hope.

Kampala, Uganda. The government run, nations’ largest hospital, is always full. I wasn’t allowed into some of the surgical areas, they were off limits for foreign tourists per the hospital administration, who were fearful of bad international publicity for their substandard conditions. But the hallways and cement wards were overwhelming enough.  I was greeted by smelly, bleeding bodies stacked shoulder to shoulder up the stairs to the main entryway. A giant multi-tiered cement warehouse, housing sick flesh. Every open space was filled with a body, each carrying their own disease or the their own pain-filled malady. A bed itself was a luxury. Women birthed babies on the floor in rows with shoulders touching in a small dark cement room.  Patients post surgery lay on cold floors bleeding into their dressings with limited to no pain medications. The lucky ones had family present to actually bring them water and food, not supplied by the hospital, not to mention, buy them medicines from the pharmacy, also not provided by the hospital. Physicians would order medications, and families would have to go out and buy them in order for them to be administered. Bodies filled hallway floors leading to more rooms with bodies lining walls, with infection jumping freely from one debilitated soul to the next. One room for the hospital rinsed catheters to be re-used over and over again. Another room washed metal bowls used as toilets for the bed-bound (or floor-bound in most cases here). Nurses were few and far between, rushing from one critical patient to another. Here it was better to be acutely ill and on deaths’ doorstep, for only then did one get care. Poverty to this degree is heart-wrenching and paralyzing to someone who would want to help or contribute. Exposure to this extreme environment has left me deeply grateful for simple luxuries: fresh clean water, a bed, a toilet.  I wear gratitude like a thick pair of glasses now days, always seeing the world through the lens of grateful awareness.  Awareness of how blessed and privileged we are to have a safe place to go to when we are sick and in need.

            But we have poverty of our own.  Our destitution is not as glaringly obvious, but every bit as demoralizing. Every day I meet patients who are buried under mounds of medical debt, dependant on the government to reimburse the hospital for the expenses they incurred. Patients I treat daily who may not know where their next meal is coming from or how they will afford medications.  I treated a patient last week who had not been seen by a primary physician in 7 years because he did not have insurance. He spent two weeks with us, seriously ill with multiple organ dysfunction, body crippled from years of neglect. I regularly discharge patients I know will see again soon, simply because I know they will not be able to afford to stay on the medications needed to keep them alive.  Patients who wait until their illness becomes life-threatening to come in for treatment, because they fear the astronomical bills that will continue to pile up. Bodies filled up with unhealthy foods, over-worked and under-rested, stress-dominated life-styles. Cycles of life-style decisions feeding rampant epidemics of diseases, coronary artery disease, diabetes, peripheral vascular disease, chronic obstructive pulmonary disease; all products of poverty driven decisions.  Poverty of pocket and of heart. People smoke because they are stressed. People are stressed because they are either working too much or not enough. Smoking leads to multiple diseases I treat every day. But I cannot say if I lived through the some of the same situations that many of my patients do, I might not smoke to cope too. I treated a patient last week who dealt with a chronic lung disease attributed most often to long-term smoking. She also struggled with chronic pain and anxiety that she took piles of medications to control.   She had gone through an abusive marriage, terrible divorce that left her bankrupt, and was currently living with family who were verbally abusive and neglectful.  She had no money, no where to go, and was stuck in an unhealthy living situation, all the while crippled by disease. Mid-sixties, she just felt like she would be better off dead. Poverty at its worst: a heart without hope.

            I hate dealing with the money and budget side of healthcare. But it cannot be avoided. I work for a not-for-profit organization, with roots dating back to nuns who served alongside Florence Nightingale, committed to helping the poor and underserved. We treat everyone. Our doors are open to the lost and broken, the uninsured and homeless, the neglected and marginalized. But money still worms its way into our conversations and attitudes. And I wrestle every day in the tension. The tension of conserving resources and saving money and being a responsible steward, and seeing stories of people in need and wanting to give with abandon knowing there will never be enough to go around. For nurses at the bedside the tension comes with numbers, numbers of bodies in beds. Our tension is birthed when bodies become numbers. When faces and stories become bills and minutes on a clock. Quick to the next and the next, assess and treat and get them out the door, there are more waiting. The faster the better, we start to feel more like factory workers producing products on a line than healers caring for human hearts and bodies. Confronted with vast need, I see my own poverty, my own nakedness. All the passion and energy and smiles in the world, will never be enough to fix it all.

I need hope. Hope that the bodies I touch feel valued, even in the rush. Hope that my limited resources poured into an ocean of need actually make a difference. Hope that a smile, a touch, an extra minute given that I can barely spare, can comfort, can spark healing. Hope that the desperate prayers I shoot up in crisis are heard. And answered. By the Author of life. By the Giver of all hope. 

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