The second day of rural travel took us to Ponce. Nestled on the southern coast of the island, Ponce is the second largest Puerto Rican city. Entrance into the city is marked by a monument spelling P-O-N-C-E, each 20-foot letter proudly guarding the way into town. We met Francisco Rodriguez, Director of Coalición de Coaliciones (see our last post for details), just inside the city and followed him through the town center towards our day’s destination. The streets of Ponce are lined with beautiful homes and storefronts, huddled together next to the narrow avenues. Many of the old facades are vibrantly colored, the Puerto Rican flag painted on the occasional door.
We arrived shortly at an unassuming building on a busy street corner. Inside lay Francisco’s pride and joy – an opioid addiction clinic that serves marginalized members of Ponce’s community. We were promptly introduced to the clinic staff with many hugs, smiles, and handshakes. In tune with the rest of the surrounding city, the clinic was brightly decorated and the walls were adorned with messages spreading motivation and the importance of community. The clinic offers numerous services to its patients, including suboxone prescriptions, group therapy sessions, and social resources such as housing placement and employment options.
Our task for the day was simple: listen and learn. Some of us were fortunate enough to sit down with two of the clinic’s patients to hear their stories. They discussed their struggles with opiate use, their paths to addiction and their motivations for seeking help. The conversations were remarkably similar to ones I’d had at Grady. Each of us on the team were humbled by the level of positivity expressed by these two Puerto Rican men—when asked how life was different before and after the storm, one of the men explained that people seemed to look out for each other more, even amongst the most marginalized members of the community. Other students began to look through some of the data and records that Francisco and his clinic have been meticulously collecting for years. Dr. Haack received an unexpected consult on one of the clinic’s patients who, amongst many other difficult life circumstances, had been living with wrist pain for six months due to a retained piece of glass.
I had a chance today to reflect upon each of the patient encounters that I’ve had over the past two days. As a medical student, all these interactions had a refrain that I am all too familiar with: an overwhelming number of people enter a room to talk to a patient about a sensitive matter and I quickly become conscious of my inability to provide any clinical utility to the situation. When I’d applied to be part of the trip during my first year of school, I dreamt of the rewarding feelings I’d get after helping to perform surgeries in impoverished foreign communities. The feelings I had after these recent patient encounters were far from rewarding. I felt intrusive, even embarrassed by the fact that I had imagined I could help even a single struggling Puerto Rican.
But the more I think about it, the more I am starting to realize why I came here and what we can do to help. As a new third-year medical student, I have three well-refined skills: listening, waiting until the right moment to ask questions, and staying out of the way. While these talents are marginal in a busy academic hospital in the mainland United States, they seem to be the perfect fit for house visits in rural Puerto Rico in the wake of a natural disaster. More than surgical procedures or new prescriptions or advanced imaging, these Americans seem to want to know that their pain and loss has not been forgotten. They have stories to tell. With the strength they derive from their pride and sense of community, they have been able to weather the hurricane and its aftermath thus far. Perhaps the most meaningful way to contribute right now is to present ourselves as fellow members of the American community who want to listen, ask questions, and be unobtrusive. If it takes a room chock full of young adults in blue scrubs to make a family feel that they are heard and cared for, then the value of the trip thus far cannot be overstated.
- Sam Broida, MS3