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As I come to know these fine people, they share with me more of their personal and sensitive stories. Their collective story is what I am trying to share with you as my way of breaking the stereotypical beliefs that exist. "Blog names" have occasionally been given to me by the person whose story I am telling. Names are never their actual names and wherever I can do so, I might use the opposite pronoun (his/her, etc.) just to help increase their privacy.

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Tuesday, January 8, 2019

In the Absence of Dignity and Respect for People on Medicaid and Dealing with Substance Use Disorder, the "Cure" for Dope Sickness is $5.00 and a few blocks away.

For the past couple of years, I have been serving men and women who live on the streets of Kensington and who are dealing with Substance Use Disorder.  I've been in situations where, as I look back on them, I know it has not been me doing these things nor engaging in these conversations.  Our LORD has allowed me the - well, I'm not sure what to call it - to sit on the sidewalk, in jail and in hospitals with people who are looked down on by society out of a total misunderstanding of the disorder they endure.

This past October, I started serving people who deal with this same disorder in a very different format, that as a driver for Recovery Centers of America.  RCA's goal is to serve 1,000,000 people who deal with Substance Use Disorders[1].  They do so in multiple settings that convey dignity and respect.  I would add to that hope, honor, and love.  As a driver, we convey that to the patient by picking them up in a black Lincoln Continental or similar vehicle.  A few who get in may be accustomed to such luxury and not actually notice it.  For others, having the back passenger side door with its tinted windows opened for them, being greeted by comfortable seats and an awaiting snack filled cooler is more decency than they have experienced in a very long time - if ever.

It's this latter group of people I'm focusing on here and now.

From time to time, and more times than one might think, I hop in one of these luxury vehicles and drive to Kensington to bring a person to Devon who, only a few hours earlier, called 1-800-RECOVERY, chatted with a caring person at that number, had their insurance verified and shared the basics of their overall situation.  The ride is scheduled and off I go.  So far, these have not been people I already know.

Since October 1st, I've been in Kensington several times.  On one of those trips, I was stopped at the red light at Lehigh Avenue and Emerald Street.  As I sat in this Lincoln, the seat of which was giving me a back rub(!) I looked toward Emerald City and saw so many people who I've come to know and love.  Two of the men were standing there conversing back and forth as they often do.  The movement of humanity to the right of the street itself mimics that of a busy mall filled with shoppers.  One of the ladies who I've known for two years turned the corner and proceeded into Emerald City.  She was dressed in such a way that I knew she was returning from a 'date' or multiple 'dates’ or an afternoon of not finding anyone to rent her body so as to support her unwanted desperate need for her medicine.

My heart broke for the disparity of it all. 

RCA is doing it right!  From the patient's first contact with RCA, they are experiencing what EVERY human being dealing with Substance Use Disorder should experience, dignity and respect.  Funding from insurance makes this level of physical demonstrations of dignity and respect possible. 

Not long ago, I drove a woman from the Philadelphia suburbs to Bracebridge, RCA's Maryland Facility.  As I drove, she told me about her trips into Kensington to buy her "medicine."  She buys from the same dealers that many who I've written about in these blogs buy from.  She named the same streets that I've come to know.  She knows the harsh reality of the streets and does have private insurance.  She had not seen any pictures of where I was taking her. 

Try to imagine the stunned silence that overcame this person as I pulled up to this estate and opened
her car door so she could enter this front door as a person made in the image of God and no longer bearing the labels put on her by people who know no better.

Click here to Visit the website for Bracebridge.

Many - No, most but not all - of the good people of the streets of Kensington are on their home county's version of Medicaid.  Medicaid funding for Substance Use Disorder is not at a level that makes Lincolns possible.  That does not mean that health care for people with Medicaid and dealing with Substance Use Disorder should be absent of demonstrations of dignity and respect. 

When a person contacts RCA, upon insurance approval, they can be taken to one of several RCA facilities before dope sickness has a chance to firmly set in.  Here's how I described in a recent blog the far too common plight of the person with Medicaid and dealing with Substance Use Disorder.

George knew what he needed to do to enter detox.  For the next few days, as he continued his normal routine of living in a tent and 'flying a sign' at street corners that read "Hungry," George connived to survive and hustled to pull together an extra $60.00 so as to buy extra dope to hide on him during his expected one day wait in the Crisis Center several blocks away.

With enough money in hand, he bought the extra dope, and then walked to the Crisis Center, pushed the button on the brick wall next to the secured ill painted metal door with the wire laced security window located in the middle of its upper half.  After a couple pushes of the button, a security guard opened the door and asked why he was there.  After explanations, the guard told George to come in and strip down in public to one layer of outer clothing, to empty all of his pockets, remove his shoes, allow himself to be frisked and to walk through a metal detector.  With growing fear and trepidation and a fading determination in his heart, George complied.  With socked feet, he walked across the worn and tattered simulated hardwood floors that ran throughout the facility to the awaiting receptionist, was handed a clipboard with papers to be filled out and told to "Sit over there and fill these out."

As George sat down, he glanced around the room of grey chairs each attached to the one next to it.  Three other people were in some stage of being processed.  All were asleep.  One was a woman whose 'one layer of outer clothing' had obviously been her only clothing for quite some time.  A man, asleep and draped across two chairs and covered with a blanket, lay motionless representing the hours of waiting he had endured thus far.  The other waiting room resident and only Caucasian of the three looked suspiciously familiar to George.  As George looked at him, asleep in his chair, he wondered if this was the same man he's seen in a recent "Has anyone seen my son?" flyer posted up and down the main avenue.

One urine sample, one medical exam, one interview and six hours of room observation later, George was starting to experience dope sickness and needed to use the bathroom.  From observing, he knew that anyone who asked to be allowed into the locked bathroom would be checked on after a very short period of time.  George knew that he could not, during that short interval of privacy, prepare and inject the dope that he had smuggled in and stored on him where nothing to be consumed should ever be stored.

With an onset of diarrhea from dope sickness nearly guaranteed any minute, George requested to use the only bathroom.  He entered it and saw one toilet and two urinals against one wall none of which had any hint of current privacy provided except for the small holes in the wall that suggested that privacy enclosures once existed.  All pipes typical of bathroom fixtures were boxed in so as not to be used in combination with one's belt for the purposes of hanging and ending the misery.  But what did that matter?  By requirement, George had surrendered his belt hours ago.

It was more than George could take.  He walked out of the bathroom without feeling better, politely told the nurse that he was leaving, was reintroduced to his belongings, left and found a back alley nearby to use as his bathroom. 

The lack of dignity and respect demonstrated by the current health care system for those people with Medicaid and dealing with Substance Use Disorder is one of the barriers to them getting the care and cure that they need and deserve as equal members of our human race. 

As our sons and daughters with Medicaid sit and wait in the absence of dignity and respect and as their dope sickness settles in, they know that the 'cure,' for as temporary as it may be, is only $5.00 and a few blocks away. 

If the medical administrators within our current system would like to take more seriously their vow to uphold their Hippocratic Oath[2], then surely they can review the process of medical care to those members of our society who are on Medicaid and who suffer from Substance Use Disorder.

[1] Of all kinds…  This blog emphasizes the drug portion of the issue.
[2] Physicians and nurses of the E.R. and Urgent Care, each one of you has, upon your graduation pledged your career to some version of the Hippocratic Oath.  While your version may have been slightly different, the following is, I'm sure, a reasonable representation thereof.  I have made bold and red, the points therein that most apply:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

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