A Passion for Science - Columbia College - Columbia University

in 1965, Medicare and Medicaid were passed, Martin Luther
King Jr. marched to Montgomery, Malcolm X was assassinated,
President Lyndon B. Johnson’s Voting Rights Bill became
law, more troops went to Vietnam and many were protesting
the war. This was the social backdrop of our class.
My years on Morningside Heights were a time of social change
and student activism. The corner of West 116th Street and Broadway
was as much a classroom as Hamilton Hall. Although premed,
I minored in history. The highlight of my four years was Jim
Shenton ’49’s renowned seminar “United States during the Era
of Disunion.”
Professor Shenton wove the milestones of current American
history into his seminar, leaving me with indelible lessons of the
tide of American history.
I left Morningside Heights in June 1965. In September, I drove to
St. Louis to begin my first year at Washington University Medical
School. With Medicare and Medicaid promising access to care to
millions previously excluded, I entered medicine believing that it
would be a tool for social change.
Quickly, I learned that the view from Morningside Heights
was not that from the heartland. Columbia had prepared me well
for medical school, but not that my profession’s vision of social
responsibility started and stopped at the hospital’s door.
Starving for the pulse of social change, I heard the words of my
Columbia swimming coach, Richard Steadman: “Defeat is not a
discouragement but a call to be better.” I started thinking of ways
to get the medical school and hospital to extend its services to the
inner city three miles from its door. With the support of two young
faculty members, some of my classmates and members of the
Pruitt-Igoe Men’s Club, we established a health center in Pruitt-
Igoe, St. Louis’ largest public housing project.
For the first 10 years after graduating from medical school, I
a l u m n i C o R n e R
MAY/JUNE 2011
80
Columbia CollEgE Today
Caring for Those Without Health Insurance
Dr. Ralph Freidin ’65 examines a patient at a free clinic in Washington,
D.C., last August.
PhOTO: ChRIS uShER
B y dr. ra L P h Freidin ’65
taught and practiced primary care and internal medicine in municipal
hospitals. By 1980, I had a family of two young children and
a wife with her own professional career. The problems of people
marginalized in our health care system were too taxing for this
stage of my life. I left inner-city medicine and joined a small private
practice in Lexington, Mass.
last summer, I saw a report of a one-day medical clinic in New
Orleans that had provided free care to almost 1,000 people
without insurance. The clinic, spread across 102,000 square
feet of a convention hall, was my small neighborhood health center
on steroids.
Believing health care was a right of every American citizen, undoubtedly
learned in CC, history classes and Professor Shenton’s
Civil War seminar, I called The National Association of Free Clinics
(NAFC, freeclinics.us). Two weeks later, I was on a plane to Little
Rock. I was asked to triage the waiting line, looking for someone
who needed urgent care. The people began to line up two hours
before the doors opened at 10 a.m. By the time the first scheduled
patient was seen, more than 200 patients were waiting.
More than 80 percent were working but none had health insurance.
Some were self-employed but could not afford the premiums
of individual policies. Some had several jobs, none of which
provided health benefits. Others had been laid off and could not
afford COBRA.
Few had seen a physician in the past year. Almost half had not
seen a physician in the past six years. All had the same reasons for
having neglected their health. Without insurance, they could not
afford to pay for a physician visit. Without insurance, they could
not afford to fill their prescriptions. Without insurance, they could
not afford any surgical procedure. If they had been sick enough to
need emergency care, they were then saddled with an enormous
bill that discouraged them from seeking further care.
A man with a below-knee amputation was in a wheelchair. He
hoped the clinic would help him obtain the prosthesis request his
medical insurance had denied.
A woman grimacing in pain had cancer treatment two years
ago but was unable to continue treatment without insurance.
Another woman was wearing a trench coat to cover her emaciated
frame. She had had three seizures in the past two weeks. A
local emergency room where she had sought help told her that
the level of her seizure medications was “OK” and discharged
her. No follow up was arranged. During her seizures she had bitten
the inside of her mouth and tongue. She could not eat. When
I told her that we would care for her and arrange for further care,
I could not see an intact tooth in her broad but crooked smile.
A man with labored breathing and a sweaty brow was slumped
in a wheelchair. His weak voice told me five days ago he was in the
intensive care unit of a local hospital for “swollen legs and chest
heaviness.” At discharge, he was handed a list of unaffordable
medications that he did not understand. Continuing care was not
arranged. He had unstable angina. I wheeled him to the front of the
line and called the EMTs to take him back to the hospital.
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