I would sit at my desk in the corner of the clinic to review lab reports at the end of a long day of seeing patients. At the beginning of my career it was a stack of paper sealed in big yellow envelopes, delivered by lab messengers. Usually they were young students, pushing loaded wire carts from clinic to clinic. At the end, it was on the computer, using our electronic medical record system. Push a button and enter passwords. Midwives were expected to see 22 patients during a clinic day. I used my break time and lunch to catch up on seeing patients because it often took more than the allotted time to address issues and concerns. Although a clinic day was scheduled and paid as 8-hours, they often lasted much longer.
In addition to prenatal care our schedules were filled with annual exams, diagnosing causes of pelvic pain, painful urination, vaginal discharge and more. Routine initial prenatal labs included a VDRL (syphilis blood test) and Gonorrhea /Chlamydia cultures. Diagnosis of gynecological symptoms often entailed testing for sexually transmitted disease (STD). Anytime I spotted a positive test result, I would sigh and put my head in my hands. I hate when that happens. It likely meant I would be late for dinner again. Positive results require a phone call to the patient to explain the infection, prescribe treatment and describe follow up. One never knows what the response will be when you tell someone they have a STD. Most have questions, some cry, others are nonchalant. Been there, done that. Sometimes I was perceived as the bad guy by revealing some secret or truth in a relationship. Sometimes phone numbers were bogus or disconnected. Sometimes the person answering hung up on me as soon as I identified myself.
I often felt myself to be on the front lines of a battle ... I wonder if budgetary decisions would be different if others could see and hear what I have seen and heard.
In Wayne County, where Detroit and Dearborn are located, chlamydia rates are highest in the state and nearly double the country’s average. At the National STD Prevention Conference held in Washington in August of 2018, the Center for Disease Control (CDC) reported 2.3 million US cases of syphilis, gonorrhea and chlamydia. Rates have climbed for at least 4 consecutive years. There is no reason to believe the trend won’t continue. As rates climb, scientists also detect emerging resistance to antibiotics used to treat these infections. As the STD epidemic looms, CDC resources for programs focusing on prevention, detection and treatment continue to be cut. It is a perfect storm for public health disaster and particularly devastating among the poor and young. My young colleagues will continue to have plenty of late night clinic phone calls counseling infected women.
Those in a position to cut funding for sexual health programs, or any health care program for that matter, are generally not personally affected by those cuts. I often felt myself to be on the front lines of a battle, seeing the carnage of the enemy, the wounded struggling on the battlefield. I wonder if budgetary decisions would be different if others could see and hear what I have seen and heard.
Perhaps some believe that the poor and sick deserve their struggles. Bad decisions come with consequences. The actions of others, at first glance, seem easy to judge as right, wrong, good or bad, but it is never quite that simple. This Call the Midwife episode suggests we look at each other with fresh eyes. My position as a nurse-midwife in the Detroit area required me to do that. We are all results of both circumstance and decisions made by others and ourselves. Whether you’ve married a sex addict or your grandmother is a back alley abortionist, the questionable behaviors occur within a larger context. At what point does society have to take responsibility?
To continue the battle analogy: that is the war that rages within our country today. Who will control the borders between personal and governmental culpability? In the clinics, making late night phone calls, midwives and other health care providers are merely medics on the battlefield. We patch with antibiotics, those we find wounded. We may be late for dinner but the wounded must continue to battle their poverty, lack of opportunity, difficult circumstances and bad decisions.