Multiply Maggie Walker’s case a hundredfold, and you get an inkling of Hilfiker’s tragically frustrating job. Technically a family practitioner, he more aptly describes his profession as “poverty medicine,” which he likens to “the medicine practiced in the Third World.” It is a profession characterized by shortages; there is never enough money or time to do a proper job of doctoring. There is one surplus: “It’s a specialty with an enormous population of patients in America, yet virtually no practitioners.” _B_Not All of Us Are Saints b(259 pages. Hill and Wang. $20) is Hilfiker’s account of how in 1983 he left his medical practice in rural Minnesota and moved with his wife and three children to inner-city Washington to work with the poor. In 1985 the Hilfiker family began living with the poor, too: they moved into the top floor of Christ House, a medical recovery shelter for homeless men.
Hilfiker is no armchair theorist, but he is an idealist. While a decade on the front lines of poverty medicine has left him a little less naive, he remains convinced that “we who had grown up with education and opportunities had not so much deserved our affluence as inherited it and that the poor were – by virtue of their oppression – “deserving’.” The problem of providing adequate health care lies not with the poor, he insists, but with those who pretend to provide for them. According to a 1985 study of homeless-shelter residents, he writes, Washington’s 3,100 psychiatrists volunteered a total of 17 hours to the city’s homeless mentally ill.
This is far from the first book to catalog the many ways in which the medical system does not work, but Hilfiker’s war stories bring the issue painfully to life. When he reports a case of child abuse to the physical-abuse unit of the local police, one of their excuses for doing nothing is that this is the first report of abuse in this family. But the family has been reported three times for sexual abuse, Hilfiker points out. “Their response is difficult for me to believe,” he writes. “Sexual abuse is reported to the sexual abuse team and is not their area.” Then there is the emergency-room doctor who treats a homeless man for frostbite late one winter night, and then sends him to a shelter – long after the shelters had filled all their beds. Had not a compassionate shelter worker arranged for the man to be transferred to Hilfiker’s facility, “the man would have had to spend another night in below-freezing weather on the street.” Considering his condition, he might well have died.
Hilfiker is blunt: “The public hospitals provide to the poor a level of treatment the rest of us would find absolutely unacceptable.” One of his keenest observations is that the medical establishment chronically fails to take into account the living conditions of the poor. Prescriptions for home health care, for instance, amount to a cruel joke when the patients have no homes.
As hard as he is on bureaucrats, Hilfiker is even harder on himself. “Once we can say it’s someone else’s fault,” he notes, “we can pretend it’s someone else’s problem, too.” Unfortunately, it’s in the numerous passages of self-criticism that the good doctor is least appealing. After the umpteenth episode of solipsistic nitpicking, readers may wish for just a little less about this sober sawbones’ guilty conscience.
But to ask Hilfiker to lighten up or stop navel-gazing is to ask him to be someone he’s not – and to miss the point of his book. He may be a bit of a bore on the subject of himself, and he may fall a little shy of being Mother Teresa. That does not detract a whit from the fact that he is a good man with his idealism still intact, bearing witness to a world of unimaginable hurt and doing what he can to cure it. At a time when 60 percent of Americans between the ages of 25 and 44 say they have no heroes, we can’t afford to be picky when the real thing comes along.
