I spent 4 hours in the emergency room of the local hospital Saturday morning with my two youngest kids in tow.  It wasn’t our emergency but our friend Patricia’s.  Patricia and her husband Benjamin are homeless. We met them last year- when we were still homed and employed.  Benjamin was panhandling at a freeway exit- the one we took on our way to church- and we stopped to hand him a few bucks.  A tall, thin man of indeterminate yet clearly mature age, he smiled, and blessed us with his thanks. I was taken by his gentle nature and humble yet independent demeanor.  And the kids were interested in the big golden dog that lounged at his feet.  I was so struck by him that after church I popped into the store and bought up a load of groceries, deli sandwiches and a bag of dog food, and we took the lot back to his corner.  Since it was too much for him to carry ‘home’ we gave him and his dog a ride back to his camp- a tent tucked away on the edge of a celery field- where we met his wife Patricia. 

Just to dispel any notion that I’m some Mother Theresa in training I will admit that I wasn’t all that taken with Patricia, who sat bundled in so many layers and hat and hoods that her natural shape was completely obscured, leaving me with the impression that she and Benjamin fit the mold of a Jack Sprat and his wife.  She was clutching what was obviously not her first beer of the day in one hand and cradling a cigarette between stained fingers in the other.  Pale bleary eyes stared vaguely at me from a weather-beaten face when Benjamin introduced us and she carefully stubbed out her cigarette and clutched at my hand in thanks when he showed her the bags of groceries.  Frankly it made me uncomfortable.

Being reasonably compassionate and further, of the belief that people should be able to spend their money (however earned or gained) any way that pleased them, I would frequently stop to give panhandlers a buck or two.  ‘There but for fortune’ I told myself.  But I didn’t generally attempt to strike up a conversation with them; much less enter into a relationship of any sort.  After meeting Benjamin I started paying more attention to the local homeless.  When I gave them a donation I asked their name and if the situation was amenable, struck up a conversation.  Soon, in addition to Benjamin, the kids and I knew Craig from Colorado who hung out at the post office and played the guitar, Peter whose post was near Target and who liked to read westerns, and Mary who sat outside Vons and enjoyed James Patterson novels.  We started carrying little kits in gallon zip-lock bags- some food, toiletries, over the counter meds, clean athletic socks- and books in the cargo space in the van for the homeless folks we met.  Our charity work (later I would tell our pastor that it hadn’t been charity work but networking) wasn’t met with universal approval amongst our friends and fellow church members who advised me to let the system take care of the homeless (more of that in a future post).  

As much as we reached out to people in general Benjamin still held a special place in our hearts so it was with distress that we heard from him one day that Patricia was in the hospital in a coma and had possibly had a stroke.  As it turned out Patricia would spend almost 4 months in the hospital returning to some semblance of health.  This is to say she’s now mobile and has all her faculties but was also diagnosed with heart disease and advanced osteoporosis and a variety of other chronic ailments. 

Four months of rest and care and restrictions on her diet and smoking gave Patricia a new lease on life and she returned to Benjamin in much better health and condition.  I was amazed at the transformation when we stopped by last month and finally took the time to sit down and chat and visit with her.  She’s a very bright and well-spoken woman with a tale of how a few mistakes and poor judgments can derail a life.  She’s also a woman of strong faith- a faith that has sustained her during the past year as things went from bad to worse. 

Now things are turning around a bit.  She’s in better health, although using a walker to get around.  And best of all she’s finally gotten help signing up with services and will be receiving a disability check that will allow them to move out of the celery field and into an apartment.  Her visit to the hospital on Saturday was to care for an infection that wasn’t healing, partly due to the difficulty of keeping the wound clean while living in a tent with no running water or bathing facilities.  I am hopeful that her health will improve when they are in an apartment.

Homeless people frequently suffer from ill health.  Minor infections turn into emergency hospital visits.  Chronic conditions plague them, untreated ailments like hypertension cause more serious health problems.  The lack of facilities to attend to hygiene lead to dental problems and skin conditions. 

Patricia’s situation illustrates the points made in an article titled “The Basics of Homelessness” by the National Health Care for the Homelessness Council.

Each year, millions of people in the United States experience homelessness and are in desperate need of health care services. Most do not have health insurance of any sort, and none have cash to pay for medical care. Homeless people are concentrated in the nation’s urban centers and are dispersed throughout rural America, frequently not near the health care facilities that they need. They don’t have transportation or real control over their daily lives, since they depend on the routines of shelters, soup kitchens and marginal jobs to meet their most basic survival needs.

Finding health care is tough or impossible. People who are homeless are more concerned with meeting immediate needs for shelter, food, clothing, and safety than with seeking health care. For some, the symptoms of their illnesses or bad experiences with the health care system in their past cause them to actually avoid health care.

Unacceptable costs result from poor access to health care. Because homeless people often are uninsured and lack access to low-cost preventive health care, they go without care until relatively minor problems become urgent medical emergencies. Ultimately, most homeless people do get treated, but it is treatment of the most expensive sort, delivered in hospital emergency rooms and acute care wards. Through taxpayer support of public institutions and through the cost-shifting inherent in the health insurance system, we all pay the high costs of care deferred.  

A recent study in the Archives of Surgery found that, even though emergency rooms are required to care for all comers regardless of ability to pay, the uninsured trauma patient is 89% more likely to die than the insured patient.  Not because of the care they receive in the trauma unit where doctors are probably completely unaware of the patients insurance status, but because of the lack of follow up care.  For the underinsured there is decreased access to rehabilitation and chronic care services.

We don’t have insurance.  We are weathering illnesses such as a bout of H1N1 without seeing a doctor. We are foregoing dental care we need. I’m getting by with glasses that don’t really completely correct my vision anymore.  Let’s just hope we don’t get into an accident before I can land a job with health benefits.

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