of people who side with Debbie on the issue, most of those comments for some reason are left on the second article, whereas the more scathing quips are on the first.
The people who agree with Debbie point out that the bus driver was in uniform, abandoned his post, and didn't explain anything to the worried passengers.
"I agree with person who reported this; an unscheduled stop for an emergency is one thing, an unscheduled stop to urinate in public is quite another. It is an incredible display of disrespect to have a bus with people on it wait while you urinate in a public place."
Others chimed in that if the bus driver had explained what was going on, it would have been more excusable. Still others mentioned the fact that the man, in fact was breaking a law.
And friends, you can argue til the sun goes down about whether or not it's a stupid law but it is still a law and the law is that you can NOT urinate in public here. I think plenty of laws are stupid***, but they're still laws. And if we're going to have laws, we need to either uphold them or protest them until they are no longer laws. Otherwise they're just suggestions.
I'm not going to tell you how I feel about the issue with the bus driver because that's moot. I don't even want to talk about whether or not a bystander should report public urination. I want to talk about people.
(See next post)
------------------------------------------
* Actually when homeless men or women urinate in the street it's because they are intoxicated or mentally impaired. Most people without homes when sober and right minded are actual hyper vigilant about dignity and privacy because of the social stigma they already face. (Sigh).
** Or a puddle of urine.
*** Plenty.
Publish Post
Wednesday, June 3, 2009
Fasting for the Homeless
Kip Tiernan, the founder of Rosie's Place in Boston, is fasting for three days to raise awareness (and donations) for the homeless.
The source of this bit of news is here at WBZ's website, and does not include any information on how you can help, so I took it upon myself to get some more information.
For the next three days (including today) you can go directly to Boston's Old South Church (link to directions) and drop off non perishable food items or monetary donations.
You can also join the fast.
If you aren't in town, or don't have time to stop by the church, you can always donate online.
Please consider giving some food or money to Rosie's Place. They are an amazing asset to the homeless women of Boston. I personally know many women who have been helped by Rosie's and who need our help to keep it going.
Thank you.
The source of this bit of news is here at WBZ's website, and does not include any information on how you can help, so I took it upon myself to get some more information.
For the next three days (including today) you can go directly to Boston's Old South Church (link to directions) and drop off non perishable food items or monetary donations.
You can also join the fast.
If you aren't in town, or don't have time to stop by the church, you can always donate online.
Please consider giving some food or money to Rosie's Place. They are an amazing asset to the homeless women of Boston. I personally know many women who have been helped by Rosie's and who need our help to keep it going.
Thank you.
Friday, May 22, 2009
Code Green
A Code Green at our facility is called when there is a behavioral emergency. We get them infrequently, more infrequently than you might imagine given our population. But we had one a few weeks ago. It was called in the lobby which meant it could be anyone, even just someone waking in off the street to our clinic.
I was in the middle of giving medications to one of our frequent fliers. She's a petite woman, and physically frail but her spirit is strong. When the code was called I apologized to her, locked the medications back into the cabinet below the counter and took off for the lobby.
As usual once I had gotten there from four floors up the situation was under control and we were all told to return to work.
I jogged back up the stairs and found the patient still waiting at the med counter.
"Is everything ok?" she asked, genuinely worried. "Are they calling an ambulance?"
I explained the difference between a code green and a code blue.
"Pfft," she said, her concerned face changing to one of disgust, "you just can't take some people nowhere."
I was in the middle of giving medications to one of our frequent fliers. She's a petite woman, and physically frail but her spirit is strong. When the code was called I apologized to her, locked the medications back into the cabinet below the counter and took off for the lobby.
As usual once I had gotten there from four floors up the situation was under control and we were all told to return to work.
I jogged back up the stairs and found the patient still waiting at the med counter.
"Is everything ok?" she asked, genuinely worried. "Are they calling an ambulance?"
I explained the difference between a code green and a code blue.
"Pfft," she said, her concerned face changing to one of disgust, "you just can't take some people nowhere."
Sunday, May 3, 2009
Swine Flu peeks through windows, scares the children
At work on Thursday we had a nursing meeting regarding the plans for when H1N1 starts showing up in Boston.
At church Saturday night a well meaning priest recommended that we not shake hands during the Peace Offering "due to recent, er, events." The Peace Offering is the part of a Catholic Mass where we "offer one another a sign of Christ's peace." Hand shaking is the status quo (oh, New England), but kissing cheeks, hugs* and hand gestures are also accepted in some folds. The priest laughed when he said it, and we laughed too, but no one touched during the Peace Offering. I rolled my eyes heavenward. There are several probable cases in Boston, but none confirmed yet. No one in the church had so much as sneezed during the entire service and here we were, offering peaceful eyebrow raises and head nods at each other.
Like the people in the Bible who don't allow lepers to walk on the same side of the street. You know, the people we swear we aren't.
"To be fair," said a coworker as I relayed my frustrations Sunday at work, "you know that people can be contagious during the prodromal phase. You're contagious for twenty four hours before symptoms. And we don't know a whole lot about why this kills healthy people off."
I think that the public paying more attention to personal hygiene is never a bad thing. If this teaches people to cover their mouths with their elbows when they sneeze, I'll be thrilled. If it means more parents will immunize their kids, I will do dance. But I'm afraid that instead it's just teaching people to distrust one another. (Here's an inconclusive article from CNN on social distancing.)
But let's go back to where I started. Although I would discourage hysteria, I have my concerns. But my concerns are based on knowing that it will spread faster through the homeless than it will through other patient groups, and that a lot of them just won't be able to handle it.
Although incidence is on the decline, anyone who reads a newspaper can tell you exactly what we learned in nursing school: "pandemics trend in waves." Now is when we start to plan for a viral resurgence in August or September.
We're talking daily about emergency preparedness, and while I don't know that we will ever have to execute any of the planning, I don't mind it. It's not a bad exercise for any of us. And it's sort of inspiring to see it all kick in. I hadn't thought about half the things we're thinking about. Like, how to get a homeless person over to McInnis if he or she is infected. An ambulance is a real waste of resources, but will cab drivers agree to take sick people? Can they legally refuse? It raises a ton of interesting questions, and I think people thrive when they're asking questions.
Part of my job as a nurse, as I was reminded by the DON, is to stay as educated as possible, and to make educated and objective decisions on a day to day basis. This obligation then extends to a responsibility to educate other people so they too may make unbiased, informed choices. Think you should pull your kid out of school? Great. I'm here to tell you the statistics of confirmed cases at your child's school. Thinking about listening to Biden telling people they shouldn't get on a plane? I will be happy to sit with you and explain how droplet transmission differs from airborne transmission** so you can go ahead and buy that ticket. Want to go to work even though you have a fever, aches, and a productive cough? I'll call your boss for you - you're staying home and drinking juice. But that's what I would tell you about any virus, any time.
And if you don't want me to hug you at church I won't. But I think as long as we all wash our hands, we can at least shake on it.
-----------------------------------------------------------------------------------------
* I like hugs. It's not as disarming as a kiss to most new englanders, but it gets the point across.
** Jeepers, Biden, it's not TB!
"If one of our guys gets it," the DON quoted the medical director, "a hundred of them will."
It's true. The current recommendation for people who think they have the flu is to stay home. Not to go the doc or to the ER where they may infect other people, but to isolate in their home with plenty of fluids and rest. If symptoms get very severe, people should then call the ER, where they would be triaged immediately.
So when it comes to homeless people there's a problem. They have nowhere to isolate themselves. Most of them sleep in shelters, mere inches away from other people. Many of them are substance abusers or mentally ill and unable to take care of themselves. Many of them are compromised by other diseases, including HIV and AIDs. How do we stop the spread of the flu through this community?
At church Saturday night a well meaning priest recommended that we not shake hands during the Peace Offering "due to recent, er, events." The Peace Offering is the part of a Catholic Mass where we "offer one another a sign of Christ's peace." Hand shaking is the status quo (oh, New England), but kissing cheeks, hugs* and hand gestures are also accepted in some folds. The priest laughed when he said it, and we laughed too, but no one touched during the Peace Offering. I rolled my eyes heavenward. There are several probable cases in Boston, but none confirmed yet. No one in the church had so much as sneezed during the entire service and here we were, offering peaceful eyebrow raises and head nods at each other.
Like the people in the Bible who don't allow lepers to walk on the same side of the street. You know, the people we swear we aren't.
"To be fair," said a coworker as I relayed my frustrations Sunday at work, "you know that people can be contagious during the prodromal phase. You're contagious for twenty four hours before symptoms. And we don't know a whole lot about why this kills healthy people off."
I think that the public paying more attention to personal hygiene is never a bad thing. If this teaches people to cover their mouths with their elbows when they sneeze, I'll be thrilled. If it means more parents will immunize their kids, I will do dance. But I'm afraid that instead it's just teaching people to distrust one another. (Here's an inconclusive article from CNN on social distancing.)
But let's go back to where I started. Although I would discourage hysteria, I have my concerns. But my concerns are based on knowing that it will spread faster through the homeless than it will through other patient groups, and that a lot of them just won't be able to handle it.
Although incidence is on the decline, anyone who reads a newspaper can tell you exactly what we learned in nursing school: "pandemics trend in waves." Now is when we start to plan for a viral resurgence in August or September.
We're talking daily about emergency preparedness, and while I don't know that we will ever have to execute any of the planning, I don't mind it. It's not a bad exercise for any of us. And it's sort of inspiring to see it all kick in. I hadn't thought about half the things we're thinking about. Like, how to get a homeless person over to McInnis if he or she is infected. An ambulance is a real waste of resources, but will cab drivers agree to take sick people? Can they legally refuse? It raises a ton of interesting questions, and I think people thrive when they're asking questions.
Part of my job as a nurse, as I was reminded by the DON, is to stay as educated as possible, and to make educated and objective decisions on a day to day basis. This obligation then extends to a responsibility to educate other people so they too may make unbiased, informed choices. Think you should pull your kid out of school? Great. I'm here to tell you the statistics of confirmed cases at your child's school. Thinking about listening to Biden telling people they shouldn't get on a plane? I will be happy to sit with you and explain how droplet transmission differs from airborne transmission** so you can go ahead and buy that ticket. Want to go to work even though you have a fever, aches, and a productive cough? I'll call your boss for you - you're staying home and drinking juice. But that's what I would tell you about any virus, any time.
And if you don't want me to hug you at church I won't. But I think as long as we all wash our hands, we can at least shake on it.
-----------------------------------------------------------------------------------------
* I like hugs. It's not as disarming as a kiss to most new englanders, but it gets the point across.
** Jeepers, Biden, it's not TB!
Monday, March 23, 2009
Methadonia Part II
Last week I wrote about some first impressions I had of the documentary Methadonia. My thoughts came from a highly specific place because of the work I do. However, I did not specify that in my entry.
I received a very well thought out response from a stranger informing me that the film did a lot of damage within the MMT (methadone maintenance therapy) community. This was the result of Michel Negroponte's decision to only depict MMT clients on the edge of society, mostly homeless or close to being homeless. Because of this small percentage represented, "Zenith" explained, MMT was further stigmatized. Many people who are using methadone to prevent withdrawal and relapse live healthy and productive lives.
Although I am already aware of everything Zenith brought up, I didn't write much on it. My interest in the film began and ended with those who have not had success stories. I watched the film with a group of other nurses who also work specifically and almost exclusively with the homeless. On a daily basis I am confronted with members of our society for whom a "normal," life with a job, home and family is, for various reasons, out of reach.
However, I did not take into account that many other people reading this may not know anyone on MMT and may take my word as the only one on the subject. And it is never my intention to mis-educate people, so I would like to re-post the comment I received in the hopes that it will at least begin to explain why methadone maintenance therapy as shown in Methadonia is not the experience of every man or woman who undergoes it.
Mr Negroponte's film was the source of a great deal of conflict within the methadone community. The film focused solely on patients who were abusing their medication and combining it with other drugs, specifically benzos, to get high. They were shown nodding off, drooling, slurring speech, etc. In addiction, almost every pt shown was homeless or very nearly so, living a marginalized life at the fringes of society and spouting common methadone myths like they were going out of style. No effort was made to correct them nor to show the other side of methadone treatment.
Due to the uproar of anger this caused, an 11 minute add-on called "Addiction 101" was added to the DVD release of the film. This included two stable, professional methadone patients--an attorney and a businessman--who have been on methadone for decades, and two doctors who are experts in the field of MMT. Sadly, however, even their noble efforts were too little too late--most people did not see the add-on, and people were strongly influenced to accept Mr Negroponte's vision of the methadone patient as a homeless, drooling, pitiful character that they wouldn't want anywhere near their children or their homes.
This kind of filmmaking simply leads to increased discrimination and stigma on an already stigmatized population. The reason clinics do not generally encourage withdrawal from treatment is not, as is commonly though, because they are crazed with greed. There is an enormous shortage of clinics and clinics are NOT hurting for patients--most have lengthy wait lists--so there is no $$$ motivation for them to hang on to those who wish to leave. The fact is, 90% of those leaving MMT relapse within one year. Sure, most pts would like to be "drug free"--who wouldn't? Diabetics and epileptics would rather be "drug free" too, I'm sure, but their doctors do not encourage them to stop taking their meds because of this.
Long term opioid addiction can produce permanent changes in the brain chemistry--specifically in endorphin production. If the patient has a permanent suppression of endorphins, they are very unlikely to do well in an abstinence based recovery. The methadone serves to stabilize the brain chemistry without causing a high or euphoria. It enables people to resume a normal life. I know many many professional people, suburban mothers, college students, etc on MMT and none of them look like the people in the film--but that isn't very "entertaining" so it wasn't shown, sadly enough.
Right now, methadone is the MOST effective method of treatment available for opiate addiction, and has a high rate of keeping pts free of illicit drugs. Yes, there are some that continue to use illicits, but far fewer than in other modalities of care.
I agree with all of that.
If there were a movie that came out about the rate of diabetic related co morbidities in low income patients it probably wouldn't focus on any success stories either. The difference is that no one out there is arguing to stop the use of insulin in patients with diabetes, but many people including entire governments (what's up, Russia?) are dead set against helping opiate addicts.
And so I will end with this: the end of my lengthy comment in response to Zenith's:
My interest would never be to stop MMT for people who benefit from it, but rather it's my intention to urge the medical community to continue to look at the cases that aren't so successful and to push forward on remedying that.
I received a very well thought out response from a stranger informing me that the film did a lot of damage within the MMT (methadone maintenance therapy) community. This was the result of Michel Negroponte's decision to only depict MMT clients on the edge of society, mostly homeless or close to being homeless. Because of this small percentage represented, "Zenith" explained, MMT was further stigmatized. Many people who are using methadone to prevent withdrawal and relapse live healthy and productive lives.
Although I am already aware of everything Zenith brought up, I didn't write much on it. My interest in the film began and ended with those who have not had success stories. I watched the film with a group of other nurses who also work specifically and almost exclusively with the homeless. On a daily basis I am confronted with members of our society for whom a "normal," life with a job, home and family is, for various reasons, out of reach.
However, I did not take into account that many other people reading this may not know anyone on MMT and may take my word as the only one on the subject. And it is never my intention to mis-educate people, so I would like to re-post the comment I received in the hopes that it will at least begin to explain why methadone maintenance therapy as shown in Methadonia is not the experience of every man or woman who undergoes it.
Mr Negroponte's film was the source of a great deal of conflict within the methadone community. The film focused solely on patients who were abusing their medication and combining it with other drugs, specifically benzos, to get high. They were shown nodding off, drooling, slurring speech, etc. In addiction, almost every pt shown was homeless or very nearly so, living a marginalized life at the fringes of society and spouting common methadone myths like they were going out of style. No effort was made to correct them nor to show the other side of methadone treatment.
Due to the uproar of anger this caused, an 11 minute add-on called "Addiction 101" was added to the DVD release of the film. This included two stable, professional methadone patients--an attorney and a businessman--who have been on methadone for decades, and two doctors who are experts in the field of MMT. Sadly, however, even their noble efforts were too little too late--most people did not see the add-on, and people were strongly influenced to accept Mr Negroponte's vision of the methadone patient as a homeless, drooling, pitiful character that they wouldn't want anywhere near their children or their homes.
This kind of filmmaking simply leads to increased discrimination and stigma on an already stigmatized population. The reason clinics do not generally encourage withdrawal from treatment is not, as is commonly though, because they are crazed with greed. There is an enormous shortage of clinics and clinics are NOT hurting for patients--most have lengthy wait lists--so there is no $$$ motivation for them to hang on to those who wish to leave. The fact is, 90% of those leaving MMT relapse within one year. Sure, most pts would like to be "drug free"--who wouldn't? Diabetics and epileptics would rather be "drug free" too, I'm sure, but their doctors do not encourage them to stop taking their meds because of this.
Long term opioid addiction can produce permanent changes in the brain chemistry--specifically in endorphin production. If the patient has a permanent suppression of endorphins, they are very unlikely to do well in an abstinence based recovery. The methadone serves to stabilize the brain chemistry without causing a high or euphoria. It enables people to resume a normal life. I know many many professional people, suburban mothers, college students, etc on MMT and none of them look like the people in the film--but that isn't very "entertaining" so it wasn't shown, sadly enough.
Right now, methadone is the MOST effective method of treatment available for opiate addiction, and has a high rate of keeping pts free of illicit drugs. Yes, there are some that continue to use illicits, but far fewer than in other modalities of care.
I agree with all of that.
If there were a movie that came out about the rate of diabetic related co morbidities in low income patients it probably wouldn't focus on any success stories either. The difference is that no one out there is arguing to stop the use of insulin in patients with diabetes, but many people including entire governments (what's up, Russia?) are dead set against helping opiate addicts.
And so I will end with this: the end of my lengthy comment in response to Zenith's:
My interest would never be to stop MMT for people who benefit from it, but rather it's my intention to urge the medical community to continue to look at the cases that aren't so successful and to push forward on remedying that.
Subscribe to:
Posts (Atom)