Medicine for the Least of These

Posted on January 1, 2005

Ever since I was twelve years old, I wanted to be a doctor who ministered to society’s rejects, “the least of these,” that Christ, “the friend of tax collectors and sinners,” spoke about again and again.

I joined CCHF back in med school, and read Health & Development articles that helped me figure out how to best train to work with society’s most marginalized. I picked a medical residency in Detroit where nearly 50 percent of my patients were drug addicts. I worked one-and-a-half years in the Dominican Republic as a missionary doctor. I then returned home to practice in San Diego, California, to work with the poor and marginalized there.

Enter HIV. In 1983, we dressed up in full isolation suits to examine our first HIV patient in the teaching hospital. The guards at the prison, where I worked for two years, wore thick rubber gloves to pass food trays to suspected HIV inmates. The fear and stigma about HIV was overwhelming back then. Many doctors would have nothing to do with such patients. Christians were proclaiming that AIDS was God’s punishment against homosexuals. Clearly there was a tremendous need for caring here, and I was sure this was where Jesus would be, if he were physically walking among us then. So I decided to specialize in HIV medicine, with my wife’s full support and encouragement.

My heart was in the right place, but I had to deal with many fears at first. I was afraid I would catch HIV. I was afraid homosexual patients would flirt with me and ask for certain kinds of exams, or ask me to go on dates. But I was sure Jesus called me to obey his command to serve the poor with the “plague” of my era. These people needed his love too, and the most concrete way to give it was through their most desperate need: health. Fearful and excited, I entered a post-residency training course. I posted verses from Matthew 25 on my wall to remind me of my assigned mission.

Guess what happened? It has been fun. Apparently, obedience doesn’t necessarily mean suffering. I am now a recognized researcher and treater of HIV, a primary-care internist, and a specialist in a disease that is constantly changing. I found gay people are appreciative and very nice and fun to be around. Drug abusers take some extra patience, but some have even done well with good care and compassion. Some die. In fact, the vast majority of those who die now are those who refuse to heed health caretakers’ advice early in their disease, and they are usually the ones who abuse drugs.

I’ve obviously made progress since the 1980s, and so has HIV treatment. Thanks to much-improved medicines, AIDS is no longer the death sentence it once was. And many people no longer treat HIV -infected people like lepers whom they must avoid and ostracize at all costs. HIV has changed, too. It is no longer just a “gay disease.”

But there is still much stigma. Many times HIV patients, especially the poor, are rejected by family, friends, employers, landlords, and churches. Now the people I deal with who have HIV are rejected for how they got it - sex, needles - or their lifestyle that fostered risky behavior. I work in clinics of “last resort,” where the staff is trained to be compassionate and objective. But outside the oases of HIV clinics is a world of stigma. It may have improved a lot, but it has a long way to go.

A few examples:

  • Patients feel they must hide their medications from coworkers and family, resulting in poor adherence causing viral resistance.
  • Patients feel forced to lie to their employers and family about the frequency of physician visits, medications, and symptoms.
  • Deliveries of food and services to residences must be done in unmarked vehicles, lest the neighbors become suspicious.
  • During discussions with a potential partner about eventual intimacy, a patient is torn between complete honesty and deceit. This interferes with sexual fulfillment, since the most complete emotional and physical intimacy is achieved by a release of one’s true inner self to the other. Dating is a big problem. Many times there is deceit and no discussion.
  • Patients feel they must not reveal that friends or a spouse has or died of HIV.

Much of church doctrine in this area is defined by judgmental and exclusive thinking (us vs. them, true believers vs. the rest, bad things don’t happen to good people). Uncomfortable with uncertainty, Christian leaders create certainty where it doesn’t exist. It reminds me of some national leaders and the caricatures of surgeons who seem to be thinking, “I may be wrong, but I’m never in doubt!”

The deceit of such thinking considers that if you have HIV you must:

  • Be cursed by God (this is a corollary of the Divine Health doctrine: If I am close with God and have enough faith, I will prosper in all things and not suffer).
  • Have sinned or are sinning, and we can’t have sinners even sitting in our building.
  • Be infectious by casual contact. The emotionally governed thinker has avoided or doesn’t believe the education (propaganda) about this disease.
  • Be a high-maintenance congregant, and I only have time for those that have something obvious to offer me.
  • Never be a potential mate for one of our members so you’d best go and look someplace else.
  • Go to another church, please. You see, this is a church of less-than-wealthy non-celebrities, so we really must have a pristine reputation, and want to maintain our fantasy of what our church should look like.

Human beings need nurturing relationships. Without them, we attempt to fill the void with inferior solutions. Many of those with HIV have depression and need counseling and/ or medication. Some self-treat with illicit chemicals and form unhealthy relationships because primary support groups like church and family have failed them. Research has shown that good HIV medication adherence is directly related to the strength of support the patient has.

The overriding ethics in a Christian’s life should be two of the main commandments: “Do unto others what you would have them do unto you” and “Love your neighbor as yourself.” We Christians often put up walls so as to not inconvenience ourselves and to pursue happiness according to a distorted paradigm. By doing that, however, we miss out on so many of God’s blessings. If you want happiness, do the counterintuitive thing: be selfless and loving toward others, especially those whom society and the church scorn. Instead of putting up walls of judgment, focus on Jesus’ radical love for everyone, and you’re likely to find, as I did, that joy and ment will replace the delusions and self-deceptions you had about these “sinners.”

Daniel Pearce, D. 0., is a Board Certified Internist, Credentialed HIV Specialist, Hospitalist, and Director of Research at AltaMed Health Services in Los Angeles, and accepts preceptors. He is the sole Anglo and accessory percussionist at an inner-city, pentecostal, Belizean Mennonite church in Los Angeles. He can be contacted at danielpearce [at] bigfoot [dot] com.

Tags: H&D, HIV/AIDS, Community Development, Biblical Principles

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