A Simple Approach to Social Justice: Healthcare for All

Holly Langely–“Sit still James!” A much younger and innocent version of myself says to my little brother. “You have to be still so I can put this bandage on your foot to make it better!” He had trodden on a piece of Lego and is crying on the floor of our cream carpeted bedroom. The colorful piles of Lego pieces strewn across the floor surround James’ model like a wall of protection. Sunlight shines through the lightly draped window, only to make the small beads of water rolling down his cheeks glisten with pain. Hating to see him in such discomfort, I knew immediately that I must help him. “Doctors put bandages on people when they are hurting,” I think to myself, “so I should put a bandage on James’ foot, then he can stop hurting, too.”

I don’t remember whether or not my bandage instantly cured James’ foot; it was after all only a piece of Lego. What I do remember, is that ever since I was little I played doctors with my siblings, and helping others has always been important to me. Unfortunately, medicine in the real world is not as simple as putting on a bandage to make everything all right. People who don’t deserve to be unwell can develop horrible medical conditions. There are also people who suffer from easily preventable diseases, but because of their circumstances might never have a chance to be cured. I learnt this as I got older, and my days of playing doctor eventually ran out. Rather than playing doctor, I grew determined that one day I would be a doctor. Because of the privileges and education that I have, I feel I have a responsibility to take every opportunity so that one day I will be able to fix, help, and care for people by being a doctor.

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There are many noteworthy individuals who have committed their lives to providing essential health care for others. One such person is Paul Farmer, a professor at Harvard University who spends significant portions of his time in Haiti, treating victims of tuberculosis. In a book describing his travels and work in Haiti, Mountains Beyond Mountains, Farmer says, “For me, an area of moral clarity is: you’re in front of someone who’s suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act” (Kidder). This concept of one’s responsibility to help others when one has the necessary resources is universal for doctors who give healthcare to less privileged people. Not all doctors who provide care in such a life-changing manner have to be professors at Harvard or travel to third world countries to do their work. The need for health care is present in every city in every part of the world, Portland, Oregon included. This need is the reason community health clinics, such as Southwest Community Health Center (SWCHC), are crucial. Possibly more fundamental to the cause than the health clinics are the doctors who work within them. Dr. Jessica Flynn is a perfect example of a passionate individual who addresses the worldwide need of healthcare for the impoverished, locally.

Although Jessica Flynn grew up in New York, she has succeeded in her dream of becoming a doctor, here, in Portland. Currently a full-time doctor, Dr. Flynn initially majored in Theatre and French at university before committing to medicine. After medical school at the University of Michigan, Dr. Flynn began her Portland medical career in 2003 as a resident in Family Medicine at Oregon Health and Science University (“Jessica Flynn”). Dr. Flynn completed her fellowship at OHSU and also became the Chief Resident of Family Medicine in 2006 (“Jessica Flynn”). She is now a doctor and assistant professor at OHSU, still specializing in Family Medicine (Health Grades Inc.). According to healthgrades, an online review of patient’s satisfaction with their doctors, Dr. Flynn is fluent in three languages: English, French, and Spanish. This website also indicates that all four patients who wrote a review of their patient experience at OHSU with Dr. Flynn gave her five stars out of five (Health Grades Inc.). While Dr. Flynn splits her time between a major hospital and a modest community clinic, her true ardor is for the care she provides at SWCHC.

*     *     *

Walking into Southwest Community Health Center, I notice that there is a different receptionist behind the front desk than who had been there a week earlier. A safety net clinic located in Portland, Oregon, SWCHC is almost entirely dependent upon volunteers who constantly strive to broaden access to health care to uninsured or low-income individuals (Southwest Community Health Center). By definition a safety net clinic is a non-profit organization that provides “basic healthcare for uninsured or low-income individuals on a sliding fee scale” (Southwest Community Health Center).The friendliness and welcoming presence of the receptionist is equally warming as the woman from the week before. Colourful pamphlets and leaflets in numerous different languages, including Korean, Arabic, and Spanish, rest on narrow plastic shelves directly inside the entrance of the clinic. The variety of leaflets ranging in topics from meningococcal disease to HIV to vaccinations and flu shots give a distinct initial impression. Beyond the doorway behind the front desk, I catch a glimpse of a small consultation room. Even from a distance I can see the room is perfectly clean. The blue bed pushed against the wall leaves a tight space for two wooden chairs below the window. The receptionist leads me through the doorway to a short, narrow corridor with an office not separated at all from the hallway by walls apart from an eye level, transparent partition that ran half the length of the office. Immediately something stands out: there is no computer anywhere, only stacks of paper and manila folders covering the desktops. Later Dr. Jessica Flynn tells me that the entire clinic runs visits and consultations for over 2,000 patients with no computer system whatsoever (Flynn).

A paper coffee cup in one hand and a chicken salad wrap in the other, Dr. Flynn greets me eagerly before clearing a space on the cluttered desk. Defying my preconception that doctors can seem distanced and solely focused on their work, Dr. Flynn has an approachable and congenial demeanor. She has a friendly voice, the type that makes you feel comfortable around a person; like you can trust her and that she cares. She is dressed in black pants and a comfortable looking cardigan, and her casual manner makes me feel instantly relaxed. A tattoo of a flying bird peers out from under her cardigan on her clavicle. She smiles a compassionate and enthusiastic smile at me and offers me a drink. After brushing her auburn hair back into a ponytail, she rests down in a chair and is instantly apologetic for the modest office space.

Dr. Flynn’s story of her medical career begins long before she first attends medical school. Many people take years to finally decide their desired professional track, but Dr. Flynn had dreamed of this life as a little girl. “Well I thought I wanted to be a doctor when I was a little kid. My aunt is a nurse so I thought, ‘Oh, I wanna be a nurse like her.’ But my mom actually said, ‘Why not just become a doctor?’” (Flynn). Dr. Flynn is an example of someone who worked extremely hard throughout high school and her early adult life in order to achieve her professional dreams.However, all humans have doubts at some point in their lives. During her college career, Dr. Flynn began to doubt her path as a doctor and seriously considered becoming a teacher. Until one day she said, “ I sat down with myself as I was applying to graduate school and thought, “I don’t think I really wanna just teach teaching, I wanna teach something that I’m never ever really gonna know all of, which is medicine” (Flynn).

*     *     *

SWCHC has its primary affiliation agreements with the OHSU Department of Family Medicine and the OHSU School of Medicine. Amongst a great deal of others, New Season’s Market, Catlin Gabel School, and Wells Fargo bank are some of SWCHC’s community partners (Southwest Community Health Center). SWCHC does not receive any government funding, so donations made by community partners and individual groups are what allow the volunteers in the clinic to provide care for the patients (Hayes). One particularly touching donation was made by a couple that put on a Christmas play and donated the entirety of the proceeds to SWCHC (Ferguson). In the fiscal year of 2012-2013, the clinic received 1,711 patient visits where 25% of patients had diabetes and 75% of patients had incomes less than 100% Federal Poverty Level (Coalition of Community Health Clinics). The clinic also targets a specific area of the population for which adequate healthcare is extremely difficult to obtain. Half of the clinic’s patients since opening in 2005 have been of racial or ethnicity minorities (Southwest Community Health Center). While there is still a long road to travel, SWCHC is making a difference working towards their vision that, “All people have access to quality basic health services regardless of their income, ethnicity, or social circumstances” (Southwest Community Health Center).

All volunteers at SWCHC strive to achieve the clinic’s vision, especially Dr. Flynn. Bridging the gap between medical universities and those fortunate enough to have adequate health care and those without, Dr. Flynn splits her time by volunteering as a medical practitioner at SWCHC in her position as Co-Medical Director during the week. Dr. Flynn has been involved with SWCHC since the very beginning of her professional medical career as a resident. While working at the clinic was time consuming, particularly during an already hectic and infamously intense medical residency, Dr. Flynn spent every free moment outside the hospital volunteering at SWCHC.

With many years of experience as a community health clinic doctor, Dr. Flynn also has many long lasting memories. The moments that stand most distinctly in her mind are memories of experiences with her patients. Several years ago, Dr. Flynn tells me, a man appeared at SWCHC complaining about a lump in his stomach. The clinic immediately arranged for him to have a CAT scan, only to confirm their worst fears. The gentleman had a cancerous tumor in his stomach. Dr. Flynn and a nurse who worked at SWCHC at the time, spent two weeks getting the gentleman into the system in order to get approval for his medical costs (Flynn). Fortunately Dr. Flynn referred the gentleman to a program that allowed him to receive the therapy and treatments he needed. While this is a happy story of SWCHC changing someone’s life, it is also a saddening reminder that there is an abundance of people with needs that aren’t being met. “There are people who don’t feel well who don’t have health insurance, so they don’t know where to go,” says Dr. Flynn (Flynn). Grateful that people with urgent medical needs do find their way to SWCHC, Dr. Flynn tells me countless stories of patients for which SWCHC was likely their only chance for a future.

Another patient who came to Dr. Flynn at SWCHC was an elderly woman, Hilary, who had recently moved to Portland from abroad. After several referrals to eye doctors and surgeons at OHSU, Dr. Flynn diagnosed Hilary with a pituitary tumor. The severity of her diagnosis meant that Hilary went to OHSU for further care. Months later Dr. Flynn bumped into Hilary’s daughter at OHSU on the day of the surgery to remove the tumor. Dr. Flynn tells me that she has never met anyone so thankful and appreciative as Hilary and her daughter. To this day Dr. Flynn still receives cards from them, and Hilary phones the clinic to chat with the 69 year old nurse, Susan. The gratitude that some of her patients display, Dr. Flynn tells me, is the most humbling aspect of her job (Flynn). Frequently patients are overwhelmed when they come to the clinic, and struggle to show their gratitude on the spot. Envelopes will come in the mail containing a few dollar bills, or a quarter with a note saying, “thank you so much for the care you gave me six months ago(Flynn). The best part of working at a community clinic is seeing the difference one can make on other people’s lives. The hardest part however is that “It’s heartbreaking to see people in the church or the food pantry or the grocery store who have food or are getting shelter from the church, but they have big gaping wounds, cancer, or are coughing; and its totally preventable” (Flynn). There are some things you can’t prevent, and some things you can’t cure, but there are a lot that you can (Flynn).

*     *     *

Every day presents new challenges in life at a safety net clinic. The doctors and nurses are repeatedly presented with people and situations that challenge them intellectually, physically, and mentally. Many doctors develop dealing mechanisms for the stresses that come with the job, but Dr. Flynn is constantly motivated by her belief in social justice. I truly believe in social justice and I believe that there are some ways in which I can contribute, but selfishly I’m very gratified by learning very challenging things like science. This is a placeof great privilege to have the honor and permission in peoples lives to be entrusted with their stories, there is nothing you can say about how valuable that is,” she says (Flynn). Social justice, as Dr. Flynn notes, plays a significant role in free health services and the mentality required to be successful in making a difference in this field. This is true not just in Portland, but also for global advocates and others who are dedicated to using their medical skills to help those who would otherwise not receive care. Paul Farmer said of his work in Haiti that, “If you’re asking my opinion, I would argue that a social justice approach should be central to medicine and utilized to be central to public health. This could be very simple: the well should take care of the sick” (Kidder).

There is no doubt in my mind that Farmer’s proclamation is a true and immensely valuable concept that must be understood, especially by doctors. In regard to Farmer’s statement in perspective of my own life, I am well. In fact, I am more than well. I have every basic need met, and many more luxuries on top of that: a nice home, a family, and an education. Because of these advantages it is my duty to bring about social justice by taking care of those who would not otherwise receive the help they need. When I was younger I took care of my little brother after he hurt his foot on a piece of lego. The simple act of reaching out to wrap a bandage round his foot may appear trivial or insignificant. I believe, however, that by reaching out to take care of others now, no matter how small the act, I will eventually be able to reach many more people in bigger ways, and strive for social justice through medicine.

 

Works Cited

Coalition of Community Health Clinics. “Community Clinics.” Coalition of Community Health Clinics. Accessed October 24, 2013. http://www.coalitionclinics.org/.

Ferguson, Patrick. “Making A Difference Proceeds of Pair’s Play Aid Health Care Center.” Oregonian, The (Portland, OR) 17 Jan. 2008, Sunrise, Metro Southwest Neighbors: Lake Oswego: 15. NewsBank. Web. 4 Nov. 2013.

Flynn, Jessica. Personal Interview. 31 Oct. 2013.

Hayes, Elizabeth. “A $2.8M Assist to Get Oregon’s Uninsured Insured.” Portland Business Journal. American City Business Journals, 11 July 2013. Web. 24 Oct. 2013. <http://www.bizjournals.com/portland/blog/health-care-inc/2013/07/health-and-human-services-spreads-the.html&gt;.

Health Grades Inc. “Dr. Jessica Flynn, MD.” HealthGrades. Accessed October 24, 2013. http://www.healthgrades.com/physician/dr-jessica-flynn-2ds9n.

“Jessica Flynn, M.D.” OHSU Health Services Providers. Oregon Health & Science University, n.d. Web. 24 Oct. 2013. <http://www.ohsu.edu/xd/health/services/providers/ index.cfm?personid=226>.

Kidder, Tracy. Mountains Beyond Mountains. New York: Random House, 2003. Print.

Southwest Community Health Center. “Services.” Southwest Community Health Center. Last modified October 24, 2013. http://swchc-pdx.org/.

 

Works Referenced

Budnick, Nick. “Oregon Cuts Tally of People Lacking Health Insurance by 10 Percent in Two Weeks.” Oregon Live. Oregon Live LLC, 17 Oct. 2013. Web. 24 Oct. 2013. <http://www.oregonlive.com/health/index.ssf/2013/10/

Culp-Ressler, Tara. “Thanks to Obamacare, Oregon Cut Its Unsinsured Population by 10 Percent Over The Past Two Weeks.” Think Progress. Last modified October 17, 2013. Accessed October 24, 2013. http://thinkprogress.org/ health/2013/10/17/2801311/obamacare-oregon-medicaid/.

EHealth Insurance Services. “Oregon Medical Insurance Statistics.” EHealth. Accessed October 24, 2013. http://www.ehealthinsurance.com/ oregon-health-insurance.

“Health Insurance Coverage of the Total Population.” Health Insurance Coverage. Kaiser Family Foundation, 2011. Web. 24 Oct. 2013. <http://kff.org/other/state-indicator/total-population/&gt;.

“Jessica Flynn, M.D.” OHSU Health Services Providers. Oregon Health & Science University, n.d. Web. 24 Oct. 2013. <http://www.ohsu.edu/xd/health/services/providers/ index.cfm?personid=226>.

Kliff, Sarah. “Obamacare Just Cut Oregon’s Uninsured Rate by 10 Percent.” The Washington Post. Last modified October 17, 2013. Accessed October 24, 2013. http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/17/ obamacare-just-cut-oregons-uninsured-rate-by-10-percent/.

Needy Meds. “Clinic List for Oregon.” Needy Meds. Accessed October 24, 2013. http://www.needymeds.org/free_clinics.taf?_function=list&state=or.

“What Is Obama Care?” Obama Care Facts. Accessed October 24, 2013. http://obamacarefacts.com/whatis-obamacare.php.

 

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