If health care is interpreted in the truest sense of caring for people’s health, it must be a practice that extends well beyond the boundaries of hospitals and clinics.
I used to work as a doctor in a rural South African hospital. When I moved back to the United States, people commented on how taxing the job must have been. And it was. Babies wasted away from malnutrition. People died of treatable infections because they couldn’t justify paying for transport to care unless they were desperately ill. I found it difficult and wrenching to confront problems that extended so far beyond the boundaries of both the hospital and my training.
Friends of mine were unsurprised. After all, South Africa wasn’t wealthy, and it was emerging from apartheid. But they were taken aback by what I said next — that the challenges of practicing medicine in the United States are little different.
These days, I work in San Francisco at a hospital in the medical safety net, a term for places that care disproportionately for those on Medicaid or without insurance. Recently, I treated a young man bleeding spontaneously into his muscles. With unstable low-wage work, he could afford only sporadic meals. So he chose food carefully — and tacos are cheaper and more filling than fruit. He had scurvy. Though I wish I could say otherwise, he was not my first patient suffering from a disease I previously saw only in refugee camps.
The guest essay I wrote this week is about end-stage poverty, the illness that kills my patients. It’s also about safety-net hospitals and what it’s like to work in one. I never thought I’d be spending hours as a doctor calling eviction defense lawyers or devising convoluted methods to contact patients who lack phones. But there are many essential lessons that medical school omits. One of those is how hard it is to keep poor people alive in this country — and what it takes to try.
