I walked into the doors of the Cone Health Regional Center for Infectious Disease in Greensboro, North Carolina basically clueless. I knew little about what my summer would look like or even what kinds of patients I would encounter. I was anxious to see how the patients and the staff at the clinic accepted me. Little did I know that this community would profoundly impact the way that I perceive disease, healthcare, and even people.
The clinic sees patients with HIV or AIDS, hepatitis, STDs, infected wounds, and much more. Because of their completely diverse patient population, no two days were ever the same at the clinic and there were always surprises. In one day, I might see a severe diabetic with an infected wound in an amputated appendage; a refugee with hepatitis that required a translator to communicate his needs; and a young man, usually depressed, just finding out that he had HIV and trying to figure out what the rest of his life will look like while suffering with a lifelong condition. Since I had little previous exposure to chronic disease, I often thought of disease as something that needed to be treated and then was gone. However, I learned that disease comes with many other accompanying factors such as social stigmas and financial burdens. By combating all of these often inter-related factors, the clinic works toward addressing the overall well being of its patients, not just simply treating the disease.
In order to treat whole persons, the clinic uses an integrative healthcare model throughout its practice, which requires special and direct sensitivity to the special circumstances of impoverished persons and families. Since people living in poverty have a clear lack of resources, the clinic must compensate for this void throughout its practice. Preventative medicine is a key focus, present in many forms including STD screening, controlling blood sugar levels to avoid diabetes, and prescribing preventative HIV medication for individuals at a high risk for HIV. The clinic offers mental health and substance abuse resources with onsite counseling, and a dental clinic for patients without access to their own dentists. It houses case managers that help with transportation to appointments, housing assistance, and other services. Its staff ensures that patients can afford the medication they need. The clinic provides patients with a support network through peer support groups and Higher Ground, a day center that focuses on the specific needs of HIV positive patients with a profound sense of community resonating throughout. The director of the center described it best as a “magical place” where community members share their lives, including their struggles and their joys, while receiving a free meal and access to on site therapy programs. Since HIV permeates all aspects of patient’s’ lives, these resources are needed for the clinic to treat the whole being of its patients. The physicians often go beyond the normal scope of infectious disease to address issues outside their specialty and enable healthy lives that the patients are capable of with proper support. A capable physician is not sufficient to combat this disease for persons rendered vulnerable by lack of material and other resources, which is why the clinic focuses on doing much more than prescribing medications to treat diseases.
As I saw the many ways in which the clinic addresses the multiple problems of the patients and heard their stories, I realized the strong association between the factors of disease and the effects of living in poverty. While not all of our patients were living in poverty, a significant proportion of them were. Many of our patients had no health insurance, jobs, or housing. Even treatment compliance was clearly related to poverty, as many patients would not have been able to receive treatment without the specific resources available at the clinic targeted for this population. The resources that the clinic offers were especially directed towards these patients, since these were the patients in the most need. I saw first-hand the vast interconnectedness between poverty and healthcare, as I observed over and over again how much harder it is for people in poverty to have the resources for healthy lives. While the clinic is able to address many of these factors with its integrative health model, it was still evident that patients with stable jobs and housing, steady incomes, and health benefits were able to manage their health more effectively than the patients struggling with living in poverty. This experience made me think about this disparity that has some roots and remedies that even integrative medicine cannot address. Simply a lack of basic medical literacy kept many of the patients from succeeding with their treatment. I learned that to equalize healthcare for all social classes, seemingly unrelated factors such as education must also be addressed.
My supervisor repeatedly asked me the same question, especially after seeing an especially difficult or complicated patient case. Every time, Dr. Hatcher turned to me and asked: “how did that patient make you feel.” This seemingly obscure question permeated my experience. Each patient at the clinic made me feel something different. I felt elated when a patient was working especially hard to make himself or herself healthy again. I felt discouraged when patients refused to take medications because the pills became daily reminder of their disease in the form of a pill. Overall, the patients made me feel hopeful. I felt their passion for choosing to live, I felt their strength in their fight, and I felt their gratitude for the clinic that made living a healthy life possible for them. As I leave RCID, I want to take the hope that the clinic instills in its patients with me as a guiding principle for the kind of physician I hope to become.