I first met Paige in December when she came to the Birmingham Free Clinic, a clinic that provides free primary care, specialty services, medications, and social service navigation to individuals that are uninsured or underinsured. Paige had recently moved back to Pittsburgh after being traumatically displaced from her home in South Carolina. After running out of her medications for depression and anxiety she found Birmingham in a Google search and came to one of our walk-in clinics. There she experienced Birmingham at its best. When she (an uninsured patient) walked out of clinic that day she had not only seen a doctor, a pharmacist and received the medications she needed, all for free, but she also had been referred to our other specialty services: dental, vision, psychiatry, and rheumatology, in addition to walking out with a food box from the local food bank. She also received an appointment scheduled with our social work team who would help her apply for Pennsylvania benefits and address the social factors that were affecting her mental and physical health. She had experienced the power of integrated care.
Today, I asked Paige what barriers she felt society has placed in her way to achieving good health: “You’re trying to work and do the right thing, but you still can’t eat. Like right now I don’t qualify for SNAP because I make too much money, but it’s like I can’t even afford an apartment right now. You guys give me boxes of food, because I can’t… I want to eat. I’ve never had any luck really with getting any housing or SNAP from the government…. I make $13/hour (above minimum wage) so that works out to be about $1600/month if I’m working 40 hours. I can’t live on that… if you have a car so you’re paying maintenance on a car, maybe a car payment, insurance, wear and tear, gas and then there’s an apartment, there’s rent, there’s deposits, there’s electricity, there’s water, there’s gas, and then there’s food on top of that.” Notice that she didn’t even mention the cost of healthcare or health insurance. She reiterates that without benefits from a job, healthcare and health insurance are just too expensive. Without places like Birmingham these needs would go completely unmet.
I asked her how Birmingham has helped her: “What else do we really have? Who do we have to count on? People like you that are donating their time to help people like me who don’t have resources. Just knowing that someone is here to help makes a world of difference. And every time I came in here, as sad and crying and as upset as I was, when I left I felt better, whether it was just you giving me a box of food or ‘hey Paige it’s gonna be okay’ or talking to the doctors and the students and everything, just that alone makes a world of difference. Like I’m totally different now. Thank god you guys are here.”
She mentioned that recently through her experience with detox and psychiatry and her own self-exploration she’s learned that a lot of time the range of emotions that she feels all project as anger. To me I’ve perceived her as such a resilient and optimistic person and asked how she maintains that through all of the challenges: “It’s do or die…and times are tough and times can be tougher and times can be better. I’m the person that wants to be happy and I want to make someone smile. You see someone that’s so miserable, I’ll crack a joke just to make them smile for that second. Or just ‘hey how you doing?’ It’s about loving everything and loving everybody… I’ve lost a brother and a sister and they have kids that are still here so I try to be strong for them. It’s hard and if I didn’t have this place I’m not sure I’d be resilient. I’m not sure I’d be okay”.
To me, Paige is a reminder of many things: that the barriers to good health that individuals face are real and damaging and constantly reinforced by society and those in power, that organizations like Birmingham, and the rest of the NHC host sites, although they are underfunded and understaffed, can provide people with small but effective ways to overcome these barriers, and that resilience, kindness, and optimism, although they may be at times hard to find, are what we need most. Each patient I see at Birmingham has a different story that deserves to be heard and they are constant reminders of these lessons.
*The patient’s name has been changed for confidentiality. She decided that she would like to be referred to as “Paige” in this piece.