Health care paradoxes

As public health nurses, we implore our elected officials to protect the most vulnerable while making difficult decisions

OPINION What does homicide in the Western Addition have to do with the closure of the worker's compensation clinic at San Francisco General Hospital? How does a mobile methadone-treatment van affect the broader public health of San Francisco?

These are just two of the questions that University of San Francisco nursing students are asking while San Francisco residents face a public health and safety crisis.

Public health and safety are both affected by economic conditions. Nonetheless, we must all question a need-blind cutback in services to public health.

It's the task of San Francisco nursing professors to address the following confounding paradoxes:

Homelessness Nursing students, Department of Public Health staff, and a host of individuals and organizations work together at the commendable, but intermittent, Project Homeless Connect, while midyear budget cuts will shutter Buster's Place, the only 24-hour drop-in center that serves homeless persons every day of the year.

Mental health Last semester USF students learned that increasingly scarce hospital beds for mentally ill and impoverished San Francisco residents were going to be cut back even further. Now budget cuts are planned that will decrease services for individuals on an outpatient basis.

Violence Nursing students learn about the effectiveness of education and physical exercise in ameliorating the deplorable conditions of the city's housing projects and streets. The Western Addition has recently suffered from a spate of shootings; it seems an odd time to close a healthy and safe alternative to the violent streets such as tennis courts.

Occupational health The Occupational Health Clinic at SF General will soon be closed. USF students want to know why they should choose to work for a public health system that puts them at high risk for hepatitis B, HIV, back injury, and exposure to violent patients.

Substance use Methadone treatment for opiate addiction is an imperfect clinical intervention, but it's certainly better than users overdosing on the street or spreading HIV and antibiotic-resistant skin infections by sharing needles. However, methadone treatment is expensive, and an innovative program to bring it to addicts will be delayed for budget reasons.

Access to care While the city's health plan, Healthy San Francisco, is a laudable attempt to provide optional health care coverage to more residents, the budgets of public health clinics and hospitals that provide the care are being cut back.

Public health nursing San Francisco has pioneered effective programs tackling the disproportionate infant-mortality, asthma, diabetes, and hypertension rates among African American and Latino San Francisco residents. Now the cadre of public health nurses who do this work will be reduced, and Laguna Honda Hospital is being rebuilt with fewer patient beds. Who will monitor and support the disabled and seniors in the community if not the public health nurses?

As public health nurses, we implore our elected officials to protect the most vulnerable while making difficult decisions.

Sasha J. Cuttler

Sasha Cuttler is an assistant professor at the University of San Francisco School of Nursing

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