November 12, 2021

During my time at clinical I encountered a large variety of patients, one in particular stuck with me. I think why this patient stuck with me was because of the uniqueness of their case, it was like nothing I have ever seen before. This individual was brought into the emergency department when found on the streets unconscious. Once stable the patient was transferred to the medical surgical unit where we met. I think what stood out most to me most was the overall condition that I met the patient in, they were dirty, non-verbal, having intermitted seizures, their lower extremities where not receiving sufficient blood flow and where, for lack of a better word, rotting, and the patient had open wounds on the lower extremities filled with maggots. I remember asking my nurse “what happened?” and she then told me that they were homeless. I had never provided care for a homeless patient before. With the total homeless population in all of Maine being around 2,097 individuals out of the 1.37 million residents of Maine, we do not see much of this population in the health care systems. 

I think the reason for this relates back to the some of the fundamentals of community/ public health. Specifically looking at the social determinates and health disparities, and the social gradient in health and health inequality. This particular individual had many social health determinates that could impact their overall health and ability to access health care. This individual was uneducated, unemployed, and with no source of income. This patient fell into the lower socio-economic class, suffered with food insecurity, so much that you could see this individual’s entire rib cage, they had no health insurances, and struggled with substance use. All of these factors put this person more at risk for health-related issues. However, all of these factors can be considered common amongst this population. This can ultimately impact the individual’s ability to access health care, related to the ability to get to health care due to no source of transportation, a lack of resource or knowledge on how to get resources, or the ability to afford health care, to name a few. Fortunately, for this individual, someone found them and was kind enough to call for EMS.  

I remember being bothered and still am bothered by the care that this particular patient received. It felt like some of the health care workers seemed to care less because of the patient’s background. For example, in order to get a better view of the patient’s airway and oral area the health care providers shaved the patients extremely long bread off quickly, leaving it all different lengths and unkempt. I felt as though had this been any other patient, perhaps a patient with family coming to visit this would have been considered unacceptable. I was also taken back by how this patient has seizures and could not speak, nothing wrong with this patient hearing, and how the health care workers talk about the patient in a derogatory manner right in the room while providing care for the patient. To me it seems like these individuals seemed to get swept under the rug when it comes to health care. I was left feeling disappointed, I felt like the health care provider could have done better. I think that I could have done a better job of advocating for my patient, and I think that the health care system as a whole could have done a better job of caring for this particular patient, and this population. I think that policy makers have done a nice job of ensuring that nobody is refused care, however I think that they could better enforce equal care of all patients admitted into their care. I also think that more could have been done during the discharge process to help this patient, such as providing a shower, a new set of clothes, a snack, or some basic medical supplies to further care for their wounds knowing that they were going back to the streets where their condition is likely to worsen. 

Overall, I think that as a society we are doing a better job or recognizing problems related to health disparity and injustice, however I still think we have a long way to go to correct the problem. I think that we could help by spreading awareness and education about this topic to health care providers down to the lowest level, including nurses, nursing assistance, and technicians. I also think that educating our communities and providing more resources to the lowest socio-economic class may be beneficial. I just know that as a nurse I want to make sure that I care for all of my patients equally and with the highest level of respect no matter their background or class. I think that by even me just doing that I can make a difference and that will in turn help fight the larger problem at hand. 

References

Maine Homelessness Statistics. (n.d.). Retrieved from https://www.usich.gov/homelessness

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Maine Population. (n.d.). Retrieved from https://www.populationu.com/us/maine-population