What Will it Take To Get Health Care to the Poor
From the Archives: Health & Development Volume 1: Number 1, Winter ’79-'80
The following is an excerpt of a conversation between John Perkins, president of Voice of Calvary Ministries; H.P. Spees, director of the South Central Mississippi Rural Health Association; and Lance Loberg, family practice resident physician in Pueblo, Colorado.
Perkins: The poor don’t have access to health care. What will it take to get health care to the people, especially the poor? We as Christians need to develop strategies to get health care to the people who need it.
Spees: The problem of access cuts across urban and rural communities. In Jackson, Mississippi’s capital, health services are naturally concentrated in affluent areas. Poor and black neighborhoods tend to be isolated, with no doctors’ offices and comparatively long distances from the hospitals. In the rural town of New Hebron, where we’ve just opened a clinic, more than half the people within five miles are black, and nearly half live below poverty level. The town had been without a doctor for 12 years.
Perkins: What this creates is crisis care. Instead of going to a regular doctor as a problem develops, people go to the emergency room when they get desperate. They lack preventive care and early detection. Another consequence is that poor people don’t get the type of concerned, ongoing, personal care they need. The institutional hospital setting just can’t give it. It also means that people end up paying too much for their health care.
Specs: As Christians involved in health care, we’ve tried to look at the factors that have created this situation and work towards changing them. One of the factors is getting physicians and health workers into these communities.
After working for two years securing personnel, we’ve finally been successful in staffing our New Hebron clinic. But after hundreds of letters and phone calls, I’ve seen a basic problem: Health care workers are programmed to work with affluent people. Besides the obvious monetary rewards, there is the advanced hospital equipment, consultation resources, accessibility to a wealth of recreational and cultural activities, the beauty of location, the private schools, and the list goes on. Similar values can lead a person to choose sub-specialty training over primary care and to serve private pay patients, refusing people on Medicaid. This is so widespread that in Jackson, for a population of 300,000, there are only two pediatricians who will accept regular Medicaid patients.
A Christian seeking God’s will in this context and with a concern for the poor is swimming upstream against culture, comfort, and the whole American success myth.
Loberg: It is a matter of commitments. If health workers are going to bring their skills into underserved areas, they will need to be motivated by something besides these usual values. My decision to enter medical school grew from my commitment to Christ. My main purpose was to pursue primary care training so I could provide health care in an underserved area. But during medical school I still felt the strong, unrelenting pressures of the choices you mentioned such as the attractions of the big city and the lures of specialty training over family practice. But my original goals have been sustained by my commitment to Christ and through relating to and reading about brothers and sisters whose lives challenge me.
Perkins: Yet, when you have people coming into poor areas to work, you have to think beyond I
basic commitment to length of commitment. It doesn’t work to have people coming in for a short time. It hurts the patients and the providers.
In 1973 we started our health center in Mendenhall, Mississippi after doing a community survey. It was clear that people were hurting for lack of medical care and that a health center was badly needed. So we started one and made about every mistake in the book doing it. One of our biggest mistakes was getting providers with a short-term commitment. We were crazy. We had one doctor - a great person - open our clinic by giving free physicals for two weeks. Then another doctor came for about nine months. Then another came for one month. After he left, we had to shut the doors. This about killed the clinic; you can see why. But the need was so great that people hung with us. We finally got a doctor for two years, and now one who is here indefinitely (from Brooklyn, too!), and we can see that it is only a long term commitment that is going to make it.
Spees: Long-term commitment is bound to be a hard choice for many people. A major factor involved is your family. It’s important that your spouse be just as committed as you are, or things won’t work out. We need to talk about committed Christian families being called to service, not just individuals. “Spouse recruitment” is as important (and many recruiters feel it is more important) than just “physician recruitment.” This is more than good business; it’s Biblical.
Loberg: You’re right. Individual commitment is not enough. This is true in many other areas as well. There’s a high “burn out” factor when a health worker goes alone into an underserved area. In fact, the National Service Corps is moving away from placement of single providers! They have seen suicide, drug overdoses, and legal and marital problems develop at high rates
As we recruit health workers for underserved areas, we need to have concern for them in arranging for adequate time away, continuing medical education, and the like. Otherwise, a potentially wholistic ministry can be reduced to a routine for sheer survival. But we also need to offer a support group there, on the spot.
Spees: This is where we need a vision for the church’s role. We also need to be giving health care not as an isolated service, but as part of a comprehensive Christian strategy to change the lives of people in poor communities. A health team can’t deal with all the problems in a community. But this team can form the nucleus of a fellowship for other Christians to join. Together they can undertake a much wider response to people’s needs and provide a broader evangelistic witness.
Perkins: What’s exciting to me about this is that I’ve seen this happen in Cary, Mississippi, with the Cary Christian Center. Instead of a singular, personal witness, both of these poor communities have seen a corporate Christian response to their needs. The result is that the needs of the whole community have been addressed - health care, economic development, and programs of leadership development and discipleship.
Spees: So the vision of committed Christians bringing health care to poor communities grows into something more: A strong fellowship of people providing an effective basis for comprehensive community development in the name of Christ. If we can make what we’ve discussed here real in our lives and through CCHF, it could provide a significant witness in poor rural and inner-city communities in our country.