Madeline is one of the sickest patients I have met in three years of medical school. Homeless, she came by ambulance to the hospital for malnutrition and frostbite after days sleeping out in a Portland area park this winter. She was resourceful: She made drinking water by melting snow in plastic bottles with her own body heat. And her physical health was surprisingly good. Her mental health was not. She thought she had magic powers, had pockets inserted in her body, that people were chasing her across country.
Madeline (not her real name) was either too addled or too afraid to give any information about her past, using a fake name and claiming she could not remember any phone numbers or any other cities where she had lived. She denied being sick, saying she was only the psych ward for “R&R” and taking her antipsychotic to gain some weight. I think her psychiatrists and I did almost nothing that helped her: her mental health was not a whit different on leaving than on coming in. But the hospital’s social workers helped her immensely. They found her a place to live and outpatient clinics for physical and mental health care.
Judy (also a pseudonym) was an older woman found wandering, confused, on the hospital grounds. She couldn’t remember just why she’d come here. She was undernourished, with an untreated infection, a wallet stuffed with cash and ATM slips and a determination to return to the home where she had fallen and injured herself at least four times in the past year. We gave her antibiotics, but could prescribe nothing for the biggest risk she faced: Falling in her own home. By the time she left, social workers and case managers had set her up with Meals on Wheels and health aides who would check on her six days a week.
It was humbling to see how little medicine had to offer these ill and vulnerable women. I am being trained in a ridiculously expensive and high-tech medical world of face transplants and $8,000-a-month humanized mouse antibodies, but am helpless to meet patients’ most basic needs, a safe place to live and decent food to eat. And food and housing are medical issues: A group that ranks the health of every U.S. county estimates that clinical medical care, including having insurance, accounts for just 20 percent of our health. Other economic and social factors such as education, unemployment and poverty, determine 40 percent, the greatest share.
I think this is the secret to success of Health Care Equality Week, an annual week of educational sessions about health care and society that ends in a student-run health fair. Hundreds of people, many homeless or hungry, come to this free fair where students from OHSU, Oregon State and elsewhere check their blood pressure, provide basic dental care and offer other simple health screenings, including the chance to meet a doctor.
While health students check weight and hearing, others offer services that may be a bigger help to the crowd. Some volunteers hand out packs of toiletries. Others give free hair cuts. People offer referrals to drug counseling, shelters and other social services. Veterinary students from Oregon State check on pets. And many come mainly for a free meal from Potluck in the Park and for friendly human contact.
I think this mix of medicine and social support is the fair’s real strength, certainly in terms of educating the students. Our foot checks and immunizations definitely do some good, and people seem genuinely grateful for the services. But you quickly come to realize that finding a pair of glasses or grabbing 10 minutes with a doctor are small support compared to an offer of a hot meal or, sometimes, even a hair cut. It’s a good reminder that decent medical care is important and valuable, often hard to get and, for too many people, not nearly enough to achieve good health.
This year’s Health Care Equality Week starts with lectures next week, and ends in the fair on March 17. For more information, check this website.