samedi 24 janvier 2015

MEDICAL CONSULTATION IN AN AMERICAN INDIAN DIABETES CLINIC

MEDICAL CONSULTATION IN THE INDIAN COUNTRY
I am proud to be a Physician to some Native American Indian tribes.  On this day, this 54 year old Indian came to see me regarding his uncontrolled Diabetes.
To get to the Clinic, he has to walk to the collection point for free transport offered by the hospital and Clinic. It is offered twice daily. The town he lives in is 35 miles north of the Clinic. The winters can be brutal in this part of the world, but he very seldom misses an appointment.
He was born in the Indian village where the clinic is located. He attended an Indian boarding school and then joined his mother who had moved to the town where he still lives. That was in 1975.
He had last worked in 1993, 22 years ago. Alcohol abuse had been a part of his life. He was sentenced to 5 years in prison for domestic violence (he was drunk). He sobered up, like they say, on 13 April 2003 (nearly 12 years ago)
His current “income” is $194 per month in food subsidies provided by the US Government. When he can get a ride, he would shop at Wal-Mart. Otherwise he is forced to buy food at the neighbourhood petrol station (junk Food at higher prices). He lives in a duplex in a poor section of the town, rented by his sister, owned by a Mexican Immigrant. His sister, unemployed, suffers from the complications of Diabetes , with one below Knee Amputation and she is on Dialysis, three times a week. Her boyfriend, also unemployed, takes care of her, helping her reach the Dialysis centre three times a week, using public transport. A nephew who is disabled with a hip injury is also unemployed, 42 years old  also lives at the house. Two nieces also call this small apartment home, one of them is currently incarcerated, the other, also unemployed, leads an itinerant life style, alcohol features predominantly in her life.
No one owns a car. The nearby Church provides clothing donated by charities. He wears XXL shirts and 38 waist pants.
This patient uses his 194 dollars food allowance to buy the following: Eggs, White bread, Cottage Cheese, potted meat, Diet pop, Crystal light powder to make sugary drinks.
Do you eat at Fast Food Restaurants, like McDonalds?
No Way, he laughs, I cant afford it, since I have no money.
I know I should eat better, but I have only 194 dollars in Food allowance to last me one month.
Pleasant gentleman, no resentment towards any one, no gripes, honest, not jealous towards those who has more than him, goes to extra trouble to come to the clinic, with both of us knowing that it is the availability of human warmth that he seeks here, that brings him here. We reciprocate what he gives us and do whatever we can do for him. The least we can do for him, is to make sure that he has enough medications, make sure that his feet are without any dangerous signals of impending ulcers, that his eyes are checked and also to make sure that he gets home safe on the hospital transport.
Why doesn’t his Diabetes come under control? The society has cornered him, he has no access to food, only chemically laden processed food. Medications can combat the effects of Food on his Diabetes but cannot deal with the chemical’s effects on his Diabetes.
He reaches out to us, the nurse educator and the doctor at the Diabetes Clinic, the Family Physician who cares for him in the hospital clinic, he gets to visit some people  he may know at the clinic/hospital, and a day is pleasantly spent, before going back to his lodging, in a city where he garners no value or respect, an alien city with an alien culture.
As he was preparing to leave, something compelled me to take out my wallet, empty it and give the money to him. Believe it or not, he was reluctant to accept but I could see he was happy to have some cash, not food stamps issued by the US Government. He smiled broadly and hurried to catch the hospital transport home.
I thought of 3 women in my life, all three sisters in one way or another who have influenced me and also watch over me.
The Diabetes Educator Nurse puts the welfare of the people like this patient and many many others like him in this isolated, poor country. To me, she personifies what I would call ‘christian” values of the western civilization, non judgmental, all done in the sense of service, with thoughts of relief from pain and suffering in these marginalized original inhabitants of this land.
My Indian sister, an extremely efficient administrator, many years ago , by her actions taught me what it means to be a relative, to the people you work with, the people you come across in your every day life in this poor community of Indians. She also believes that we must have a head to toe approach to our patients, that we must provide the best quality care we are able to provide to each and every Indian who comes to the clinic.
I have to reiterate that these unfortunate souls may be poor in material things but they are not poor in spirits and generosity of themselves.
My British-Jamaican sister has a big heart and as I write this, aboard a flight to Miami, it is she that I am going to see. I am certain she would have prepared some dishes that I like. She knows that I had been in a food desert for the past one week. (PS . I enjoyed the Curried Goat she had prepared, with rice, she has already prepared the breakfast for tomorrow of Jamaican fish fritters and avocado, and always good strong British Brooks Bond Tea)
This past week, Consultation of this sort took place, over and over again. Patients had travelled from far and mostly from the village, most of them wanted to talk, some had problems (not medical but social) which took hours to negotiate with the authorities. As my Indian sister would say: Let us take care of them, head to toe.
The role of Medicine/Medical Care Provider is not limited to diagnosis and treatment but also alleviation of their suffering, not just physical but social, cultural and spiritual.
I am proud to be a Physician to the Indian, the native people of America.
As I pulled into the drive through window of the small bank, the only one in a thirty mile radius, I realized it had closed for the day. So here I was, metaphorically without any money in my person, beginning a pleasant journey to my Miami and Cuban homes and hearts.

May my Mezhinga be blessed with the good spirits of these ancient people.