Who Will Keep Watch Over The Flock?

by Bill Holmes

Several years ago I met Sally Jane as she walked into clinic pushing her severely impaired granddaughter in a wheelchair. Sally Jane had become Melissa’s caregiver when her mother abandoned her, no longer able to cope with the daily behavior problems and seizures. Sally Jane had only an 8th grade education, lived in a mobile home and had no health insurance. Having received plenty of well meaning advice about how to “fix” her granddaughter, Sally Jane carried a bag of herbs and vitamins a friend had helped her purchase on the Internet. She had also heard about a place in Florida treating children like Melissa with hyperbaric oxygen. It was not an approved treatment for her condition, but this did not phase her.

Medicaid covered her granddaughter’s medical expenses, but Sally Jane struggled to find adequate medical care for herself. Respite care for Melissa was scarce. Even the best efforts of the social worker could not overcome the enormity of the problems of poverty or the lack of education, income and health insurance. Under intolerable stress, Sally Jane’s health deteriorated culminating in her untimely death at 55.

According to Luke’s gospel, the story of Jesus’ birth was announced to poor shepherds keeping watch over their flock. A shepherd otherwise engaged, risks the life or health of her sheep. Similarly, we are called to be aware of what is happening outside the walls of the church, the clinic and the hospital because that is where sheep are often found. But how can health care professionals and the church make a unique contribution? What can or should we do beyond the care we provide professionally? We can be comforting shepherds to the Sally Jane’s of our community.

First, be an educator! Guidance is needed as your faith community members and patients face changes in healthcare delivery, often reimbursement driven. Formularies will change or be reduced. In addition, a plethora of claims for the effectiveness of this or that treatment greets them on the Internet. Websites look very official but few are peer-reviewed. As a rule of thumb, as advertisements on a website go up, trustworthiness goes down. Medical school and hospital websites are usually more reliable.

Be an advocate for the poor and middle income. Income and education level have been factors in health outcomes throughout history. Life expectancy is significantly longer (6.5 years) for men and women in the highest income brackets. What often goes unappreciated is that even those with an income at 300-399 percent of the federal poverty level have worse health outcomes than those with 400 percent or greater. It is not just the very poor who are having bad health outcomes, but also those in the large and ever growing middle class.

Be an advocate for education for low and middle-income children. Keep in mind that the way to better income is tied heavily to education. Public health literature documents great health disparities at various levels of education. The lack of a high school diploma or equivalent is associated with being three times more likely to die before age 65 than a college graduate.

Schools need volunteers to help in reading tutoring. Several years ago the Reading Is Fundamental program was cut from the federal budget. This program provided free books for children to take home as their own. Ever see a child get excited over owning her own copy of a Junie B. Jones book? Reading is foundational for success in school and in the job market, both of which will more likely mean “health care coverage.”

Be an advocate for minorities and immigrants. Minority status is statistically associated with lower levels of education, income, health care access and outcomes. There is no simple one-to-one correlation. Employment, wealth, neighborhood characteristics and social policies, as well as culture, health beliefs and country of origin all come into play. The church is called to a ministry of hospitality and of welcoming the stranger.

The task we are given is not easy, but we can make a difference. It will take a team of shepherds.

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