Thursday, March 22, 2012

Healthcare for the Underserved

I thought I had some coherent thoughts for this blog post, but I can't seem to get them organized, or even find any specific point that I'm trying to convey. However, it's been so long since I posted, that I'm going to go ahead and write something anyway, and see where it ends up.

For the last two weeks, I've been on a rotation called "Healthcare for the Underserved." I've been riding around on a large RV that's been converted into a mobile medical clinic, driving around to the destitute areas of the city, seeking out the homeless and other people with little access to medical care. For some reason, I've run into a lot of things this week that have made me think of the New Testament, specifically the gospels. I thought I'd share them with you.

The first was a man just slightly younger than I am. He hobbled onto the bus with a really bad foot infection. I was asking about his medical history, and he mentioned to me he had been recently given the diagnosis of Hansen's disease. I wasn't familiar with that so I looked it's another name for leprosy! I couldn't believe I was seeing a man who actually had advanced leprosy, which causes loss of sensation in the limbs. Since you can't feel pain in them anymore, you can seriously injure your hands and feet without even knowing it. It's hard to believe that it exists in the developed world anymore, since it's a bacterial infection that is relatively easy to treat. It broke my heart to see this man in such a state. Having seen him, though, helps me visualize the stories in the gospels of Jesus healing the lepers. I wished I could heal this man like Jesus did. Even with the best medical treatment, the best we could do for him would be to defeat his foot infection and treat the infection of "Mycobacterium leprae", so that his areas of numbness wouldn't spread. But we can't undo the damage that's already been done. He'll likely require his big toe amputated at the hospital we drove him to. And we can't fix the nerves that have already been destroyed.

The other things is that I've been washing a lot of feet lately. Trimming nails, paring down horrible callouses and corns, treating ulcers, and scrubbing fungus-infected feet down and slathering them with antifungal ointment. We all need our feet, but none of us perhaps as much as a homeless person, living in a camp off the road, walking to get wherever he needs to get. Yet, almost every single one of them that I've seen in the last two weeks has required a significant amount of foot care. There's something so humbling about scrubbing someone's feet. I can't really explain it. You get a little tub, fill it with warm soapy water, and get to work. Big nail clippers, often a scalpel to cut away all the dead skin. It would take too long to really get down to the new skin underneath the entirety of both feet, so you just take care of the worst areas, and start working on the next person. It's really thought-provoking to consider Jesus cleaning the disciples' feet.

You don't realize how essential your feet are until you start to see people who are missing toes, whose toes are so horribly twisted and ulcerated from shoes that don't fit, with infections and odor and pain. I'm not sure what my point is in sharing all this, but I wanted to share these experiences. Coming from my last rotation, in a dermatology/cosmetic surgery rotation in a wealthy side of town, to seeking out the homeless, has really been a change. Last month, people were coming in and paying thousands of dollars to have their tiny leg veins lasered off. This month, people are so grateful for the most basic care that we provide. It's such a shock. real point to what I'm writing, I just hope I have been able to convey some of the amazing experiences that I'm gaining as I finish up medical school. I'm truly honored to be almost a doctor, and to be serving under the Great Physician, who can cure more than physical disease.