with quiet delight at having found the words. Like all employees at St. Jude’s, Joanna receives a salary of $7.00 an hour. “Che Guevara is my ideal as a political doctor,’’ she laughs. “But I’d rather just practice medicine." And that’s what she does, with the clinic open about 50 hours a week in addition to her home care visits. Choosing to practice in a worked-out coal-mining area, Joanna and her staff provide medical services for those who could not otherwise afford them, a patient group with chronic illnesses, many of them in need of terminal care. “Joanna has different ideas about life and death than most people,” her nurse and housemate Sister Greta explains. Greta’s Book of Common Prayer lies on the table, and she spends her days Christ-like, cleaning ears for the elderly, cutting in-grown toenails, washing the feet of the poor. But Joanna Roberts has a more social vision of their work. “Improving health is a very hot political issue,” she explains with a smile. “Tons of money are made every year on sickness, so the idea of doing preventitive care is a very treacherous thing. Medical care for poor people means a lot politically in this country. I think the concept of primary, comprehensive care does work and can be economically efficient. But first it requires that the executives and professionals don’t rip the system off. “I don’t think our clinic lives on sickness but on health, and we have altered practices of health care in this entire area because we’ve raised patients’ expectations. Our theoretical position is, ‘This person should have health care!’ And we promote the idea that if you are under treatment, the treatment should be satisfactory and acceptable to you, and it should be possible. “Three years ago, when the miners started going out on strike and the mines were closing, we set up a drug fund operated through the community board: the funding comes through the store at the community center and the money-raising events they have. When people can’t afford medicine, we tap that fund to pay for it. In the last year and a half, the fund has spent $10,000, which is quite significant to raise in a poverty area. This tells people that if something is important, then some professional should be able to assist you to make it happen. My opinJoanna Roberts at St. Jude's Clinic ion is that you educate people about health problems by behaving as though their health is important. Raised in a poor family in Buffalo, New York, where she received her medical training at the county hospital, Joanna Roberts’ most important contribution to alternative health care may be her emphasis on the class bias of medicine and her desire to develop programs suited to the poor. “Most people that go into medicine are upper or middle class, and they just assume that what fits them must fit everybody, and that all these others that it doesn’t fit are either lazy or stupid. They don’t conceive of the possibility that the kind of health care appropriate for disabled or working people would be different. I'd like to see primary care designed I around who a person is." Such a shift in j priorities will not come about, she understands, through the medical schools. “The kind of person who’s interested in doing what I’m doing doesn’t get into medical school; probably doesn't even apply. Medicine is vulnerable only through economic pressures,” she insists, “and I think the change is going to be directed by consumers, not physicians. People will start to go to other professionals for what they used to go to doctors for, and when the medical community becomes pinched economically, they’ll start to consider what they need to offer. Today the whole thing has reached a point where the professional is selling people on heart transplants, sort of convincing people that doctors are needed because they can resuscitate dead people." She laughs and her lighter clicks again. “I think it’s selling something which is not really needed, and can only go so far, because people do have very real medical needs which eventually they will demand be satisfied. “But I don’t know,” she shrugs. “I don’t know whether people can force professionals to deliver adequate services. And I question whether most professionals today are capable of delivering adequate health care, because most of them don’t have the aptitude, the capacity, or the training.” She smiles when asked to explain. “In my last year of residency, the Chief of Staff retired. He was one of the two really great physicians I’ve known. He called everybody together and said, ‘I want to tell you the secret of medicine.' He was an old man and fairly well-known, so everyone was leaning forward waiting. Then he said, ‘The secret of caring for the patient is caring for the patient.’ That was it. And the guy sitting next to me whispered, ‘The Chief’s gone senile,”’ Joanna laughs. Coda: A Fortunate Man Back on Art’s front porch, we look toward a long, dark ridge and watch an occasional coal truck whine down the highway. Insects buzz in the summer’s heat, but soon it will be winter and Art will go to work and come home in darkness. This is the last day of a short vacation, and his mind is already turning back towards patients and the problems of the clinic. A car honks repeatedly as it passes. “That’s Edward Johnson,” Art explains with a smiling shake of his head. I’ve been seeing him for eight years. He has severe emphysema and black lung. He also has a lot of arthritis in his back from a bad mining accident when some vertebrae were crushed. In the last year he’s had this nodule on his lung which is probably cancer. He and his wife have been real nice to me.” “How do you feel about treating so many terminal cases like his?” I finally asked. “I like elderly people,” Art answers. I probably wouldn’t practice internal medicine if I didn’t. But I think I like older people more than most internists; I’ve always liked older people. I’m drawn to the dignity and suffering that goes along with the last chapter of human life, I guess. There’s something in it that really moves me.” Art, Tommy and Joanna share a favorite book. Written by John Berger about a national health service physician in England, it’s called The Life of a Country Doctor, and is subtitled “A Fortunate Man.” They all agree. Lynn Darroch recently visited friends on the East Coast. His last article in the CSQ examined the economy of metropolitan Portland. His beat is jazz. SELECTED HIGH QUALITY PRE-READ BOOKS PRINTS; OLD (LEAD) TOY SOLDIERS; MILITARIA 231-9270 8133 S.E. 13TH OLD SELLWOOD PORTLAND, OREGON 97202 with Always Affordable 2239251 ^ -^ 4 1 5 NW 21ST Mon-Sat IOto6,Thu,Fri til 8 Breakfast 1925 S.E. Hawthorne Breakfast! • THE TOWN’S BEST JUKEBOX! • AMERICAN FAVORITES! • LIKE SPAM & EGGS! • SATURDAYS TOO! • ... 1231 SW JEFFERSON! 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