Mission of Mercy – Roanoke: another health care diary

posted at Daily Kos, Blue Virginia, and Blue Commonwealth

I sit in a house of a friend, in Roanoke County, VA, having just finished the first of two days of volunteering at yet another Mission of Mercy, the free dental projects put on by the Virginia Dental Society, this at the Civic Center in the city of Roanoke.  Yes, as of this week, we have new laws revising health insurance coverage in this nation.  Yet the need for care for many remains unaddressed, and will remain unaddressed for some time to come.  After all, we still insist on separating dental health from general health.  The changes in health insurance by themselves do little to address the crisis of dental health, or the lack thereof, for many in this country.

I am neither a dental or a medical professional.  I volunteer in dental triage, helping with paperwork and patient flow so that the volunteer dentists with whom I work can devote more of their time to patient care.  I have done so in Wise VA in July, Grundy in October, and Springfield 2 weeks ago.  And I will return to Wise in July, which is why I will for the first time not be at our annual gathering, this the 5th back at the site of the 1st in Las Vegas.

I have a few thoughts to offer below the fold, which I invite you to read.

Much of what encountered today was familiar.  The setting was somewhat different, a large convention center –  Wise was on the fair grounds, Grundy in a School, NoVa in a community college with a computer network that allowed the transmission of radiographs to dentists at their chair.

Still, most of the people we saw were poor and white.  Some had not seen a dentist in years, others come to events like this on a regular basis as the only source of their dental care.  There is clear evidence of poor diet, and poor general health.  Many of those we saw had multiple medical problems, as evidenced by all the medications they were taking.  A fair number were unemployed.  We had diabetics, we had obese, we had people whose clothing spoke loudly of their poor economic circumstances.

I am told that again a few were sleeping in their cars starting yesterday afternoon, perhaps not as severe as at Wise, where on Tuesday they began gathering for a Friday event.  People were lined up in pouring rain beginning around 3 or 4 AM this morning.  When I arrived shortly before 5:30 there were several hundred online in a serious downpour.  If nothing else, that should be evidence of the needs we would be addressing.

By now I know many who volunteer at these events and they know me.  That includes dentists and dental assistants.  Many I saw at Wise, some I saw at Grundy.  

Both of those with whom I worked were new to Mom.  Bill recently relocated to Richmond where he teaches at VCU Dental, having previously been based in Pittsburgh.  This was not the first time he volunteered, because he went to New Orleans after Katrina.  He told me about seeing children with partial orthodontic work, with braces that were twisted and broken, but whose orthodontists no longer had offices or practices in the city, some having relocated to Houston or elsewhere.   Al is from further North, like me originally a New Yorker.  Both wrestled with the conflict between what they would like to do for the patients we saw and what they knew was possible – as Bill put it, he had to keep a wall between his head and his heart.

This time I tried to be sure to get the first name of each person and address her/him by it as we seated them.  We wanted to make them comfortable.  

And again we were comforted by them, by the overwhelming thanks they offered us for being their to help them.  

I do not know what I can add to what I have written before, each time I volunteer at one of these events.  The time flies by, we see so many patients, often having to make very quick judgments about what we can do for them.  Suddenly on realizes that we have been seeing patients without a break for about 3 hours, perhaps 30 or more an hour (I was not keeping track, but Bill who teaches dental diagnoses and emergency dentistry could really process a patient quickly – it was all I could do to keep up with the paperwork and putting on the correct wrist band).  And yet no matter how much we do it still seems like so little.  I again remind myself of the little boy and the starfish on the beach that he is throwing back into the sea.  When a man tells him he cannot hope to save all the starfish, he says he knows, but he can save these.  We are like that little boy.

That may comfort me in what we are doing.  It also breaks my heart.  And it angers me.

We are a rich nation.  We should not have the crises we have in health.  It is bodily health, nutrition, dental health, medical health.  Let any of these break down and all the rest are at risk.  And yet we treat them in separate silos, in isolation from one another.

And our people suffer as a result.  There is so much suffering.

And no matter where you are, we have cultural and language issues.  We expected it in NoVa, we had worked to identify translators, including the two of my students who offered assistance in Spanish and Farsi.  We had one Spanish translator whose services we needed occasionally.

And then there were the five.  Four patients, and one woman to translate for them.  None of the patients spoke any English.  The language for which the woman translated was Burmese –  in Roanoke, at the junction of the Valley and Southwest, about a 4 hour drive from our nation’s Capital.  

Perhaps it was arrogant of me, but I realized that we needed to keep the four somewhat together because her services were needed.  Two needed xrays, two did not.  I feared that one or another might wind up in getting services while she was elsewhere, so I asked and received permission to take the two needing xrays to the front of that line in order to get all 4 to the service areas, adjacent to one another, where the translator could be easily accessible to all four.

I am tired.  I drove down after teaching a full day yesterday.  My host, whom I know from Virginia politics (he is an elected official in this area) had some serious catching up to do.  I had had only 5 hours sleep on Wednesday night and I got only 5.5 last night.  I did not feel it while we were working, but once we stopped it hit me hard.  I was, after all, standing on the concrete floor of a Civic Center for long stretches without sitting down.  Even when I teach 4 consecutive 45 minute periods in my classroom I sit down to put in attendance and I may lean against a stool.  

Yes, I am tired.  But that seems so insignificant when compared to the needs we are serving.  

Which is why I keep doing these events.  And why I keep writing about them.

Another starfish.  Another chance to try to make a difference.  Another chance to explain, illustrate, persuade, that what we have achieved this week is but the first of many steps we will need to address the health needs of the people of this nation.

I am a bad penny.  I will turn up –  at events like the one today, in blog posts like this, in emails to people on the Hill.

It does not make me comfortable.  I feel little satisfaction, because the needs seem so vast.  But I refuse to give up.  These people have hope – that they can turn to us for help.

This nation still has hope that the way we do things, in health care and in government, can be changed sufficiently so that the real needs they feel can be addressed.

If I am not coherent, it is because I am tired, because I lack words sufficient to the need.  I do not apologize.  I do what I can.

It is not enough.  It is what I can do.  And that will have to suffice.

What else?

How will you answer that question?

How will you demand that our leaders answer that question?

Because until we can say that we have done ALL that is possible, so that there are no unmet needs, there will always be something else we could, we should, do.

This was a Mission of Mercy.  There will be many more, because there is so much need. Remember that, remember that Mercy takes many forms.  Remember that giving of oneself in however minute amounts of time and energy can make a huge difference to the people for whom we care.

Remember that if nothing else, you can contribute through the Virginia Dental Association, which has been sponsor or cosponsor of all the events at which I have volunteered.  

Thanks for putting up with me.

Peace.