Medicine from the heart . . . Bency Louidor-Paulynice

On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.

As a follow-up on the residents’ community health months, first-year residents at Hahnemann Family Health Center were asked to reflect upon their community health experience. Their theme was homelessness. Clearly, Bency Louidor-Paulynice, MD, has learned the power of having a home and why we all need to be more vigilant to inquire about this most basic necessity.—Hugh Silk, MD

 What it Means to Not Have a Home
At the beginning of our community health project, we embarked on a mission to understand the effects of homelessness in the community and learn about the resources available to that population. We visited different organizations that provide services to the different homeless subgroups, such as families, children, individuals with substance abuse and mental illness, victims of domestic violence and immigrants. I was amazed by the different structures that exist to help the homeless population. These organizations are driven and determined to improve the lives of the less fortunate as if it were a calling and not simply a way to earn a paycheck.

I have come to realize during the past two weeks that someone without a home loses his or her identity. Having a home means that one has a place to take refuge, a place that brings joy, a place to raise a family, a place to prepare and share a meal, a place where you are accepted and welcome for who you truly are and not who you ought to be. All the worries simply melt away when one enters his or her home. A home does not come in one shape or size. It can be a meager room or an extravagant château. I have never understood the true meaning of having a home until I have witnessed what it means to not have one.
Having a home takes precedence over all other necessities such as access to nutritious food, medical care and transportation. Therefore, it will be a difficult task and even an impossible one for the medical provider to help the homeless individual understand the importance of managing chronic illnesses such as hypertension, diabetes, hyperlipidemia and depression.

I have noticed that we do not inquire about the living situations of our patients unless the visit is for a physical exam. We even become very displeased when a patient does not comply with medical advice without even knowing the root cause of the noncompliance. Instead, we should make it a habit to go one step further in understanding what barriers the patient might be encountering. We should also make it a habit to know what services our patients with needs such as homelessness are receiving in the community to know what else they could benefit from. We should be active participants in the overall care of our patients, especially those who are homeless.

We must remember that not having a home can mean not having a sense of purpose.