A whole different world

One week per year, each medical student from my school has to spend four days working with free health care clinics and homeless shelters in the community. My week ends tomorrow, and I think I learned more about people this week than I will for the next 18 months of medical school.

Cleveland has been ranked the poorest city in the nation 3 of the past 5 years. There is no denying that, even walking through my neighborhood and seeing the countless for sale signs, not to mention the half dozen or so houses in my neighborhood that have been vacated, foreclosed, and/or auctioned. But I'm still sheltered here in my community, without a doubt. I get a glimpse of the poverty when I take my morning route to school through East Cleveland, a city that was absolutely devastated by crack cocaine many many years ago and has yet to make the slightest recovery. But as I'm driving past the boarded up houses I'm still in a different world. Listening to music, paying attention to the road, thinking about the day ahead. But working in the clinics, there is no denying the world around me. The world where some of your questions are:

Where have you been getting your medical care?
Where did you sleep last night?
Do you feel safe?
When did you last use?
When was your last HIV test?

The thing that really made an impression on me was not the fact that there was so much poverty around. I knew that. It was the people. People who were nurses, administrative assistants, parents of kids in college, veterans. People who once were like me. They had a job, a family, money for food and clothing. And then something happened. For some it was tragedy- loss of a loved one, divorce, loss of their home. But for most, the thing that happened was drugs- usually the drug was crack. People lose everything because of this drug. Kids, homes, and most of all, they lose whatever it was that makes them who they are. And they are/were totally dependent on it. I asked one patient how much she used. She told me- I don't know. If I had a dollar I spent it on crack

But the nice thing about working at the Care Alliance and 2100 Lakeside is that you commonly work with people who have decided to finally try to make a change in their lives. The first thing people do when they decide to get clean is to take care of their health. So we are the first contact in their clean life. Sure, many people will try and fail to get clean in an endless cycle. Some aren't even trying to get clean. That is not for us to judge. But the fact that there are services like this in the community for people to go for free to seek help is really amazing. And there are plenty of people who have dedicated their lives to ensure that this happens.

And for the most part, it is a very rewarding job. You don't get to use the fanciest equipment, or prescribe the newest and best drug, but you get to practice really good medicine to a population that is in need. A population that is, for the most part, more grateful for the care they receive than you will see at any private clinic around. The patients at the clinics get education, monitoring and medications to keep their blood sugar in tight control and their blood pressure low. They get anti-depressants and anti-psychotic medications if they need them, and help finding a place to eat or sleep if necessary.

The shelter was just as impressive as the health clinics. Cleveland has one of the best and biggest men's shelters in the country. It runs on a several tiered system. The first tier is simply a place to sleep. You can check in at 4pm, but have to check out at 8am, taking with you anything you came in with. You can come in high on crack, pot, drunk, or psychotic as long as you are not too disruptive. No one is judged and there are people available if anyone wants to talk about change. But nothing is expected of the people in the first tier. It is free shelter and food.

People who graduate from that tier can move into the second tier. People have assigned beds and a locker. But more expectations are there. Classes need to be attended every day. Residents have to commit to getting clean and making a change.

Eventually people can move into the other side of the building. One community is made only of people with full time jobs who are actively saving and paying off debts necessary to get back on their feet. There are savings plans and personal case workers who ensure that everyone gets their license and deals with all outstanding tickets and warrants. There are weekly random drug tests. They have to pay a rent, per week which increases as time passes. When they move out, they get their rent back. Many of the workers at the facility were former residents who got clean and have their lives back because of the shelter. They understand what is going on with the residents- not because they read about it in a book. Because they were there.

The experience really made an impression on me. The only negative feeling I had was a sense of guilt. It was because I know that I can't possibly understand what these people are going through. I feel like- why should they listen to a 28 year old girl in preppy clinic clothes who has obviously never had a day in her life that could compare to a day on the streets. Never been addicted, never hungry. I know inside that I shouldn't feel guilty that I have lived a privileged life. But I felt like I was being judged for how easy my life is. But the irony of my feelings is that the people I am so afraid are judging me go through every day having people like me judge them. I guess it was then that I really felt like I understood a very small part of the battle they go through every day.