Many Marias – by Gail Gustavson

At a community clinic, healthcare can be a part of more than curing a sore throat or monitoring diabetes. Healthcare can transform someone’s daily life, and in my role as a patient navigator I attempt to guide these changes to their completion. Being in this position does not always mean success, however.

There is a patient who used to come into the clinic weekly to check on the status of her case, until the clinic moved further away from her residence. Now she comes in only once every couple weeks. This patient, let’s call her Maria, is 79 years old and relies on her local Sea Mar CHC for so many aspects of her life. I have come to realize that a case like this can weigh on the case manager heavily. Simply due to her resident status, Maria is ineligible for many services. Simply because she has a roof over her head and is not addicted to drugs or alcohol, or managing chronic diseases, Maria doesn’t qualify for many programs that are specific to individuals with these problems… Though she sleeps on the floor, doesn’t have a cell phone, and supports herself with occasional childcare and a small amount of money from her estranged son. Maria’s case is desperate but not desperate enough. She cannot qualify for anything without insurance or money, neither of which she has. Her support network is Sea Mar, and despite years of slow delivery and sporadic assistance due to the relentless red tape of free programs, Maria still will appear at our door and ask us what we have to tell her today.

Whether we let this push us to action or descend into despair is up to us. This is the struggle of service-based jobs and government-funded programs. That the success of so many good intentions wind up depending on specific criteria of qualifying or not, and often the criteria group individuals with such specificity that there is no room for individuals who ‘almost’ have diabetes or who are ‘almost’ homeless. We must wait until the status changes to diabetic, or homeless, before we can act. As patient navigators, it is so difficult to watch this happen because we know that once the body decides to be diabetic that patient will have to take multiple expensive medications for the rest of their life, even if now these medications will be covered. Or we know that once they are homeless they will be able to live in shelters, but we also know that the stress of not having their own place, and having to move around and live on some charity’s schedule will alter their health in ways we can hardly anticipate.

Maria might have to wait until things get worse before she can get better, and this is a reality of the system. Despite all this disappointment, we at Sea Mar somehow find a way to pull all the connections we have and hopefully one of them comes through and solves a problem that can be essential to solve to keep someone from homelessness or a terminal chronic diagnosis. It is still amazing at the end of the day to look at my successes and remind myself that no matter what happens, I tried really hard to make something happen. And that is more than other clinics can say for themselves, I think.

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