An Open Letter to the Next President of the United States Regarding Healthcare for the Poor

Dear Mr. Trump and Sec. Clinton;

I realize that with only a few more weeks before America decides which of you will be our next leader, you are both busy talking about the things that you believe will get you elected. But for a moment, I want to tell you about some people who are often forgotten: the working uninsured. I doubt you’ll mention them in your campaign appearances or even on your social media – and I understand that – but I still have to make their case.

I will always make their case.

I have worked in Memphis, TN for 30 years as a family physician at Church Health. At our clinic, we provide healthcare for people working in low-wage jobs who do not have health insurance. We’ve cared for over 70,000 people through the years without relying on government funding. I have no desire to make the work we do political, but with all humility and kindness, I ask for whichever of you becomes our country’s next president to please consider the following points when it comes to the healthcare needs of the poor in America.

  1. We have a serious problem with issues of mental health and substance abuse. A person with a serious mental health issue will live a much shorter life than the rest of us. These issues cannot just be willed away. Behavioral heath issues disproportionately affect the poor.
  2. The number one predictor of health outcomes is education. A poor education leads to an unhealthy life.
  3. Listen to the people you are trying to help. The answers are unlikely to come just from smart people in Washington or large institutions.
  4. Do not claim the problem is solved by whatever new policy you institute. You can help with policy, but it takes all of us to change our health outcomes.
  5. Everyone in healthcare is not out to get rich. Do not be cynical about those of us who work to care for others because we feel called by God or are driven by matters of social justice. I know there is tremendous fraud in the system, but there is also tremendous good.
  6. Effective treatments must be affordable for all. That requires lowering costs and finding a means of access for all. It does not mean the government must do it all. In Memphis, we have over 1,000 physicians who volunteer their time for the uninsured and undocumented. Almost every physician I know will state that they went to medical school because they wanted to help people. If you show them a way to care for people who have no other options, physicians will do the right thing. If you assume physicians only care about the money, then they will back away. Everyone needs a pat on the back to thank them for when they are kind.
  7. We all need help to better deal with the issues around the end of life. Rich and poor are tortured because we cannot accept that death is a part of life. We waste billions of dollars and cause endless heart break by offering unacceptable hope for the future when accepting that the end of this life has come is the right thing to do. Call on our faith communities to address this issue and we will all become healthier.
  8. Health and healthcare are not simply commodities; they are necessary elements for all other aspects of our country to thrive. For all Americans – rich, poor, and every color – to thrive, our health outcomes must improve. If we are to be judged as a great country, people building our houses must be cared for when they fall off the roof no matter what their immigration status is.

In my thirty years of caring for the people who work to make our communities great, I’ve been amazed at the resiliency of people who have so little. The joy they are able to maintain even when they have little money and work harder physically than I ever dreamed of doing inspires me every day. It makes me proud to be an American.

Surely, in the years to come, we can work hard together to assure them that we as a country will give them the benefits of the best health care system in the world. Indeed, doing so is truly part of what makes America great.

With hope for healing,

Scott

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Naming the Unnamed: the Important Work of Dr. Lori Baker

Last week, I spent some time at Baylor University in Waco, TX. I admit, Mary and I went with great curiosity about seeing Magnolia Farms, the home of Chip and Joanna Gaines from the HGTV home-remodeling show Fixer Upper. Who would have believed that Fixer Upper-fever had over taken the town? Each month an estimated 33,000 tourists travel to Waco just to gawk at what the Gaines have created.

That was our first stop, but after that we spent time with Baylor students who are very interested in the link between faith and health. Their energy was so invigorating, and hopefully we’ll see some of them come to Memphis and work with us as Church Health Scholars during their a gap year between college and medical school.

What I was not expecting was to meet Dr. Lori Baker, a forensic pathologist based at Baylor. It turns out she has a PhD in anthropology from the University of Tennessee and spent seven years in Memphis. What she has followed as her life’s work is both inspiring and gut-wrenching.

Dr. Baker works to identify bodies that have died in areas of genocide or on the US/Mexican border. She then returns the bodies to their families. She has worked in Serbia and Honduras, but she mostly works in Texas.

Every year, 500 people die trying to come to America. Before the 1990s, our country did not even keep a record of the deaths of these unknown people. On the Texas border, people pay a “coyote” to help them cross the desert, and once across and into Texas, they’re told that Houston is “just a 30-minute walk away.” They are led into barren lands that are mostly privately owned ranches hundreds of square miles in size. There is no water, so the irony of calling these people “wet backs” is disturbing. They will die of dehydration. Most bodies are found about 70 miles from the border, often in the fall during hunting season. They are buried on the spot or in cemeteries with unmarked graves.

Dr. Baker, with a small group of students and volunteers, works to identify the people who never realized their American dream. She then tries to return the bodies to their families. It is heart-wrenching work, but surely the work of the Lord.

She is one of the only forensic pathologists in America trying to identify these tragic souls.

Two weeks ago, I saw a young man barely out of his teens from Honduras. While crossing the border into the US, he became dehydrated. He was admitted to a border hospital and told he had damaged his kidneys and that he would need dialysis. He then came to Memphis where he had family. Thankfully, he is young and his kidneys had recovered by the time I saw him. But he came within a hair’s breadth of being someone who met Lori in the desert.

When I last saw him, he was smiling, ready to go to work building houses with his uncle. But I can’t help but wonder what his smile masks. Did he see people along the way who Lori will examine later this year? Did he know where they came from? Did he know their mamas?

My talks with Lori educated me on a facet of immigrant life that I never considered, but I cannot get out of my head the profound sadness of it all. She gets regular hate mail for doing what she does.

The line between life and death is so very thin. My troubles seem of little consequence when I think of all those who set out on such a perilous journey. I don’t know if I will see Lori ever again, but I do know I will not talk to a recent immigrant to Memphis from the South without thinking about what could have been.

Thoughts On Brexit

I spent a year going to school in London. At the University of London, I was surrounded by people from all over Europe and the world. The amazing diversity of London has always been one of its best assets, and I can’t reconcile my memory of London as a place of unity and diversity with the reality that is Brexit.

Turning in seems to be the majority sentiment for a county that once ruled much of the world. I am in no position to judge the British on how they rule themselves, but I am confident that focusing only on one’s own self-interest is never a good plan. Any time decisions are made based on how one party – whether that be a person, a group, or even an entire country – can get more for itself, the result is rarely a strategy that works well in the long term.
I believe that finding ways to be generous to neighbors and engaging with people who are different from ourselves has been the most effective business and social strategy for hundreds of years, and I hope that Britain will find a way to avoid isolating themselves while at the same time exercising their autonomy. Obviously, that’s a hard balance to strike.

Like many Americans, I pray that the British exit from the EU does not lead Americans to say we should follow the same path. We live in a complex world and it is critical that we find ways to better engage the rest of the world, not isolate ourselves from it. I am confident that the Christian path is to welcome strangers into our midst and to go into all the world. Anything short of that is not following the path Jesus set before us. Sadly, too many people who claim to follow Jesus would rather we circle the wagons and only share our abundant resources with those who look just like us.

My experience living in London opened my eyes to remarkable people and powerful ways that others around the world live out their lives of faith. None of us are able to love God fully by just following our own understanding of how God created the world. We truly need each other. If America is to be a great nation, we must open our hearts and arms to all who would want to be in relationship to us. It says it on the Statue of Liberty, but Jesus also says it in the Sermon on the Mount.

I pray we will listen closely to God’s desire for us to engage the whole world in acts of love, justice, and joy. Anything other than that is a path that no Christian should be willing to take.

A “Cure” for Type 1 Diabetes is Not One-Size-Fits-All

Today, I treated someone who has type 1 diabetes mellitus. While it’s common for me to see people with diabetes multiple times a day, this consult was unique. Most diabetics I see weigh well over 200 pounds, but this gentleman weighed barely 130 pounds. Being diagnosed at age 14, he knew a great deal about diabetes.

Now in his mid-twenties, he takes insulin shots several times a day and knows how to check his blood sugar. He knows all the right foods to eat, but still his diabetes was poorly controlled because he is what is called a “brittle” diabetic. Brittle diabetics suffer from dramatic blood sugar spikes and drops, often without warning.

He is the perfect candidate for a new and promising research study that will allow the transplantation of insulin-producing cells into the bodies of type 1 diabetics just like him.

But did you know that less than 10% of all diabetics are type 1?

My patient today was in the minority of the diabetics I treat. Almost everyone I treat has type 2 diabetes, which is in many ways a completely different disease. Type 2 diabetes is determined more by lifestyle and eating habits than by insulin-producing cells.

FACT: Our bodies live off of sugar.

Everything we eat is chewed up and swallowed into our stomachs. Our intestines then turn all food, no matter where it came from, into sugar. That sugar goes into our bloodstream and travels to the cells of our organs. This is where the problem arises. The sugar needs to get into the cells but cannot do it on its own. It needs help, and that’s where insulin comes in. Insulin is produced by our bodies and floats around in our blood until it comes upon the sugar. It then grabs hold of the insulin and connects it to insulin receptors that are attached to the walls of the cells, sort of like a key to a door. Once connected, the sugar enters the cells and the sugar is converted to energy.

Make sense?

With type 1 diabetes, there is a problem with the insulin. With type 2 diabetes, problems arise because of a patient’s lifestyle.

The pills that are used to remedy type 2 diabetes work to make the body’s insulin more effective. These pills don’t work with type 1 patients because the person’s insulin is totally broken.

With type 2 diabetes, there is also the issue of the receptor being “sick”. Interestingly enough, it is often possible to improve the health of the receptors by doing those things that we should all be doing anyway, things like exercising and eating more fruits and vegetables. This is why we strongly encourage all type 2 diabetics to join our Wellness center and work with our dietician on ways to eat better and exercise more. As a Certified Medical Fitness Facility, Church Health Center Wellness is equipped to serve the needs of those struggling with chronic diseases like type 2 diabetes.

I truly hope that the high tech “cure” for diabetes happens in the near future, but if it does it will only be for the small number of people who have type 1 diabetes.

For the lion’s share of people with diabetes and all the terrible consequences it can lead to, the best treatment is prevention.

A Lesson In Empathy from a St. Jude Family

“You’ve got to help me, Doc. My sinuses are killing me.”

The person speaking was a big, burly, and gruff man in his early forties. He wasn’t the type of guy you’d expect to go to the doctor for sinus trouble, much less be so insistent on me making him better. There was something about him that didn’t particularly agree with me, and the same was true of his wife who sat in the corner. She told me more than I wanted to know about her husband’s runny nose.

I then looked closer at the chart and realized I was talking to a St. Jude family. St. Jude’s is a research hospital in Memphis that treats children from all over the world with various forms of childhood cancer. This past weekend, runners from all over the world descended on Memphis to run in the annual St. Jude Memphis Marathon in support of the lifesaving work done at the hospital. My friend and colleague Antony Sheehan was one of them.

Antony and his wife Andrea pose for a drive-by photo with Antony's completion medal

Antony and his wife Andrea pose for a drive-by photo with Antony’s completion medal

Often, the children must stay in Memphis for up to two years while being treated, which means the parents are also in Memphis, sometimes unable to work either because they are from another country and do not have a work permit or because their child requires constant attention. In these cases, the Church Health Center takes care of the families of the sick child while they are in town. We don’t charge them for the visit.

I looked up from the clipboard. “So, why is your child at St. Jude?” I asked quietly.

There was a brief pause. Then the wife said, “He has a brain tumor and they just started chemotherapy again yesterday.”

“How long have you been in Memphis?”

“We came 10 months ago and he has been in the hospital almost the whole time.”

I wondered how hard that must be for anyone to endure. Granted, here at the Church Health Center we’re constantly confronted with the difficulties of life. We exist because the world is imperfect.

We’re here for traditionally-underserved patients like Bethany whose mental health struggles haven’t been properly addressed by their healthcare providers in the past. We’re here for patients who have no choice but to leave their native countries in search of a better life. We’re here for patients like Ollie who have been bruised and battered by the currents of life but still give at their own expense.

I’m used to seeing people in pain, but I cannot imagine what it must be like to watch my own child suffer. Listening and empathizing made me more forgiving of my patient’s harried attitude. The rest of their visit was much more congenial and in some unclear way, they no longer had to carry the weight of the world all by themselves.

I believe that we were all put on this Earth to help each other in some way. Sometimes, simply listening and realizing that everyone we encounter is dealing with pain beyond our own experience is enough to make this world a better place.

It is that empathy that makes us more Christ-like.

On Loving Memphis

Last week, I was on a walk while on vacation near San Francisco. It was an extremely pleasant day. Nevertheless, one person after the other walked past me without saying a word. Everyone seemed preoccupied.

Finally, a man got out of a truck and greeted me.

“It’s another beautiful day!” he said. I agreed. Then he added, “It’s why we live here.” He seemed pleased with his statement.

I thought to myself, Really, you chose your home based on the weather?

Maybe that was just something to say to a stranger, but it got me thinking about why we chose to live in Memphis. I doubt it is because of the weather, and there are certainly other places that are more aesthetically beautiful. We don’t have mountains and we don’t have an ocean; we have a big, muddy river.

So why choose Memphis for our home?

Loving Memphis

To start with, I cannot imagine walking down the street here and not being spoken to, stranger or not. People here know that our greatest strength is our connection to each other. When I came to Memphis 30 years ago to start the Church Health Center, I was a stranger, relying completely on the goodwill of those around me to help establish our health ministry. Yet I was embraced and the Center has flourished.

I often say that Memphis has two things in great abundance: poverty and religion. Both, I think, shape the fabric of our city and why I for one chose to call Memphis home. While great poverty is not something to strive for, its presence here makes us all grateful for what we do have. I am privileged to have spent years with people who have little material wealth but who have used their spiritual capital to find peace and strength of character in a complex world.

When asked, “How are you?,” they answer without thinking:

Fine and blessed.

And they are.

As for religion, where else is one of the first questions you are asked, “Where do you go to church?”

Even if your answer is Temple Israel, “church” is just code for how you connect with something greater than yourself. I realize many among us believe they have a unique pathway to God, but I am so glad to live in a place where who I am is not just defined by what I have.

While many will quickly point out that the river, our four seasons, and fishing and hunting and our sports teams make Memphis a desirable home on many levels, I chose to live here because I have found love and a true sense of purpose in this big small town.

If you love Memphis, Memphis will love you.

Are you in New York City? I encourage you to connect with Choose901 this week to learn more about making Memphis home. Click here to learn more. 

How Will You Say “Welcome”?

Give me your tired, your poor, your huddled masses yearning to be free.

These words from Emma Lazarus’s poem “New Colossus” appear on the plaque at the base of the Statue of Liberty. Lazarus’s words have inspired generations of people who have come to America seeking a new life, safety, the opportunity to flourish.

But I have to ask: How do these words jive with the position of the United States on the refugees coming out of Syria and Iraq today?

How Will You Say Welcome

Our government has made clear there will be no increase in our current quota for immigrants. While the US has said it will accept 10,000 Syrians in the next year, that number is part of a total of 75,000 immigrants slated to be accepted for the year—from the entire world. A few years ago, Antony Sheehan, the Church Health Center’s president, had to win a lottery to get a visa to enter the US from the UK, which is not a major source of terrorists the last time I checked.

In contrast, Germany just agreed to admit 500,000 Middle Eastern immigrants this year.

But the number of people fleeing ISIS brutalities is in the millions.

Last summer, the immigrants fleeing war and torture in Central America caught our attention because they were on our southern border. This summer, Syrian refugees have been pouring into Eastern Europe. That’s far enough away that since the refugees are no longer camped out at the Budapest train station, their story is not leading the news. And whatever happened to all of the children who came alone across the Texas border last year?

How can we turn our backs?

In the Gospel of Matthew, after Jesus is born, Mary and Joseph flee at night to Egypt because of their fear of a despotic ruler. As Christians, how do we not see the parallel in our own time? We worship Jesus, but would we turn him away at our borders if he wanted to be a part of our community? This cannot be what the adult Jesus would expect from us.

The #1 message of hope the New Testament offers us is to “Fear not.”

But what could be more fearful than leaving your home and all you know to become a stranger in a strange land—especially when a treacherous journey with your small children seems like the safest option, your best hope of keeping them alive?

It is clear that the followers of Jesus are expected to offer hospitality to strangers. I am betting that at the end of time, we will be judged not on how we responded to the issues we face in our very wealthy society, but on what we did when those who had nothing came knocking at our door.

When that day comes, may we all confidently know that we did all we could to say, “Welcome.”

Until then, keep the image of Mary, Joseph, and Jesus in your mind. How will you welcome them?