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The Reality of Health Care and Urban Poverty

So others might eat. This summer was about doing everything in my power so that the low-income of our nation’s capital might live a better life. At S.O.M.E., we give our clients many of the tools they need to break the cycle of homelessness and lead a better life, e.g. food, clothing, shelter, therapy, addiction treatment, employment training, dental care, and health care. S.O.M.E. exists to “help the poor and homeless of our nation’s capital,” and “never to pass judgment, but to nourish, support, encourage, and when needed, to challenge.” When I walked in to 60 ‘O’ Street in my new blue scrubs for the first time, I didn’t know that what I thought it meant to be a doctor would change.

" I was upset to find out that the three wards with the lowest-income populations also happened to be the wards with the highest incidence of diabetes. Why must income level define a diagnosis?" writes Hollender, a 2016 SHECP Intern.

” I was upset to find out that the three wards with the lowest-income populations also happened to be the wards with the highest incidence of diabetes. Why must income level define a diagnosis?” writes Hollender, a 2016 SHECP Intern.

The days started out innocently enough; meeting all the medical assistants, nurses, doctors, caseworkers, and staff. Then I began to meet patients, each with a different story. I would call their names and bring them to the back, where I took their blood pressure, temperature, weight, oxygen levels, and pulse rate. I would then ask them why they came into the office today. These five minutes often felt short but could impact both the patient and me. I met an elderly woman who confided in me how her granddaughter was raped on her way home from work, a veteran of the Vietnam War who spoke to me about his battle with PTSD, a woman struggling to feed her growing children that suffer from too many allergies to be able to eat at a soup kitchen, a man battling to find a job because he has no record of his birth, a diabetic man who had his foot amputated because he couldn’t afford insulin shots, a young man who had been shot in his knee and will never walk without discomfort, a woman suffering from HIV too afraid to tell her partner because he might beat her, and a Muslim woman who feared for her children’s future if Donald Trump were to win the presidency. Every day, I became more aware of the compassion I need to become a physician, especially when working with low-income patients.

Despite the horrific tragedies so many of the patients had gone through, I rarely met a patient in a bad mood. I always greeted people the same way—“Hello, I’m Meredith and I will be taking your vitals today. How are you on this fine day?”—and most answered “blessed” with a hefty smile. The patients may have been low in income, but they are definitely not low in their spirits.

I became especially interested in the diabetes epidemic that seemed to plague the low-income population of Washington, D.C. As I delved into the issue on the Department of Health’s website, I was upset to find out that the three wards with the lowest-income populations also happened to be the wards with the highest incidence of diabetes. Why must income level define a diagnosis? This correlation is an unfortunate reality at S.O.M.E. and across the United States as well. Many of our patients are diabetic or pre-diabetic and need constant, meticulous monitoring of their blood sugar in order to stay healthy. This monitoring is costly—patients require a glucometer, test strips, alcohol pads, lancets, and emergency glucose. In addition, they have to make many visits to the doctor, which costs them time away from their job. Unfortunately, many of our patients don’t have a choice about what they eat. At soup kitchens, they have to eat what they are given. They can only control how much they eat, which can be hard if they don’t know where their next meal may come from. Unfortunately, it is too easy to become ill and need medical attention. These compounded issues illustrate why it is so hard to be ill and of low-income.  Efforts from local hospitals in the D.C. area include free diabetes support groups and diabetes self-management education classes. During my free time at S.O.M.E., I created an easy-to-read pamphlet on diabetes and made a comprehensive list for our doctors of the places in D.C. that offer support for patients with diabetes.

In my quest to become a physician and my experience with both urban and rural poverty, I have learned time and time again that compassion and kindness can be just as important as any other treatment. Hope, a smile, and someone to listen was often exactly what the patient needed. I learned how important it is to take into account each person’s narrative when interacting with him or her, even just for a few short minutes. I had to think of patients in terms of their story, not narrowly in terms of their diagnoses. In addition, this summer has inspired my interest in public health, which will allow me to explore why a person’s income defines their diagnoses. The experiential knowledge I gained from this summer comes with a responsibility to take action to end this health care injustice. My small role at S.O.M.E. likely affected me more than it affected any patient with whom I had the pleasure of speaking. I envision a nation where income level doesn’t define diagnoses or treatment, and I hope to play a role in that future so that others might live a better life.

I wish I had words to thank the Shepherd Consortium, the staff of S.O.M.E., and Professor Jennifer Warlick for giving me the opportunity to open up my eyes, recognize my privilege, arouse my intended career as a public health professional and physician working with patients in urban poverty, and meet the wonderful patients at S.O.M.E. I will take this knowledge with me wherever I go, and I hope to one day cross paths with S.O.M.E. again.


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