Last summer, when my daughter and I met to talk, soon after her ‘graduation’ to heroin use, she wore long sleeves with one arm wrapped in an ace bandage. “I have an abscess”, she announced, almost proudly. “Wanna see it?”, she asked, as if it were a badge of honor. No, I didn’t want to see it. Why would I?
“’We know what to do”, she continued. “We use milk and . . . “ At this point, my microbiology and public health professional background kicked in and I didn’t really listen to what she was saying. My head was reeling and I was silently screaming, “Are you fucking serious”?
Recently, however, as I recalled that conversation, I was curious about junkies’ home remedy for the treatment of abscesses. When I tried to Google a reference to this, I landed on the following article about addicts’ compromised medical treatment in ERs and in medical facilities. I think it’s worth reading. Needless to say, my opinion of and perspective on addicts’ access to and quality of health care has drastically changed. Read the full story about Dr. Neill Flynn and his inspiring work to give drug addicts the medical treatment they need and deserve.
The 30-year-old, 45-foot RV manufactured by a short-lived Southern California company called King’s Highway sometimes smells like it’s overheating. The sun-worn white exterior screams for a paint job; you can tell someone else thought so, because it’s partially sanded down as if in preparation for bodywork. An old cartoon-character dog logo of some sort is still partly visible toward its rear. A water hose runs from a nearby building into the RV to supply the faucets inside, and water leaks through the frame of the RV, leaving a muddy puddle underneath. Inside, the RV is outfitted with two medical-exam rooms–one at the front, behind the driver’s seat, and another toward the rear–and a workstation in between, all with low, mustard-yellow ceilings and faux-wood-paneled walls.
Peter Simpson, who runs the nonprofit Harm Reduction Services (HRS) office down in Oak Park, right there on 40th Street at 12th Avenue, found this thing at a Sacramento County auction a couple of years back. He put all $2,800 on it–everything HRS had in the bank at the time–but worried he’d be outbid, so he called the good Dr. Neil Flynn, who kicked in another grand, winning the RV. Flynn is the man who started this medical clinic–the Joan Viteri Memorial Clinic–that targets Sacramento’s injection-drug users, those people in the community who are high in risk but low in medical-insurance coverage.
During an annual lecture to medical students over at the UC Davis School of Medicine–one of Flynn’s speeches where he talks about how drug addicts are abused in this country and in which he calls them “America’s untermenchen”– a student suggested someone go find those drug users and street workers and deliver medical treatment to them, old-fashioned house-call-style medical outreach.
Flynn, 57, works in the infectious-diseases department of UC Davis’ Medical Center in Sacramento, with AIDS mostly, conducting research and doing drug studies and vaccine trials. For nearly 20 years, he says, he has studied how to bring compassionate medical care to drug addicts. So, this student’s idea fit right in with his philosophy, which is this: Drug-prevention money is doled out backward. Eighty percent of all government funds to combat illegal drug use go toward law enforcement, he says; the remaining 20 percent to medical treatment.
“The paradigm is almost 180 degrees from where it should be,” Flynn said. “Punishing the behavior is almost the antithesis of what there needs to be.”
Doctors need to start viewing drug users as addicts, not as criminals, he says. “We, of all people, should know that addiction is not something people have control over or can be considered self-inflicted,” Flynn said. If doctors can’t get that straight, how can law enforcement and the rest of society be expected to?
But he acknowledges that bias against drug addicts was packed into his medical schooling.
|The abscess has gotten smaller, UC Davis medical student Tina Oliver, left, tells Dr. Neil Flynn, right, describing what she’s learned from her visit with a patient named Denise.
PHOTO BY LARRY DALTON
“I was taught … that these are scumbags–criminals who prey on other people and that they don’t care about anybody but themselves,” said Flynn, 47. However, “when I talked to these people, they were not as we represented them in our practice and teaching.”
In 2000, the first year of the Viteri clinic, volunteer medical students from UC Davis conducted 1,000 patient visits. The clinic closed for two years and reopened in 2003 as one of six school-sponsored volunteer clinics. Neither the students nor the supervising doctor are paid for their work.
For the first time this year, the clinic went mobile, rolling to West Sacramento to reach people there. Next month, the RV will travel to North Highlands. Organizers want to reach those in Del Paso Heights and other areas. Ten to 15 patients are seen at the clinic each Saturday afternoon. Flynn said that with approximately 14,000 daily injection-drug users in Sacramento, there is enough need that the clinic could be busy a second day of the week, or for a second RV in another location.
Reaching more of the often-neglected population could save taxpayers even more money, according to Flynn and HRS. When drug injectors without medical insurance are seen at the county’s taxpayer-funded UC Davis Medical Center emergency room, the hospital eats the cost. Just to break even, the hospital spends $1,000-$1,500 for a routine visit, Flynn estimates. The Viteri clinic can provide the same service for about $200, he said.
In three years of the clinic, Flynn said, “we have seen enough successes that we know we’re on the right path.”
In March 1997, Joan Viteri was a bright, passionate 32-year-old woman. She was happily married and holding down a full-time job. She loved riding horses and displaying her “wonderfully wry” sense of humor, according to her cousin, Rachel Anderson. “She had a heart as big as all outdoors,” Anderson said.
Viteri was also a heroin user. And she developed an abscess.
“She’d been a drug user for years, had abscesses, and been to ERs and been treated like crap,” Anderson said.
Anderson, who works trying to prevent the spread of HIV among Sacramento’s injection-drug users, said emergency-room doctors too often judge them for their behavior and treat them accordingly. The stories make their way throughout drug communities–doctors who don’t want to treat drug users at all; doctors who refuse to use topical anesthetics before cutting into an abscess; doctors who cut liberally, leaving large scars.
“It’s like they’re saying, ‘If this is hard enough, hurts enough, or disgusting enough, maybe you’ll stop doing this to yourself,’” Anderson said. “Or it’s just strictly done as a form of punishment.”
And so Viteri didn’t go to the hospital, even though she knew her wound was bad enough to need treatment. Her husband couldn’t convince her to go, so, four days after Viteri first noticed the abscess, he called Anderson. “I sat with her for hours until I finally got her to go in,” Anderson said. Turns out Viteri had contracted flesh-eating bacteria–necrotizing fasciitis.
She went into surgery to have her arm and a big chunk of her shoulder cut away, said Flynn, who cared for Viteri during her short hospital stay. During a second surgery to remove more bacteria, Viteri died.
“Her body couldn’t take it,” Anderson said. “It’s almost like somebody dying of measles today. It was a preventable death.”
Flynn said Viteri–a productive young woman “well on her way to giving up heroin”–perfectly illustrates what he is fighting against.
Anderson agreed, explaining why she and Flynn thought to name the clinic after Viteri: “I don’t care what your stance on the drug war is. I will argue to the day I die that she did not deserve to die, at age 32, for being a drug user.”