Medicine Beyond The Hospital

In Dr. Wither’s address “Go to the People: Ethics and Access of Street Medicine,” he “diagnosed the healthcare industry as not healthy” because it closes its eyes to the pains that ferment beneath the slick surface of society. 

Yes, Withers acknowledges, hospitals can obey the charts and categorizations—but that is not enough to provide authentic, just treatment. In other words, contemporary healthcare falls short of aiding those it does treat and arrogantly overlooks those it doesn’t. 

Withers argues that there are a number of key issues with contemporary healthcare. Firstly, it misses the emotional dimension of health, for patients are as much, or more, in need of companionship as anyone else. Secondly, it isn’t interested in all those who don’t or can’t come to get treatment or cannot register their pains in the language that satisfies health professionals and middle-class norms. And, ultimately, it treats lower-class, disabled, and minority sufferers as objects to be either improved or dismissed.

Withers suggests going out, learning, and helping the hurt people who never see the hospital lights or have been burnt by their glow. That is how he has spent his life: in the off-grid wilderness that lurks in our abundant, purportedly affluent society. Of course, he says, this sentiment and lifestyle is not limited to healthcare but extendable to countless experiences. 

To borrow a turn of phrase from philosopher Paulo Freire, the recipients of a kind of pain should become the subjects, rather than the objects, of the mission to alleviate it. Since Withers himself makes an offhand reference to Freire, I will make note of the latter’s influential commentary on the topic. 

In Freire’s work Pedagogy of the Oppressed (1970), he conceptualizes and condemns “false generosity,” the use of command and control to “save” victims. Instead, for Freire, powerful people who want to help the harmed must cooperate with them, with the end goal of enfranchising them as leaders and healers. Freire suggests that this is both practically and morally correct. Victims are best able to explain and alleviate harm, and they have the right to be treated as active human agents.  

In my opinion, the ideals and practices expressed by Freire and Withers are attractive and worth observance. History is fraught with top-down expressions of altruism that flounder or become merely self-satisfying outlets for moral satisfaction. Too often well-intentioned people turn towards a voyeuristic and intrusive study of suffering. These sentiments lead to the flagrant dismissal of many woes, as in Withers’s story. As the son of an impoverished family with its own health issues, I admire his genuine, humane, and humble response to these concerns.

But, given my own experiences, I believe there are a few questions that should be straightened out before pursuing a “subjectifying” mindset through street medicine. What is required—financially and administratively—to scale up the street medicine initiative? Does it risk leaving out resources for other health programs? Is its healthcare consistently effective? Can it pick at the structural causes behind the economically and socially disempowered communities it serves? Can it avoid becoming predatory and voyeuristic itself? What is to be done when, as Withers mentioned, these programs aren’t given financial and legal backing from governments? 

These questions, and more, are relevant when considering the specifics of the initiative and its future. But regardless, Withers’s effort is exemplary and commendable, for he sets an inspiring example of someone with deep moral passion and the will to do something about it. His address has also importantly reframed the profession of a clinician as more than a white coat. For Withers, the need for healthcare does not end when the hospital doors close but continues all day long. For these ideas, examples, and practical endeavors, we should all lend an ear to Withers. And, I hope and believe, further constructive, moral, and honest discussion will empower people to help others, in and beyond healthcare, with compassion and diligence.