This Is Public Health
This is a picture of a lab within a free clinic. More specifically, a mini fridge inside a lab. This small lab offers free testing and bloodwork among many other services, for patients with little to no income, and/or those who are uninsured (this includes undocumented populations, and those whose criminal record makes them ineligible from receiving anything other than emergency care). This little fridge may seem small and unassuming, but it contains vaccines that we get for free from various drug companies, for patients at a high risk for developing the diseases these vaccines fight against. Most of the vaccines inside are for Hep A and B, but many patients also work manual labor or construction jobs so there are also frequently TDAP vaccines and tetanus boosters on hand.
We started this clinic last year and I have unintentionally learned a lot about addiction and recovery. The majority of our enrolled patient population consists of former drug users, many of whom are in recovery programs, have surrendered their lives to Jesus and are deeply committed to accountability and sobriety.
Sadly, this still doesn’t mean they are given second chances by the government to receive benefits or healthcare. Most of us know nothing about fighting the demon that is addiction, let alone staying sober in the midst of suffering from significant illnesses or injuries. Our team considers it a privilege to walk alongside this particular patient population especially, and we began to try and think big picture about their life journey, the plans of restoration that we believe Jesus intends for them, and also about the burden of disease in here in Ybor City.
In the five years that I’ve lived in Ybor, I’ve learned that Florida Avenue is notorious for the buying and selling of illicit drugs, most famously heroin. And on the other side of the interstate, along Nebraska Avenue you can find the robust underworld of prostitution that most don’t even know exists. Maybe you’ve driven by, but haven’t recognized what’s going on just outside your car window, or maybe you’ve wondered about the pay-by-the-hour motels that litter Nebraska, the ones that seem empty during the day, crowded at night and somehow never seem to go out of business. It doesn’t look like what you see in the movies, there’s no glamour or high priced escorts here. What you’ll find in its place is addiction. Addiction drives both men and women to sell themselves in exchange for drugs or money. Addiction is the pimp that holds people hostage. And addiction is what has broken relationships, in many cases leaving people destitute and relationally impoverished.
There are many factors that contribute to the prevalence of addiction here. Tampa is known to some as a place for “sex tourism” in a way that is not that different from red light districts in Europe and Asia. The demand for sex is a global problem that affects our beloved city. This industry has a sort of trickle down effect on the poor here, where addiction and prostitution (trading sex for reimbursement of any kind) go hand in hand. Individuals are arrested on the street all the time for prostitution, but this doesn’t touch the drug problem that drove them to such practices in the first place, let alone the local burden of infectious diseases and STI’s. Many never make it to a recovery program and addiction in turn has been criminalized. It’s rarely treated as a disease or as a something that could affect people on the cellular level, genetically predisposing them to use and form an addiction. Few people ever consider why addicts use, and what physical, mental, emotional or spiritual pain drove them to such a place. There are so many other factors like the social stigma addicts experience, the criminal record acquired from such a lifestyle that makes it nearly impossible to get a good job to support yourself, let alone a family, or the mental handicap that some addicts experience from years of abusing harmful drugs. The odds are quite literally stacked against them and there are few lifelines out.
Part of the practice of the free clinic is to vaccinate patients, so that if they ever engage in high risk behavior again, they are at least inoculated against Hepatitis A & B. We never want to discourage patients or assume that relapse is just around the corner, but through vaccinating, we want to give them confidence along their journey. Because of these vaccinations, they know if relapse happens, all is not lost. Maybe through our efforts they will avoid contracting Hepatitis A and B, and also avoid what could potentially be a complex coinfection with a different genotype strain of their same disease or with other life threatening viruses like Hep C and HIV. Maybe this gives them the freedom to reconcile with their spouse who may be Hepatitis positive, or who may also be an addict in recovery with the equal risk of relapsing, contracting and spreading an infectious disease. This mini fridge, and the vaccines within it, offer a form of protection, and is one factor helping to reconcile spouses and bring families back together. Our humble clinic wants to help break the cycle of addiction by pointing our patients to Jesus, reminding them of the promises he has made to them, by coming alongside the communities that are reaching them, and by offering medical services to this population.
Still, relapse is bound happen, it’s never less than heartbreaking, but I find some comfort in the bigger picture. We send patients back out into the world in a way that prevents the further spread of these diseases. We vaccinate to interrupt all the factors over the course of their lives that send patients and those they come in contact with, however they come into contact, hurtling towards disease. Because of these vaccines, I am hopeful. One day the patients who relapse will return, and then we will be able to see some of the fruits of our labor. And when we try and help patients put the puzzle pieces of their lives back together, we will have a few less diseases to treat. Maybe they get back on their feet more quickly than they did before, because this time they had help beating the odds and breaking the cycle.