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Medical Humanities

Traversing the Gap

I don’t think you realize what you have done to me.

Before I met you, I treated this as a requirement – as another obstacle to receiving those two letters after my name. 

I foolishly thought to myself, “Why do we need to do this? Doctors are not forced to work at free clinics. Why are we?”

I’ll admit, I did not even want to see you when I first met you in those torn jeans and faded Yankees shirt. You were sitting in your chair wincing in pain and all I could think was, “Great, why I am here on a Sunday?”

And then you opened your mouth.

Twenty-two of your thirty-two teeth were gone. You looked up at me with fear in your eyes and said in broken English, “Please.”

My initial reaction was to retract, looking at the grotesque nature of your gums – a white liquid oozing out along your maxilla and mandible  – to leave the room and run, but your scared eyes kept me there. 

I looked at your right molars, your dental abscess that was filled with puss – and that’s when you opened up. 

Your wife left you in Mexico several years ago.
You came to the U.S. illegally and work two construction jobs to feed your three kids. 
You haven’t seen your parents since their terminal cancer diagnoses. 
You don’t have insurance or regular access to healthcare.
You sleep 4-5 hours a night, worrying about the future. 

And you even had the courage to come from nearly 30 miles away when you don’t own a car, have never been to East Palo Alto, and had to hitch a ride with two of your friends, one of whom is currently looking after your three little ones. 

And when I ask you if you are tired, your shoulders come down, your eyes relax, and you manage to smile. You begin pumping your legs over our exam table like a child on a swing. You ask me about our ophthalmoscope on the wall; the stethoscope around my neck; and playfully glance at the reflex hammer. 

And maybe that’s why you smile. This room, this equipment, and this clinic are not for us – not for our medical school course, but for you. For once, perhaps in a very long time, someone is caring for you. 

That is why I am here this morning. This is not a requirement of medical school, but a requirement for life; a necessity for you and for the millions in this country who are ineligible for insurance. We provide the first line of care for those who are often overstressed, overworked, and overburdened. They fall outside the health care safety net and present at our clinics because they have nowhere else to turn.  

Several months later, in blue scrubs and a pullover, I stood in front of the 102 students that comprised my medical school class. As manager of the free clinic, I held the microphone up to my lips and asked, “Who knows the population of East Palo Alto?” Silence. “What about the uninsured rate?” Silence.  A sea of blank faces greeted me. 

Medical student interest in the free clinic was at an all-time low. Only two of my fellow students showed any interest in the clinic, and when I approached my medical school class, I was surprised to find that not one of them knew about the uninsured rate or demographics in the surrounding community – a community in which we live! 

Yet, this is understandable. 

We are in a time when medical schools are constantly pushing for more research and medical students are seeking out specialties other than family medicine or primary care. So why spend time at a free clinic? 

For one, free clinics offer valuable experiences and lessons that cannot be found in hospitals or other clinical settings. They teach us how to address acute medical issues with limited resources, how to communicate across cultural and socio-economic barriers, and how to develop innovative medical solutions that patients can actually follow. Moreover, they address a widespread problem of providing access to care for the underserved. Many of these individuals cannot see physicians, let alone specialists. They do not have the luxury of enrolling within Medi-Cal or under new provisions provided by the Affordable Care Act given their circumstances. 

As physicians in training, we have the knowledge, skills, and resources to make a difference and help bridge the gap between the healthcare that is provided on our medical campuses and the lack of it in the surrounding communities. We have the power to be caretakers for those who have to work two jobs and support three children, all as a single parent. We have the power to lessen, if not eliminate, the burden on these individuals so that they may raise families and attain a better quality of life.

And so while change can be hard, it is certainly possible. In just ninety days, we have improved operations at our clinic, reached out to over 20 different shelters to provide health care, and are in the process of procuring a mobile health van to increase access for communities in need. In addition, over a quarter of the medical school class is now involved in some leadership capacity at the free clinic. 

I still remember that patient in the torn jeans and faded Yankees shirt – the very first patient that I ever saw as a medical student. I remember at the end of his visit when he refused to take a referral for free dental and primary care because he didn’t have the time. I remember the look of determination on his face after he told me that he needed to get back to work that very same afternoon. And I remember him wiping away the tears from his face and simply saying, “Please. Just the pain.”

It was on that day that I began to think, I owe them my time. 

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Author Info:

Paras Singh Minhas
Bachelor of Science, Microbiology
Stanford University School of Medicine