As the budget results roll in, the future of California’s healthcare and public services finds itself consistently downtrodden and weary. Though this is a subject many others have written about, I think it’s something none of us can advocate enough. These trends are unacceptable and altogether unsettling.

Having worked with mental health organizations and HIV/AIDS advocacy foundations alike, the budget cuts struck home when my inbox was flooded with updates and newsletters detailing the effects the budget will have on these individual organizations. If I receive 10-15 emails in a week from 10-15 different foundations who are now struggling more than ever to serve populations in need, I cannot begin grasp the number of people who employ these services who are hurting as providers are forced to cut back and shut down.

The budget cuts extensive preventative care programs, which seems contradictory to the concept of basic healthcare. It should be our goal to help people before they are hurting, not offering healthcare as a last ditch resort. By providing those in need with a solid foundation of health care services and programs our state could potentially decrease emergency room visits and frequency of urgent care needed by the public. As far as a budget goes, prevention is the most inexpensive and takes less of a toll on resources—saving both money and lives.

Though it may take time to truly understand the full effects these cuts, the Clinic here at St. Anthony Foundation is sure to feel some pressure in the upcoming months. Our services here may be needed now more than ever as more and more people in California are liable to fall trough the cracks of California’s public healthcare plan.

Frankie and Laurel’s recent posts have me thinking . People die of curable diseases because they can’t afford the cure. Even in San Francisco they die. I know such a person.

Years ago, when I helped coordinate the adult religious education class in my church, we had to deal every year with the question of theodicy. Why does God let bad things happen to good people? Who is bad enough to deserve death by starvation, plague, earthquake, tsunami?

It’s an old and difficult question. But it gets a lot easier when you eliminate the long list of “natural” disasters that are caused or made much worse by the conscious decisions of human beings.

Examine the list of famines caused by war: burning of fields, mining of rice paddies, troops fighting in large open spaces where the crops are grown.  Study the plagues caused by the intentional contamination of a people’s water supply to force surrender in war or the unconscious contamination by people upstream who have no choice about what they put into the water for the people downstream because they have no other means of washing and dumping. The knowledge and resources exist, but the political will does not.

Earthquakes, of course, are natural. But the disaster is often man made. In Afghanistan, poor neighborhoods were devastated while wealthier neighborhoods incurred very little damage because buildings in poor neighborhoods were flimsy while buildings in other neighborhoods were earthquake resistant.

As Frankie and Laurel point out, it’s not the disease, it’s not even lack of healthcare; it’s lack of access to healthcare.

The United States suffers from the disease of poverty. In our business, we often see the causes of poverty listed as “lack of job skills, lack of work history, physical disability, mental illness, alcoholism and addiction.”

But these are not the causes of poverty. The causes of poverty are lack of job training, lack of job mentorship, lack of accommodation and training for people with disabilities, lack of residential recovery programs, lack of services and supportive housing for people with mental illness, lack of affordable housing for the underemployed.

Why don’t we have enough of these things? Is it because we can’t afford them? In the United States? In CALIFORNIA? As a homeless activist I used to know said, “This is not a poor country. Someone is making a decision.”

We need to re-examine that decision. We need new priorities.

I am in the waiting room of an oral surgeon’s office as I write this, waiting to get my wisdom teeth pulled. The strips of peeling faux leather on the waiting room chairs, faded posters depicting proper oral hygiene, and bulbous silver hanging lamps scream not so much ‘retro’ but ‘seen better days’. Having gotten up at 5:30 am to make this appointment, I am feeling the same way myself.

But I am also feeling blessed, because when I started having wake-me-up-in-the-middle-of the-night tooth pain, I was able to be seen by a dentist (who determined the pain was being caused by my wisdom teeth) and then an oral surgeon within a week. Most people in the world are not able to do that. As the pain was getting beyond the daily maximum advil dose, I was able to take time off to get my teeth attended to. Most people are not able to do that either, without risking their employment. And I even had the blessing of dental insurance, which covered a significant percentage of my dental appointments. That is nothing short of a miracle.

As my stomach grumbles with morning emptiness, I reflect on the hungry people in the meal line at St. Anthony’s. I wonder how many people in that line began their journey to homelessness because they could not afford an absence at work or medical bills when they or a loved one were ill or in pain, and so they lost their job, got sicker, and one day could not pay the rent.

At home, I have frozen peas, otter pops, and soup ready for me, able to be at whatever temperature I need them to be so I can feel better faster, because I have a kitchen. Most of the people waiting for a hot meal at St. Anthony’s do not.

I know I will feel lousy and feel better again soon. I know this, because I have the luxury and privilege of housing, healthcare, and good employers.

Gil Gross at KGO says “They can only take your teeth, not your wisdom.” That’s only if you can afford to get your teeth taken care of. Otherwise you get compounded “wisdom of experience” and “wisdom born of pain”. The way I’m feeling right now, I’d trade my tooth pain for naiveté any day.

As they struggle to make ends meet, Patricia and her family get the medical attention they need at the St. Anthony Free Medical Clinic.

Like any mother, Patricia wants the best for her children. She lives in a small Tenderloin apartment with her husband, Isaac, and their five children. The day-to-day struggles of making rent, taking care of the children, and putting food on the table have gotten more and more difficult; lately, it has been hard enough just to get by.

Four months ago, Isaac was laid off from his job as a cook at a local restaurant. He recently picked up part-time work with another restaurant, but at three days per week the hours are not enough to make a living, much less provide for a family of seven. Isaac is ineligible for unemployment because he is working; yet he does not work enough to qualify for employee benefits, and his paycheck is not enough to support the family.

A sustainable income for a family of four in San Francisco is approximately $60,000 per year– drastically more than Isaac earns working part-time. The cuts to Isaac’s salary have made it extremely difficult for the family to afford basic necessities like food, rent, healthcare, and clothing for their children. Last month they had to take out a loan to pay the rent, which they are now repaying, $15 each month.

Now more than ever, Patricia and Isaac have been reaching out to community resources like St. Anthony Free Medical Clinic to provide stability and help get them through these difficult times. Located just down the block from their apartment, the Clinic is one of San Francisco’s oldest and largest free medical clinics and the sole provider of free pediatric care in the neighborhood. Each year, the Clinic cares for more than 3,500 uninsured poor and homeless patients. With the city’s skyrocketing unemployment rates and an exceedingly high cost of living, it is no wonder more and more families are turning to St. Anthony’s and other community clinics for their medical care. More than 80,000 San Franciscans lack health insurance, a number that will likely rise as unemployed or underemployed families lose employer-based medical coverage. At the same time, city-wide budget cuts have reduced the availability of other safety net services for families most in need. For uninsured families like Isaac and Patricia’s, the Clinic is a lifeline.

Patricia learned of the Clinic from a friend. “I didn’t know where to go for medical attention. A friend of mine said ‘I know where to take you, I know of a medical clinic where they’ll see you for free.’” The Clinic has become a lifesaver for the family. Dr. Katy Broner provides primary care, immunizations, and well-child checks, and helps them access the Clinic’s range of specialty care like allergy treatment and podiatry. The Clinic’s onsite pharmacy and dispensary allows them to pick up their medications, free of charge, without having to travel across town.

The Clinic has also been a point of entry for other St. Anthony’s services. Dr. Broner has referred Patricia to St. Anthony’s Free Clothing Program for help obtaining school clothes for her children, and to the Social Work Center to consult with a social worker about rental assistance. “I know if I need something, I come here. I know the doctors will take care of me,” Patricia says. “Whatever problem I have, I always come looking for Dr. Broner.”

Isaac continues his search for full-time work. Patricia, always with her children’s success in mind, has begun taking English classes to help them with their schoolwork.

With a restored sense of stability, Patricia is hopeful for the future and grateful for the sense of community that she finds in the Clinic.

“I know a lot of people affected by the economic crisis and am glad that I can come here. It’s the only place I know of where people without any money can still get medical attention.”

The recent scare of Swine Flu, and it’s possible fatal consequences, has lead to a panic among office workers, food industry workers and many other occupations that put people in close contact with one another.  Workers have been advised to stay home, parents forced to find childcare for days and sometimes more than a week when confirmed cases are reported at their children’s schools.

For many however, calling in sick is not an option. Swine Flu serves as one broad example of the pervasive problem that so many low-income and underemployed workers face. For the 49% of workers without paid sick days calling in does not only mean losing income, but could mean losing their jobs. Additionally, for families who do not have the extra money to for childcare have to choose between leaving their children unsupervised or losing a day’s pay and possibly jeopardizing their jobs to stay home and look after them.

Swine Flu is just one example of this problem which manifests in many ways. Low-income families often have to make difficult decisions that affect their families health and stability: deciding what bills to pay when money is tight, what groceries to buy knowing that what is most nutritious is not usually what is most affordable, and even having to decide what medicines can and cannot be afforded.

St. Anthony Foundation’s network of programs provide services that help support families through unstable times and the educational tools and resources to help parents make the most beneficial choices possible when faced with these tough decisions.

That was quite the heatwave last week. Trying to get ready for work amid the 80 and near 90 degree heat, I realized I owned nothing even seemingly professional that would suffice in that weather.

Looking beyond my own needs, and comforts I thought about our guests at St. Anthony Foundation. So often, especially in our moderate San Francisco climate, we only think of the winter as a time to be concerned about clothing, about shelter, and the effects of severe weather.  However, homelessness and poverty do not discriminate based on the season.   St. Anthony’s services, especially our Clothing and Housewares Program, Social Work Center and Free Medical Clinic, are just as busy during the summer months.

Guests that come through the Clothing and Housewares Program are looking not only for work clothes, but for clothes that will protect them in weather on either side of the thermometer.  Summer months present health concerns of their own as well. Dehydration, heat stroke and malnourishment are a few of the health risks that the Clinic sees during these months that if left untreated can develop into critical health problems.  And, in these hotter months, utilities, rent and food do not get any cheaper.  Our Social Work Center, is still just as busy helping connect guests to the supportive services they need to maintain their benefits, access emergency food, and find housing.

Although images of charity in our minds may be focused on snow falling and holidays, in reality we can all find ways to help year round to bring more stability to those in need.

Many people think of poverty programs as schools or hospitals. Poor people come to the program, they use the tools they are given, they graduate from poverty. They find the cause of their poverty, they are cured.  The next group comes in.

At St. Anthony’s we have thousands of guests who do graduate. They learn new skills or they learn to speak English. They get clean and sober or they get health insurance. They find a job that will allow them to live independently.

But many of our guests face multiple barriers to participating in society. They live with both physical disabilities and mental health problems. They struggle with an addiction and they struggle with illiteracy. They are elderly, which is not a disease and has no cure.

These are the guests we hope to keep connected to our programs, not to graduate. If they keep coming back to St. Anthony Social Work Center, they can access benefits and keep the stable housing we’ve helped them find and get help managing their limited incomes. If they keep coming to the Free Medical Clinic, they can get help managing a chronic illness and get medication on the spot, so they don’t forget to take it. If they remain in the Madonna Senior Residence, they can built strong relationships with other residents and blossom anew by aging in place.

These are the guests we hope will stay in community with St. Anthony Foundation. Their lives will become more stable; they may even become more self-sufficient. But their strength lies in staying together, not in “graduating.” And by remaining in community here, they make our community strong.

Once again, impending budget cuts threaten to undermine critical health and human services that so many of our poor and homeless guests depend on.  The impact will be shared across the spectrum of agencies that serve marginalized communities, with basic mental health and outreach services taking some of the biggest hits.  A few of the proposed cuts include:

Eliminating drop-in services at Tenderloin Health Resource Center, which currently serves 30 guests per day.

Closing Caduceus Outreach Services, which provides comprehensive psychiatric support and outreach to approximately 100 each year.

Closing the Tenderloin Clubhouse, a day treatment program for mentally ill Tenderloin residents.

All in all, these cuts will result in roughly 1,600 people being dropped from mental health treatment and a 46% reduction in capacity of San Francisco’s mental health system.

The proposed cuts may help solve some of our budget woes in the short-term, but in the long run they will only cost us more.  As mental health resources shrink, more people with mental illness will inevitably turn to emergency psychiatric care at SF General; those with acute mental illness often end up in jail.  Caduceus Outreach Services, one of the aforementioned potential victims of the budget crisis, estimates that it costs $200+ per hour to hold someone in involuntary psychiatric detention at San Francisco General Hospital‘s Psychiatric Emergency Services unit, or $34,675 to incarcerate one person in San Francisco County jail for one year.  The cost to provide restorative treatment and social support for one person in a place like Cadaceus: only $3,500 per year.

I understand the need to cut back in tough times.  But we have to find a way to balance the immediate fiscal demands of a budget in crisis with our city’s commitment to ensuring the long-term health of its residents, especially those most at risk for falling through the cracks.

This month St. Anthony Free Medical Clinic joined the ranks of some of the leading healthcare innovators in the country by going paperless.  A transition several years in the works, the Clinic finally made the dramatic leap from old-school paper records to a new fully electronic medical records system.  The new system won’t just save space, it will revolutionize the way we care for our uninsured poor and homeless patients.

With less of an administrative burden, doctors will now have more time to provide direct care.  Quality of care will improve, as the new system includes immediate access to information that helps doctors make accurate clinical decisions, at the point of care.  And, we are now able to share important patient data across the citywide network of health clinics and hospitals in real-time, which will improve care for patients who move often and seek care from multiple sites.

The new electronic medical records system couldn’t have come to fruition at a better time, as in our new facility we are poised to offer more patient visits than ever.  I’m anticipating that these exciting innovations will help us meet the challenge of not only caring for more patients, but providing the best possible care to those most in need.

Change is certainly in the air with the new year. In case you haven’t noticed, St. Anthony Free Medical Clinic recently moved across the street into a brand new facility. The new clinic is larger, better designed and better equipped, and will enable us to treat an additional 5,000 patients per year. With increased seating capacity in our new pediatric waiting room, larger exam rooms, a private counseling room, and the greater capability to respond to medical emergencies, we will offer a calmer, more comfortable environment for our guests.

The change is certainly a welcome one for patients who will benefit from the new clinic’s expanded capacity and services, and for the staff who’ve been working out of a converted garage space for the past 50+ years. Our therapists, who have moved from a glorified broom closet to a large counseling room with windows, couldn’t be happier. All the clinic staff seem to share a collective feeling of excitement and enthusiasm about the new space. We are all looking forward to a future of hope and healing for the poor and homeless guests we serve.