The Faces of the Uninsured

Over the next few weeks, I want to introduce you to a few of my patients. All of their names have been changed to protect their privacy, but as you get to know them, I believe you will see the faces of the uninsured in America in a new way.

The stories are all about real people whom we have seen recently in our clinic, and there are dozens more of them. I can assure you that each of them are just like you: they hurt, they bleed, and they feel. They are our friends, our neighbors, and ourselves.

"...No man is an island, entire of itself. Every man is a piece of the continent, a part of the main. If a clod be washed away to the sea, Europe is the less, as well as if a promontory were, as well as if a manner of thy friends or of thine own were: any man’s death diminishes me, because I am involved in mankind...."
John Dunne, Meditation 17

Trish

Trish looked scared and lost as she walked into our clinic a few weeks ago. When we first met her she was eight-months pregnant at the tender age of nineteen and fleeing a domestic violence situation. We didn’t know it yet, but Trish had escaped her violent partner by moving into a burned-out, boarded-up, abandoned building in the West Hill neighborhood of Albany, New York with her father. Because she won’t leave her father alone, she cannot move into a shelter. As I write this, it is November, which can be very cold here in the Northeast. The boarded-up building she is living in has no heat or electricity.

In spite of her circumstances, she was still so full of wonderment about her pregnancy that I couldn’t help wanting to get in her corner and care for her. I just wanted to see life start to break right for this woman who had suffered such trouble.

All of our staff began to reach out to her as the details of her story came to light. During her exam that first day, we discovered that her baby was in a breech position putting both Trish and her newborn at risk for life-threatening complications if the baby did not change position before Trish went into labor. If the baby didn’t turn, Trish would need an expensive C-section, but she has no health insurance.

After addressing her medical needs, our staff at Compassion in Action/Koinonia Primary Care began to gather much-needed and practical baby gear to help her prepare for her coming newborn. Car seats, baby clothes, furniture, and best wishes began to flow in as they began to advocate for Trish’s needs. We even took the clock off of our break room wall to send home with her so that she could time her contractions, just in case she started to go into labor.

As of this writing, Trish’s breech baby hasn’t turned. She needs to have the C-section, which is a procedure that I am not qualified to perform. During the past few weeks, we had to find an obstetrician willing to donate his or her time for Trish. We are very fortunate that a local obstetrician has volunteered his services. Trish is scheduled for the C-section tomorrow.

Thank God that the community is reaching out to Trish. My hope is that all of her needs will be met. She still needs to find housing for herself, her father, and her newborn. I believe that everything will turn out right for Trish.
I just don’t know how many more situations like Trish’s we can handle.

33 Cents

One of the turning points of my life occurred when I was a "geriatric" 39-year-old 4th-year medical student. I was introduced to a man in Albany who was trying to raise a small amount of money to buy supplies and equipment for a Cholera "hospital" in central Mozambique.

Neto and I met almost by accident. I was leaving home to study for an exam at the library, but I had returned to retrieve a forgotten book. When I re-entered my home the phone was ringing. "Bob you've got to meet this guy sitting in my office" my friend Peter blurted out excitedly. “He's been sharing stories with me about Mozambique, and I'm getting really excited about what's going on there. You've got to meet him!” A meeting was hurriedly arranged.

A short while later I found myself in the presence of one of the most interesting—and extraordinary—people I have ever met. Neto has a smile that can light up a dark room. His warmth immediately burned through my awkwardness in meeting a stranger. His vitality and infectious laugh could make anyone feel that they had known him all their life. I would later learn that he could play the guitar such that it would make you weep, and also climb a coconut palm tree to pick out the choicest young coconuts with the sweetest "water." Within one hour, we were close friends.

Neto told me how he had given up a lucrative career and lots of money in his native Brazil to follow his heart to Mozambique. His fiancée gave him an ultimatum, "It's either me, or Africa!" They were to be married in four months. "I love you, but I must follow my calling to Africa. Please come with me!" An engagement ring thrown at his feet was the only reply. Neto later sold it to pay for a one-way plane ticket. By the end of the evening, I knew we would be working together.

Four months later, Peter, an LPN, and I arrived at Albany County Airport ready to embark on the adventure of our lives, our first medical "mission of mercy to Mozambique." I was as green as a ripened lime, counting a trip to Iowa, as my furthest journey to date. I never expected the look on the ticket agent’s face when I responded, "12" to his question, "How many bags do you wish to check in?"

The agent responded, "No way, these bags are not going!"

Peter, a more experienced traveler, came to the rescue. "These are emergency medical supplies for Mozambique; there are lives depending on them. They must go!"

"No way!" was the agent’s response.

Never being daunted by a hopeless situation, Peter replied in his firm, but gentle manner. "Alright, we will leave these supplies here if you call the President of the airline, and he tells us they can't go. Otherwise, we are not moving!"

The ticket agent was flabbergasted, but then amazingly picked up the telephone and began dialing corporate headquarters. Peter whispered to me "start praying!" I didn't need the reminder. The agent was getting frustrated as he was being transferred from department to department. We continued silently praying our hearts out. The check-in line was getting longer and longer. Finally we got a break! The executive vice president of the airlines answered the phone.

The agent explained the situation to him in very unflattering terms. I couldn't help thinking we were dead. "What do you want me to do with these guys? They have the whole ticket area in a mess and the flights are going to be late." the agent said. I was still praying, all the while having visions of police officers coming to take us away. Finally the response came, "Help them load it on the plane!" God had saved our butts, again!

This was the first of many miracles we experienced on this truly incredible adventure, but all this paled in the light of what we would soon experience! Arriving in Mozambique we quickly found ourselves in the middle of what had to be a chapter from Dante's Inferno.

We worked in seven refugee camps with 50,000 refugees in various stages of filth, disease, and starvation. The nearest real doctor was 500 miles of African road away. In our makeshift clinic we encountered every conceivable horror. There were cases of malaria, infection, and starvation all served with an ample portion of hopelessness and despair and topped with lice and scabies—just in case you weren't already feeling you had landed somewhere in the vicinity of hell.

Peter and I would return from a long day in the clinic seeing hundreds of people. We would flop on our mattresses on the floor and cry until our pillows were soaked with tears. This was no gentle crying; our sobs would have rattled the window panes, if there had been windows. I remember praying "Lord, please kill me! I'd rather be dead than see one more starving baby! I can't do this anymore!" God didn't answer my prayer.

As if all this wasn't enough, after our last day of clinic and just when I was drinking in the relief of being delivered from the pit, a horrific traffic accident occurred a few hundred yards from our base. The causalities included 9 severely injured people. Soon our base was an ICU.

Somehow the honor of being the first 4th-year medical student ever to establish and run an ICU was lost in the blood, the fractures, and the fatigue as I operated all night using only local anesthesia, but even the anesthesia ran out half way through. So I cut and sewed with none while many patients were too much in shock to even feel my knife. It was only by God's grace, and miracles, that every victim survived.

For our departure, Neto had organized a special church service to thank and honor us. He had prepared the people to bring something to give as a thanksgiving. We didn't know what was happening as he called us to take the place of honor in the front of this thatched-roof, mud-walled church. He said "Now it’s our turn to give to those who have given so much to us. Come forward and bring your offering of thanks to God for them!" I was overwhelmed with emotion as I saw the people come forward with joy in their hearts. Through my tears I saw an old woman; she looked ancient, all bent over with bare feet and leather skin. Her gift was a single egg that she placed on the mud altar. I saw a man using a makeshift crutch—necessary because a land mine had blown off his leg—bring a small coin. I saw a child bring the aluminum pop-top from a precious crushed soda can. They came by the hundreds bringing a banana here, a half a sweet potato there, a small coin all mixed with our tears. The money that was received during this offering amounted to 33 cents. It was too holy to ever spend and remains in our office to this day—a gift from the poorest of the poor.

Since then I have been on over 20 medical missions of mercy. I have seen over 100,000 people all over the world in the poorest and most desperate of circumstances, and now I work back in my old neighborhood, the poorest in my city, to do what I can to help. I have been exhausted and down to my last dollar too many times to count. I have been broken in so many ways and have cried more than a million tears. A reporter asked me recently "Dr Bob, surely you could have a great career as a physician, probably a big house, a nice car, and you wouldn't have to work half the hours you do. You're getting older, why do you do the things you do?"

My reply: "for 33 cents."

.........................

In the Summer of 1997, Sebastiao “Neto” Veloso made the ultimate sacrifice and gave his life for the people of Mozambique. He died shortly after our working together,at the age of 32, of unknown causes. He is buried in a shallow grave in Dondo, central Mozambique. I had the privilege of finding and visiting his grave in 2004, ten years after we first worked together in Mozambique. I anointed the ground with my tears. He is survived by his beautiful wife of almost 3 years, Charlene, and their son Joshua who was 14 months old at the time of Neto’s death.

Neto, my friend, I don't know whether I'll ever meet a better man. Thank you for introducing me to the world of caring for the least, the last, and the lost! Rest in God's arms until we meet again.

Bob

Health Insurance in America--The Status Quo Must Go!

Recently, I was reflecting about the fact that 46 million Americans are currently without health insurance. Just who are these people?

In my office we see many people without health insurance, and often these are not the poorest of the poor. Many of our patients who are poor qualify for Medicaid, and have at least some access to health care services. (This is far from perfect, which we will discuss at some later time.) It seems the "working poor"--those that make just enough to not qualify for medicaid, but whose employers do not offer much in the way of benefits--are the most at risk. I recently heard a talk that by the year 2024 no employer will offer health care benefits to their employees, that's at the present rate of employers dropping their health plans due to cost. We are in crisis, but no one seems to be talking or doing much about it!

Another group are those who don't understand how to work through the system or for whatever reason, don't cooperate with the system. Have you ever tried to keep track of the ever changing face of requirements? Just when you think you've got it figured out you realize things have changed again. In our neighborhood we spend an incredible amount of time keeping track of people. Their addresses change, their phones are disconnected, and on and on. They often think they have benefits but find out they've been canceled when they arrive at the office; then what do you do. Their cancellation notice went to some address that is now ancient history. What happens when they need medicine? Can you say go your way brother, be warm and well fed, we'll pray for you? That's not good enough! In most places these people never get beyond the receptionist! They usually end up in some ER further complicating the clogged system!

Then there are those who just "slip through the cracks", such as the 8-month-pregnant woman who came to Albany from New Jersey to avoid a domestic violence situation and has no health plan. We also have a number of patients who are in the country illegally. Some might think these people shouldn't get care because of their immigration status, but I took an oath to care for all people. Even those in prison receive some form of health care.

These are all people! They laugh, they cry, they hurt, they bleed, they have families, at least the more fortunate ones, they are like you and me! The uninsured are not only in the inner city, we just see a lot more of them here. We cannot just drive to the suburbs and pretend it isn't there just because you can't see it from there. If we really love humanity, then we better do something about it! The clock is ticking on our society, and God is watching. What are you going to tell Him when He asks " what have you done for the least of these my brothers?"

The status quo must go!!! Write me and tell me your ideas.

Dr. Bob