I think on of my biggest frustrations is when people fail to see the bigger picture. When a system plays out, just the way it is designed to operate, why do we blame the people who are merely actors in the process? Why do we shoot the messengers?
For example, there are 30-40 million people in this country without health insurance. Many of those people are good, respectable individuals who find themselves in a difficult, and possibly temporary, situation. Others have been raised within a culture of poverty – social, spiritual, cultural, and financial poverty – they don’t know any other way. It isn’t their fault they are in the situations they find themselves, and they don’t know any other way out. Why do we blame these victimized people for the using the only system they know?
Instead, why don’t we – those with education, finances, spiritual roots, and solid family backing – why don’t we redesign the system and fix it? Blaming the victims isn’t going to get us anywhere. Complaining about the system doesn’t do anything for us either. Bottom line is, if 30-40 million people don’t have access to health insurance, we have a problem.
Those without health insurance still have access to healthcare, but they obtain it through the most expensive, backwards way possible. Calling 9-1-1 for an ambulance to take you to the emergency room because you have a headache, is wrong. But for many they have no other choices. When I ask these people why they called for an ambulance, they tell me:
- They didn’t have enough money for a cab.
- They were too ill to walk to the bus stop and figure out the transfers.
- There are no family or friends with cars.
- They didn’t know what else to do.
I, like many of my co-workers, get frustrated by this. But seriously, why don’t we fix the system?
Instead of going to a private physician, these people go to the emergency department. Why? Because by law the ED can’t refuse them. A physician’s office can demand payment upfront, or refuse people based on their inability to pay, but the ED cannot. So, instead of costing $75 for an office visit, this person with a headache – or stomachache, or infection, or cold, or…. ???? is now utilizing a $300 ED visit. Instead of a $15 cab fare, they have just used a $1000 ambulance ride.
We, those of us with the resources to change this, should be ashamed of ourselves.
A couple of weeks ago, we responded (with lights and siren) to the home of a woman complaining of stomach pain. When we arrived, she told us how she’d had the pain for several days, but couldn’t handle it anymore. We took her to the hospital. Enroute, I discovered she was a Crohn’s Disease sufferer, has had multiple surgeries, is unable to work, and is uninsured. How discouraging this life must be. How could I ever judge her for seeking medical assistance when the pain must be intense?
Just a few days ago we responded to a downtown homeless shelter. It was reported that a woman had passed out. When we arrived, we found a fire department paramedic crew talking to a homeless girl who may have only been 17 or 18. She looked like she w as probably a very attractive girl at one time in the not-to-distant past. But now, she was skin and bones, weighing very little – and she looked weak and tired.
She was trying to explain to the fire-medic that she was just tired, and he was suggesting the she go to the hospital. That’s when she explained that they wouldn’t do anything for her. She had MRSA, and the antibiotics necessary to cure it, are not covered under Medicaid. And because she can’t afford the medications, she cannot be cured. As we left, my heart wept. This once beautiful daughter, was no longer beautiful – and she was very sick. Not only could she no longer afford to get healthy, but she no longer had the currency of the street (her beauty) to keep her alive.
The 40 year old man in the back of my ambulance has a headache. He’s had it for three days and it keeps getting worse. He can’t sleep, can’t eat – and even if he could, he can’t keep food down. He’s never had a headache like this before and he is scared. If it was me, I would have called to see my doctor, gotten a migraine prescription, and gone home to enjoy the afternoon with my family. This man doesn’t have those choices. In fact, once he arrives in the hospital, he’ll be ignored, judged, and disrespected.
The uninsured are treated as less than human. Some care providers treat everyone with great respect, but that isn’t the way everyone behaves. We see so many of these people, that it is hard to raise up compassion. They are called system abusers. Some resent the sense of entitlement that these folks project. Maybe they’re just embarrassed? Or maybe they are so ashamed of being treated like dogs, that they have given up with trying to kowtow to the well-educated, well-paid healthcare providers. Maybe, like other disempowered people groups, they have accepted the role they play, and have quit making pretenses.
Recently I had some Somali refugees in my ambulance. One spoke no English, and the other was interpreting for her. She was in pain for a minor medical issue and the easiest thing to do was take her to the hospital. I asked the young man where he was from and he told me Kenya. “Oh? Where?” I asked – just trying to make conversation.
“Near Nairobi,” he replied. “Outside of Nairobi – from a refugee camp.”
Thats when it donned on me, these young adults were children when Somalia disintegrated in the early 1990s. A friend of mine was on an advance triage and survey team that went into Kenya after the Somalis fled. She told stories of mothers dying, while their starving babies continued to nurse. This small team was not equipped, or expected, to do any medical care – they were just there to survey the needs. Time after time, my friend looked into these mud huts and saw dead, or dying mothers, with babies and toddlers left to fend for themselves.
It was heartbreaking. The disease and starvation were of truly catastrophic proportions. The entire team got sick themselves and watched as thousands died during the week they were in camp. It changed my friend to see that.
I realized that these Somalis in the back of my ambulance were survivors of that horror. Through no fault of their own, they lost their families, their homeland, their identities, and their will. And now, only through the generosity of some aid group, or church organization, they have been given the opportunity to leave the refugee camp that has been their home for their entire life, come to America, and start over. But just because they are here, it doesn’t mean they know how to capitalize on the opportunities. They are broken souls – they are lost.
Some of the people we see, are just working class people, without a lot of education, and not much wisdom. They are products of their environment and subculture. They are Black, White, Asian, Hispanic, immigrants, and everything in-between. Some have made a series of poor choices, others have been cursed with bad health, or bad circumstances. Some come from broken families, broken ideas, and extremely dysfunctional backgrounds. For some, the brokenness goes back generations.
Some of the people I see are nice, respectable, and intelligent – but they are emotionally and/or spiritually impoverished. Others are slow-witted, developmentally disabled, or cursed with a chronic disease like schizophrenia, epilepsy, or Crohn’s Disease. They have the will to survive, but they have been broken and battered after a lifetime of illness.
Sometimes we encounter people who have been trashed by the people that were supposed to raise and care for them. One girl described being tied to her bed and people paid her father to have sex with his daughter. I remember a boy whose father shot himself in front of the whole family. Then there are the kids who watched their father beat their mother, the same way their grandfathers beat their grandmothers. The boys then went out and found women to beat, and the women moved in with men who beat them. The cycle continues.
We arrived to find a 35 year old man sitting on the ground, bleeding from the head. He had a seizure while sipping a cup of coffee. Apparently, he had run out of money and hadn’t taken his anti-seizure or anti-psychotic medications in a couple of months. As I rummaged through his backpack and wallet, trying to figure out who he was, I discovered that not only had he been evicted from his apartment, but the Sheriff’s office had issued him a no trespassing warning. He had a notice, long since expired, that warned his pet dog would be exterminated if he didn’t recover it from the shelter by a certain date.
This poor man, someone’s son, probably began experiencing epilepsy and schizophrenia around his late teens, or early 20s. Before that time, his life was probably fairly normal, but in the course of the last 15 years, it was spiraling downward. Now, at the time we saw him, he was transitioning from being a functional, housed individual, to someone who was destined to live on the streets. His previous existence was over – his future was not looking too good.
A couple of weeks ago we responded to a street corner in Portland for a man having chest pain. Upon arrival, we rolled our eyes to see a 40 year old homeless man lying on a piece of cardboard. He and his friend had tried camping under some trees, but the rainfall from the night before had still soaked their clothes. The man reeked of vomit and urine – we were unimpressed.
But as we moved him to the ambulance, we began to realize this was more than a cold, wet, homeless guy hoping to get a hot meal and some dry clothes. He was describing some serious symptoms. The 12-Lead EKG revealed that he was having a serious heart attack and we began an emergency Code-3 transport to the hospital. On the way, this man told me he was dying – and sure enough, within a couple of minutes, we were doing CPR on him.
He’d been having chest pain for several days. If he’d known, or if he’d had the resources, he might have called us sooner. If he’d called us sooner, he probably would have survived. If…
All of the people I’ve mentioned above will probably not live long lives. In fact, several of them may die before the year is over.
Many people die because they have self-medicated themselves to death with drugs or alcohol. Others die early because they don’t eat well, live in dangerous environments, or have untreated ailments. Some die because they no longer want to live – they are unloved and broken. They either take their own lives, will themselves to die, or live risky lifestyles that bring an early death. They don’t deserve this kind of life – no one does.
We, the ones who have resources, should be ashamed of ourselves. Why do we allow so many to live like this? Why don’t we love these people as much as we love ourselves? Or at least as much as we love our own family?