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Sunday, January 16, 2011

Health Care Access

Regardless of the current debates over health care laws, local medical communities could use significant self-examination about taking measured, practical steps to be more accessible to our under-privileged neighbors. Instead, poverty is often held at arm's length with little acknowledgement of our own role in perpetuating the barriers to health care.

Let's examine the situation many of us are familiar with: When is the last time you went to the doctor? Or dentist? Did you procrastinate scheduling the appointment? Did you look forward to it, or were you apprehensive? How long did you wait once you got there? Were you feel ignored by the receptionist? Did you feel intimidated by the doctor?

Did you feel awkward or embarrassed while you were examined? Did you understand what the doctor said to you? Did you remember to take the meds you were prescribed? Or might you have missed one or two doses? Did you know how much 5 milliliters of syrup was? Did you remember to make the follow up appointment?

These are some of the challenges that I face with any doctor's appointment I make, regardless of my income level. So now let's remember that I rarely, if ever, have to worry about:
  • Taking time off work to get to a doctor's office hours, without getting fired or sacrificing precious income needed to survive
  • Finding and paying for childcare while at the appointment
  • Finding transportation to the doctor's office (if you're lucky there is public transport, but often that isn't not a viable option)
  • Paying for parking (our med center has little to no free parking) 
  • Spending time away from work to simply sit in a waiting room
  • Avoiding dirty looks from the receptionist and other patients because of the way I am dressed
  • Paying for the doctor's visit (you may or may not get health benefits from your job, be able to afford the monthly cost, or even afford the copay)
  • Finding transportation back home (because the person that brought you isn't necessarily available to wait around and bring you back)
  • Finding time/childcare to go to the pharmacy and wait for the prescription to be filled
  • Finding transportation to the pharmacy
  • Paying for medication (again, often without the benefit of insurance)
  • Finding transportation home
  • Reading and understanding the medical instructions 
  • Worrying about how to go through the whole ordeal again for the follow up appointment

Anyone can find themselves in a situation of poverty at a moment's notice: a death of a bread winner, loss of a job, an injury that prevents work, identity theft. Some of us have the privilege of a financially secure family to fall back on (even at the cost of some shame and embarrassment). But if not, you may find yourself the victim of a pervasive form of discrimination that assumes that if you are poor, you must be lazystupid, an addict, or in some other way wholly deserving of your lot.

God is consistent throughout the bible in His heart for the poor. From the slaves of Egypt, the nomads in the desert, Joseph the dreamerDavid the shepherd, and continuing with Jesus's priorities while on earth. Look at how Jesus spent his time with the poor and the rich. Which group did he chastise with stern warnings? With which group did Jesus eat with, socialize with, count as His friends? How does His model match the relationships you value in your life?

Further, it is important to remember that the privileged have the most to gain from a relationship with the poor. This is not a charitable endeavor, but one that is fundamental for own souls. We need to understand what it is to depend on God rather than money, to enjoy every day as it comes, and not to be preoccupied with the rat race that is 'planning for the future,' to gain pleasure from relationships rather than from stuff, to respect natural resources rather than domineering over them, to trust in the daily manna rather than storing up treasures. These are skills that I do not posses in any meaningful way.  Do you? In a world where some churches have million dollar mortgages, we have a lot to learn.

20 comments:

  1. Have you read the book "Nickel and Dimed"? WOW!
    It changed my perception and how I act (in our service related culture)... This post reminded me of my epiphany a few years back.

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  2. I am familiar with Barbara Ehrenreich's books, by have not read 'Nickel and Dimed'. I definitely keep meaning to, so thanks for the reminder!

    I like what you say about living in a 'service-related culture.' I had the privilege of spending some time in Italy, which threw into sharp relief the assumptions I make as a customer. I found that the saying 'the customer is always right' is not held everywhere and in fact can be quite the opposite (I had a friend who was told by a sales clerk that to make their dress look as good, she need to loose a few kilos!). Although I didn't like the treatment I got at times, it was a strong reminder not to take for granted the people in industries that are supposedly there to 'serve me.' Respect all around! Why is it so hard sometimes?

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  3. In the 1800s when muckracking was big and there were many social movements dedicated to ending slavery, improving the treatment of the mentally ill, and helping the homeless, some of the people involved came to a road they probably had not expected to find...how do you help the deserving poor and not the ones who were just looking for a free handout?

    Today, the poor seems to all be categorized as bums looking for easy cash so they can get booze, but the actuality is that this is just the more visible part of the population. Yet just as Christianity might be shunned because of the actions of the more visible members, are the poor/homeless facing the same problem...being categorized by the actions of a few?

    Ingrained in American mentality is if you aren't earning your way, you're nothing. Would this not be an area of difficulty in socializing? Would some people feel shamed because they lucked out and don't want to constantly have to apologize for it? Would some others look at the luckier few with envy for not having faced the problems they did? Would struggles below the surface emerge? Would people realize again why they often prefer to be in the same group....because no one likes being made to feel singled out, ashamed? What then do you do when the seemingly "right action" does not promise that one is always in the right?

    So that's my thoughts on why people might not do the good that is called out to us. People like to be around people they imagine to be "like them." After that, it gets tricky. In sum, I read a story once of a pastor talking with another pastor from Africa. As they talked, the pastor from Africa revealed that they prayed for the poverty of the American church every day. From that man's perspective, he was the one with the wealth, not the American. That's what I can approve of.

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  4. Great post Mel! Thanks for the discussion points.

    In my experience living in an area of low socioeconomic status (SES), very few of the people around me want free handouts. In fact, many would rather not be pitied charity cases and would like to earn what they are given, if only through being a good friend. Therefore, to me, it is worth the risk that one of the many people that is helped might be "undeserving." Indeed, aren't we all undeserving of the grace and overflowing blessings we receive in Christ?

    I so feel your second paragraph! How often are we judged by the loud crazy ones in our group! What a consent battle we all (homeless, Christians, Muslims, et al) have to fight.

    I also really like your third paragraph. Meritocracy is very much a part of Americana, which would be great if it were truly only merit that was the basis for advancement in society. Instead, the Mathew Effect (http://en.wikipedia.org/wiki/Matthew_effect_(sociology)), is very much at play and success begets itself, leaving many in the dust. That isn't to say that the poor are helpless or played no role in the situation, but far too often the blame is solely on the victims shoulders.

    The result, then, is the relational brokenness that you mention. It is SUPER common. The person in poverty can experiences shame , low self-esteem, and worthlessness. While those more fortunate, can get so caught up in their guilt and awkwardness that they miss out on the beauty that God is trying to show. The reality of a broken world is a gross thing to encounter and it is much easier to pull away.

    Guilt often stems from a perception of ourselves as being quite different from those with less privilege, rather than being very similar at our core. The tragedy is that it can then sometimes becomes an impediment to interacting and communing in fellowship with those less fortunate. What I am suggesting then is that we must face any guilt we feel and wrestle with it. Much in the same way that we would with any feeling of guilt that Satan whispers in our ears that separates us from God. Why do we feel it? How does it affect our relationships? How does it change our actions? What can we do about it? And how can we move forward as redeemed children of Christ into a more wholesome relationship with ALL of God's children --regardless of our feelings toward one another?

    The people in my life with few monetary resources want to be related to as people, as my friends...not primarily as homeless folks. They don't want me to apologize for who I am. We both recognize the consequences of my privilege: it will take me longer understand where they are coming from, I will make poor assumptions, I will be prejudiced, and may unintentionally say hurtful things. But they are patient, and in most cases accepting of me just as I am. I am very fortunate to have such friends.
    In the end, we have to work to get over our natural desires to remove ourselves from uncomfortable situations. And as a person of privilege, I feel like I have more responsibility to make this move because I have the choice to be comfortable everyday--in my physical environment, in who I hang out with, in who I can help but be around. More often than not, I am with people that are similar to me; not everyone has this choice. But if we step out on faith and embrace the opportunity that discomfort provides, I believe that an underlying deeper community emerges on the other side.

    wow....that was super long....sorry...I just really liked your comment..I am thinking a post on guilt may be in store soon. I have had several recent comments in that vein.

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  5. From facebook, Angela wrote: "Hi Katelin, I don't think this phrase, "culture of poverty" is problematic in itself. The culture of poverty does represent a value system that is shared by the members of its victims (meaning, people who are in the lowest economic classes). This is the idea that there are certain attitudes and values that are adopted by these cultures to help them adapt to and cope with the burdens of poverty. Some of these adaptations are positive and some are negative for the community in different ways, but all ultimately help to perpetuate the cycle of poverty. You seem to be glorifying the positve aspects of this culture- community, emphasis on family - while ignoring the negative aspects - gangs, a lack of value placed on education, violence between neighbors and families. You seem to be attributing the positive aspects of the culture to something that is inherent in the culture of the poor, indeed something that makes them more skilled in certain ways. Then, presumably, you attribute the negative aspects to things that are imposed on the poor, something that has no inherent roots in the culture. I don't think this situation is as divided as you suppose. Poverty may be imposed on these members of society, but the culture that grows up as a natural result has a role in perpetuating the poverty as well, and this may be the hardest problem to overcome."

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  6. Thanks for the comments, Angela!

    Firstly, I will say that I certainly do have a bias in favor of the poor. This seems to concern you, but I am ok with it. Every writer has biases and this is mine. I come to it for several reasons. Far too often, the pendulum swings against the poor while the privileged suppress their own responsibility. So I don't mind pushing in the other direction sometimes. But it is good to check one's self, because two wrongs don't make a right.

    That being said, there is a huge number of outside forces that perpetuate poverty and that wildly stack the odds against the poor. In my experience those pressures far out way internal faults, which of course contribute as well. It is easy to see how years of poverty can lead to feelings of hopelessness and desperation, which in turn can lean to terribly maladaptive and destructive behaviors. However, these characteristics get plenty of press and need no further amplification from me. And so you would like me to also attribute the silver linings of poverty to the external forces that cause it? *shugs* ok. It doesn't change the situation. And it doesn't change who has the power to rectify it.

    I confess I have not been able to clearly articulate why the seminar's titled struck me so. It think it is the suggestion that poverty itself is valued by those living in it. The Southside, for example, has a culture, yes. But we are not defined by our poverty. Perhaps I felt that framing the discussion in such a manner perpetuated the very 'we deign to them' mentality that I think the panel was trying to address.

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  7. I think I understand that sense of seeing something wrong with the language. Sometimes, it seems that even in trying to address the issue of bias, people who unwittingly continue to still hold to that bias end up promoting it because there is still lack of information on how to do it differently. I think specifically about the problem Frederick Lloyd Douglas faced when speaking out against slavery. Sure, the Christian abolitionists wanted to help him out and much admired his oratorial skills...until it came down to the issue of surrendering power. In the end, they wanted to be in charge and he would just be the person subject to their help. Eventually, he left and started his own newspaper, The Liberator (I'm going on memory off this name here).

    It would be very easy for me to fault the abolitionists that did this, yet it's hard not to see why they did it. It feels good to have that sense that you're doing good and when that sense is taken away, it can bring that person face to face with their insignificance, always a hard place to be. NPR did a story about how Haiti was voicing discontent about the way the charities were handling the situation. Haiti wanted all that money now but the charities decided to dispense it out over time. Not that I'm an expert in the situation, but I can't get away from seeing in these two realities a similarity. Some people don't realize how tightly they cling to those things that mean power...and I'm including myself in this.So easy to fall into that trip of believing I'm something because I can give monetarily connected items...but the people who give love are the ones who really got it going on.

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  8. Katelin, this is a very interesting post and you make some vital points in your article. I definitely agree that the seminar's equation of diversity with poverty is extremely problematic, as poverty is endemic to all not just "diverse populations" (an euphemism often reserved for people of "color"). So very astute observation on your part!

    Angela, I do agree that there are many negative aspects related to poverty, and many negative mindsets have been formed. However, I do agree with Katelin and think that these are in response to the situation at hand. Like any marginalized groups, the poor create mechanisms for survival. Let's take gangs for instance. You state that this is one of the negative aspects of poverty, and indeed it is. Yet these gangs offer a sense of power and autonomy that many poor people feel they do not have. I personally think the same attention that our society gives the Tea Party, but I digress. The point is, gangs and violence is not just a result of poverty, but the result of marginalized groups trying to gain some control of their existence. Hence, yes, the negative aspects of poverty are in response to the poverty itself.

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  9. I think that is a good definition of a culture of poverty, ptown. Basically, when faced with the burdens of poverty people will adopt behaviors to help them cope. A lot of these behaviors do perpetuate the cycle of poverty. This idea is often abused as an excuse to blame the victim, but I think that shouldn't scare the thoughtful away from aknowledging all the contributing factors to a very complicated problem. Sometimes "shifting the pendulum in the other direction", looks a lot like shifting the blame.

    And one more thing... This seems obvious, but I've never heard someone make the argument out loud. Sure there are a lot of forces stacked against the poor. Isn't the most important force the fact that we live in a world where things cost money? Even if we stripped away all the prejudices and biases and "meritocracy", It would still be very hard to acquire the things neccesary to make money if you had no money to begin with. And, It would be relatively easier to acquire the things neccesary to make money if you had it. This little glitch of how the world works has a lot of explanatory power. Isn't this the ultimate cause of poverty? All the human psychological responses, that we make so much of, are icing on the cake, compared with this structural cause.

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  10. haha! Of course the issues are complicated. Otherwise, they'd be solved! I'm trying to write a blog, not a dissertation (though maybe I should work on that too... :-P). Next time I'll be sure to state the obvious for those that need it--I just figure the poor get plenty of blame all the time on the nightly news, so I don't need to add to it. I am trying to write about things that don't get talked about as often--namely the roles that the rest of do/can/should play.

    I like the points you make in your second paragraph. So true that it takes money to make money, and so poverty often begets itself--for generations even (I know I sure benefited from the fact that my parents and grandparents owned houses and went to college). It's just one more of the many battles for the marginalized! It's the systematized and institutionalized forces that are often the hardest to combat. The huge levels of excess of a few make the barrier too high for the many. I have hope that it doesn't have to be that way--I know I could be sharing more than I do.

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  11. Just saw this list that talks about poverty. I disagree with a couple of them, but many of them are good: http://whatever.scalzi.com/2005/09/03/being-poor/

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  12. Also just saw this link: http://motherjones.com/politics/2011/02/income-inequality-in-america-chart-graph

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  13. A related article submitted by Ryan:
    http://www.cnn.com/2011/SHOWBIZ/TV/03/07/secret.millionaire.ew/index.html?hpt=Sbin

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  14. I am familiar with Barbara Ehrenreich's books, by have not read 'Nickel and Dimed'. I definitely keep meaning to, so thanks for the reminder!

    I like what you say about living in a 'service-related culture.' I had the privilege of spending some time in Italy, which threw into sharp relief the assumptions I make as a customer. I found that the saying 'the customer is always right' is not held everywhere and in fact can be quite the opposite (I had a friend who was told by a sales clerk that to make their dress look as good, she need to loose a few kilos!). Although I didn't like the treatment I got at times, it was a strong reminder not to take for granted the people in industries that are supposedly there to 'serve me.' Respect all around! Why is it so hard sometimes?

    ReplyDelete
  15. Great post Mel! Thanks for the discussion points.

    In my experience living in an area of low socioeconomic status (SES), very few of the people around me want free handouts. In fact, many would rather not be pitied charity cases and would like to earn what they are given, if only through being a good friend. Therefore, to me, it is worth the risk that one of the many people that is helped might be "undeserving." Indeed, aren't we all undeserving of the grace and overflowing blessings we receive in Christ?

    I so feel your second paragraph! How often are we judged by the loud crazy ones in our group! What a consent battle we all (homeless, Christians, Muslims, et al) have to fight.

    I also really like your third paragraph. Meritocracy is very much a part of Americana, which would be great if it were truly only merit that was the basis for advancement in society. Instead, the Mathew Effect (http://en.wikipedia.org/wiki/M... is very much at play and success begets itself, leaving many in the dust. That isn't to say that the poor are helpless or played no role in the situation, but far too often the blame is solely on the victims shoulders.

    The result, then, is the relational brokenness that you mention. It is SUPER common. The person in poverty can experiences shame , low self-esteem, and worthlessness. While those more fortunate, can get so caught up in their guilt and awkwardness that they miss out on the beauty that God is trying to show. The reality of a broken world is a gross thing to encounter and it is much easier to pull away.

    Guilt often stems from a perception of ourselves as being quite different from those with less privilege, rather than being very similar at our core. The tragedy is that it can then sometimes becomes an impediment to interacting and communing in fellowship with those less fortunate. What I am suggesting then is that we must face any guilt we feel and wrestle with it. Much in the same way that we would with any feeling of guilt that Satan whispers in our ears that separates us from God. Why do we feel it? How does it affect our relationships? How does it change our actions? What can we do about it? And how can we move forward as redeemed children of Christ into a more wholesome relationship with ALL of God's children --regardless of our feelings toward one another?

    The people in my life with few monetary resources want to be related to as people, as my friends...not primarily as homeless folks. They don't want me to apologize for who I am. We both recognize the consequences of my privilege: it will take me longer understand where they are coming from, I will make poor assumptions, I will be prejudiced, and may unintentionally say hurtful things. But they are patient, and in most cases accepting of me just as I am. I am very fortunate to have such friends.
    In the end, we have to work to get over our natural desires to remove ourselves from uncomfortable situations. And as a person of privilege, I feel like I have more responsibility to make this move because I have the choice to be comfortable everyday--in my physical environment, in who I hang out with, in who I can help but be around. More often than not, I am with people that are similar to me; not everyone has this choice. But if we step out on faith and embrace the opportunity that discomfort provides, I believe that an underlying deeper community emerges on the other side.

    wow....that was super long....sorry...I just really liked your comment..I am thinking a post on guilt may be in store soon. I have had several recent comments in that vein.

    ReplyDelete
  16. Thanks for the comments, Angela!

    Firstly, I will say that I certainly do have a bias in favor of the poor. This seems to concern you, but I am ok with it. Every writer has biases and this is mine. I come to it for several reasons. Far too often, the pendulum swings against the poor while the privileged suppress their own responsibility. So I don't mind pushing in the other direction sometimes. But it is good to check one's self, because two wrongs don't make a right.

    That being said, there is a huge number of outside forces that perpetuate poverty and that wildly stack the odds against the poor. In my experience those pressures far out way internal faults, which of course contribute as well. It is easy to see how years of poverty can lead to feelings of hopelessness and desperation, which in turn can lean to terribly maladaptive and destructive behaviors. However, these characteristics get plenty of press and need no further amplification from me. And so you would like me to also attribute the silver linings of poverty to the external forces that cause it? *shugs* ok. It doesn't change the situation. And it doesn't change who has the power to rectify it.

    I confess I have not been able to clearly articulate why the seminar's titled struck me so. It think it is the suggestion that poverty itself is valued by those living in it. The Southside, for example, has a culture, yes. But we are not defined by our poverty. Perhaps I felt that framing the discussion in such a manner perpetuated the very 'we deign to them' mentality that I think the panel was trying to address.

    ReplyDelete
  17. haha! Of course the issues are complicated. Otherwise, they'd be solved! I'm trying to write a blog, not a dissertation (though maybe I should work on that too... :-P). Next time I'll be sure to state the obvious for those that need it--I just figure the poor get plenty of blame all the time on the nightly news, so I don't need to add to it. I am trying to write about things that don't get talked about as often--namely the roles that the rest of do/can/should play.

    I like the points you make in your second paragraph. So true that it takes money to make money, and so poverty often begets itself--for generations even (I know I sure benefited from the fact that my parents and grandparents owned houses and went to college). It's just one more of the many battles for the marginalized! It's the systematized and institutionalized forces that are often the hardest to combat. The huge levels of excess of a few make the barrier too high for the many. I have hope that it doesn't have to be that way--I know I could be sharing more than I do.

    ReplyDelete
  18. Sidenote: 

    This ipitus for this post was A local medical center's recent sponsoring of a panel discussion on poverty and patient care entitled “Respecting Diversity: The Culture of Poverty.” 

    First of all, that title is all kinds of problematic. Diversity = poverty? wha?? And 'culture of poverty'? I don't know it...seems like an awkward way of discussing the environment that fosters and prolongs poverty--as though poverty is a value system inherent to its victims.I was particularly struck by one of the questions put to the panel and the medical center event (which included no patients or impoverished): something to the effect of "how might it feel to be at the bottom of the cultural, social, political and economic ladder?" This questions speaks more about our own attitude in the medical center than anything else. Most of my neighbors on the southside DON'T feel they are at the bottom socially and culturally etc. They value themselves and their relationships. We should too.

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  19. Interesting post and comments.  I recently read "The Tragedy of American Compassion" by Marvin Olasky, and it's an excellent book which discusses these very points and questions, showing from history the way America used to take care of its poor (separated by 'worthy poor' and 'lazy poor') and the major change which occurred when the government began getting involved with welfare programs.

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  20. Will definitely have to check that book out! Thx!

    ReplyDelete