Introduction
Evidence from various medical research studies indicates that there are a number of barriers which inhibit the African American population from gaining access to medical care. Some of these barriers include lack of health insurance coverage and the lack of knowledge and awareness about health issues. The lack of health insurance is an indicator of poverty and low income levels among the community members. Medical professionals serving in poor communities refer to their practice as poverty medicine, what is poverty medicine, what does it entail, and who are the beneficiaries?
The concept of poverty medicine
According to Downing (2002), the term poverty medicine refers to the medical practice undertaken by doctors in homeless and poverty stricken populations. It is the medical practice carried out by medical practitioners who have a personal calling to provide health care services to the less privileged sections of the population. Downing states that, “poverty medicine was what it was as much because of the patients and their culture as because of whom I was, and what I did. It is their story that I also want to tell, it is they who make poverty medicine unique” (Downing, 2002, p. 5). This perception is supported by many practitioners practicing poverty medicine.
Poverty medicine also refers to the effort made by various medical practitioners to curb the scourge of poverty in the society. It refers to the programs health practitioners initiate in order to combat poverty within the health institutions, and the community at large. Downing (2002) argues that poverty medicine describes the reality of poverty. It helps the individual to understand the origin of poverty and what measures can be taken to tackle or curb the scourge.
It dictates that health practitioners should place aside their political interests while attending to patients (Downing, 2002). Poverty medicine also refers to the campaign of eradicating poverty and the provision of quality health care to poor communities. Downing (2002) recalls one such advocacy plan that failed to address the issue of poverty but rather turned political. The demonstration called at the hospital was ill advised.
The demonstration was triggered by a summons, which the employees received for allegedly absenting themselves from their work stations. There were allegations that they forcefully entered the administrator’s office. The matter was referred to a court of law; however, the practitioners won the case. The practitioners were protesting because of the budget cuts imposed on the health institution by the state.
These budget cuts had an adverse effect on the health care services provided to the poor communities. The hospital administrator was also against the budget cuts, but the decision could only be reversed by the city leadership. However, the demonstration was against the hospital’s administrator who had nothing to do with the budget cuts imposed by the city. This demonstration was far from the actual political issues that led to poverty or poor health.
Essentially, medical services play a huge role in the alleviation of poverty through providing assistance through health care, but they have done so little to eradicate poverty. Downing (2002) argues that this demonstration illustrated the huge gap between private and political medicine. In the struggle to alleviate and prevent poverty, priorities are blurred by politics. Political arguments cannot solve or prevent cases of poverty.
There is the need to separate political and personal medicine so as to tackle the challenges that come with poverty medicine (Downing, 2002). Downing (2002) holds that in his efforts to prevent the causes of poverty, he encountered various challenges that have derailed his efforts. He argues “poverty medicine forces us to come to grips with poverty, to settle in our minds where it comes from, to do something about it” (Downing, 2002, p. 12). Practitioners are forced to decipher the primary causes of poverty and make decisions on how best to tackle the issue.
This practice is people oriented, and politics should be avoided while discharging one’s duties. However, politics cannot be placed aside from poverty and other related issues. For instance, a patient may lack the sufficient financial resources to get access to health care services. As a result of poverty, the individual may develop adverse habits such as drug abuse, which reinforces the poverty conditions.
The individual may be persistently sick due to his physical environmental conditions. Some individuals suffer because they do not have access to preventive medical services. Occasionally, the patient may possess a different perception about the world as compared to the physician. Downing (2002) believes that it is normal for practitioners practicing poverty medicine to engage in demonstrations.
They also engage in other community and development projects. On several occasions, individuals practicing poverty medicine have ventured into politics or joined liberation movements. However, regardless of the numerous challenges encountered in poverty medicine, beneficiaries of these services appreciate the efforts of the practitioners (Downing, 2002). Occasionally, practitioners are given gifts either by the patient or the patient’s kin.
Before the death of Albert, Dr. Downing was responsible for his care. After he had passed away, his wife brought his husbands most treasured object as a gift to the doctor, as a sign of appreciation for the effort he made trying to save her husband’s life. However, Dr. Downing was skeptical about accepting the gift from the lady. He felt guilty because of the death of Albert.
Albert’s death was as a result of the doctor’s negligence. Had the instructions been written in the patient’s file, and clearly indicated that the medication was to be administered in the morning, then the patient would not have died as a result of an overdose. By forgetting to indicate that the medication should begin in the morning, the treatment was administered immediately which killed the patient (Downing, 2002). Downing was very emotional about this case which led him to reject the gift of the pocket knife.
To Albert’s wife, the gift was a sign of gratitude; she was poor and had just lost her husband who probably was the only bread winner. To the doctor, it was not ethical to consider taking the gift since he felt responsible for the patient’s death. This is because the doctor’s mistake led to the death of the patient. Downing (2002) holds that it was easier to admit his mistake rather than accept the gift.
However, Downing argues that the real gift was not the pocket knife. The gift was how Albert’s wife conducted herself according to their cultural customs while the doctor responded according in his own culture. According to Downing (2002), the best gift is the complementing cultures and their appearance. This brings us to the next perspective, who owns poverty medicine?
Poverty medicine belongs to the community. As much as the practitioners continued to engage in fighting and wrangles of who is best suited to run the health facility, sick patients continued to stream into the hospital. The issue of absenteeism could no longer be sustained. As the health facility grew, it continued to experience more financial challenges.
It was definite that the clinic could not survive without external help. When the clinic needed funding they applied for a grant from the government; however, the grant also came with certain regulations that had to be adhered to in order to enjoy the benefits of the grant. The population served by the clinic was poor and could not afford medical services. As a result, the clinic was unable to finance its operation (Downing, 2002).
Hill, Granado, Opusunju, Peters & Ross (2011), claim that the population served by poverty medicine is predominantly composed of African Americans. This community is generally poor and do not have access to health care services. Poor communities usually do not have any control over the forces which cause disease or encourage good health. They are aware from experience that their chances of transforming their environment are basically slim.
It has been reported that patients who lack medical insurance are more predisposed to postpone medical care compared to those who are insured. As a practitioner, it is essential to have knowledge about the cultural background and socioeconomic status of patients. After a while some of the volunteers came to know the natives better, some of them had various reactions. For example, some of them suggested that they were amazed by the dedication of Idabel, and the remarkable loyalty that she had towards her family.
Some nurses got to acquaint themselves better with the local people. Some of the remarkable things that they recollect having done were offering themselves as gifts. In societies hard hit by poverty, the norm is to ask any new visitors what they have brought as a gift to the community. Most of the volunteers responded by saying they had brought themselves as gifts (Downing, 2002).
The community was used to associating visitors with the gifts they gave to the people. Consequently with time, the perception of associating visitors with gifts slowly faded. Downing (2002) remembers an instance when a young child confessed of not having a single friend at school; she later went ahead to say that he was the only friend she had. He also assisted by helping a young girl to open a bank account with a local bank.
Additionally, after some years the influence had grown and another young lady had also opened a bank account in a local bank. For Downing, this is the best influence or gift that he could have offered to the community. Some of the lessons learnt are that all individuals have their own standards, which are different in relation to their preferences. He also learned that love can prosper amidst clutter (Downing, 2002).
However, the conduct and practice of practitioners are guided by the ANA code of ethics. There are several provisions of the ANA code of ethics which are applicable to this case study. The first provision states that “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems” (American Nurses Association, 2011, par. 1). Nurses in all professional engagements should conduct themselves with compassion and admiration in relation to the intrinsic dignity and individuality of each human being.
They should not be limited by any considerations with regard to the socioeconomic standing, personal traits, or nature of the medical conditions the patient might be suffering from at the moment. This provision exemplifies the work carried out by Dr. Downing in providing medical care to communities hit by poverty. When Albert passed on, Downing was very emotional and blamed himself for the death of the patient. This shows that he was discharging his duties with compassion and respected the dignity of the patient (American Nurses Association, 2011).
The second and third provisions of the ethics code are also applicable in this case. They state that a nurse’s obligation is towards the patient. The nurse is also required to advocate and protect the interest of the patient. The safety of the patient in a nurse’s care is also entrusted to the nurse. In this case, the demonstration against the financial cuts imposed on the hospital illustrates the determination of practitioners to campaign for the rights of the disadvantaged in society (American Nurses Association, 2011).
The biggest challenge to medical practitioners is the culture of the communities in which they practice. It is evident that most practitioners who practice poverty medicine usually come from different cultures, other than that of the native community. Power squabbles have been witnessed in the practice of poverty medicine. Downing (2002) argues that the disadvantaged and the poor in society do not have access to power.
However, when they are allowed access to power, they will usually fight over it, or they will divide it equally amongst themselves just like a bag of rice in a refugee camp. However, it might also be a breach of the cultural norms (Downing, 2002). Downing claims, “we who practice it are often from a culture different from that of the poor we are trying to serve” (Downing, 2002, p. 47). There is a significant cultural gap between the European and third world cultures.
The government should tackle the challenges brought forward by injustice and inequality. However, governments have a problem in addressing issues of poverty that arise out of injustice and inequity. Various programs have been established to guide poverty medicine. However, most of them have been overwhelmed by government bureaucracy (Downing, 2002).
Use of technology is one of the strategies employed to bridge the gap between the West and developing nations. Some medical technology students hold that the excessive use of technology in treating patients may at times inhibit the patient’s capacity to cope with the disease. There are occasions in which technology is administered without any regard of the patient’s financial status and the effect it has on the family. This feature mostly manifested itself in Africa.
When technology is used to a large extent, the dependence on the family structures of coping with the disease is broken. This is relatively true for both financially stable and financially challenged families. However, individual, family, and cultural strength is observed in situations where minimal technology is used. Downing (2002) suggests that these particular strengths were found in the African continent.
Regardless of the good intentions of poverty medicine, its biggest obstacle has been the government bureaucracy. Poverty medicine started as a good cause to help the needy in society get access to reliable and quality health care. However, it has experienced a lot of challenges in its practice. Most governments initiate programs and policies aimed at providing quality health care for the poor, but these initiatives have been hampered by the bureaucracies of government.
Poverty medicine also lacks adequate funding, and since they provide services to the poor in society who cannot afford medical services; they are unable to sustain their operations.
Conclusion
Medical professionals serving in poor communities refer to their practice as poverty medicine, what is poverty medicine, what does it entail, and who are the beneficiaries? The central objective of poverty medicine is to provide reliable and quality medical care to the poor and vulnerable communities. Poverty medicine was established to assist low income and poor members of communities to get access to health care, but has been overwhelmed by cultural barriers, politics, and government bureaucracies. For nurses and other practitioners to be successful in poverty medicine, they need to assess and find solutions to the barriers affecting the practice.
References
American Nurses Association. (2011). Code of Ethics.
Downing, R. (2002). The wedding goes on without us: Including Bury me naked. Nairobi, Kenya: Jacaranda Designs.
Hill, M., Granado, M., Opusunju, J., Peters, R., & Ross, M. (2011). The impact of income, public assistance and homelessness on seeking medical care. American Journal of Health Studies. 26(3): 174-181.