Tuesday, August 01, 2006

Eskimolitos and The Economics of Poverty

The heat gripped the city tightly today. The children pranced in the sprinkler park, and the elders sat in the shade of the trees playing Bingo and dominos. The youth played basketball, oblivious to the heat and the dire warnings of poor air quality and smoggy humidity. I don't know how many times I warned people to be careful in the heat today, sounding like a broken sweaty record.

At my wife's senior center, popsicles from the Department of Elder Affairs made the rounds---the Puerto Ricans call them "Eskimolitos".

All of our patients receive checks from Social Security on the first of each month, making that a relatively quiet day for the medical providers. Unfortunately, today---the hottest day of the year---was "Check Day", and hundreds of our clients and patients rushed around the city to cash checks, pay bills, shop, and otherwise hurriedly rid themselves of the small amounts of money with which they subsist on a monthly basis. I spent some time today worrying about the many people in compromised health who, out of force of habit, spent the hottest part of the day on the simmering streets.

This line of thought led me to consider the economics of poverty and how our patients do---and don't---manage their funds. In previous posts, I've described the extortionate prices that our patients pay for leased household furnishings and the money that's squandered on such high interest rates and fees. Similarly, our clients generally do not have bank accounts, choosing simply to cash their checks at a check-cashing facility (which takes a cut, of course) and subsequently paying their bills from the same store (with additional fees paid for each money order written). Add to this the extraordinary amounts which people pay for premium cable television service, and it's no wonder that when push comes to shove, there's precious little money left for such things as prescription co-payments and extra fluids and popsicles for hot weather. It's enough to make a nurse steam with incomprehension.

So, there they all ran, the macadam soft under their shoes, their monthly stipend from the federal government dwindling at each stop. Some walk, some take the bus, some get rides from neighbors, friends, and family members. Their children hopefully learn to use banks, checks, debit cards, and on-line bill-paying, leaving the old-fashioned money orders and fees to the elders. Check Day is a monthly phenomenon, an orgy of consumption, a rush to fill the cabinets and stock the fridge, pay the rent, and flatten the bills. With poor planning, the final week of the month then becomes a time to scour the cabinets for that last can of beans, visit the free lunch program, or find a ride to the food pantry.

Today, the heat be damned, they criss-crossed the city in a mad dash of accomplishment and consumption (not to mention responsible bill-paying, a praiseworthy practice). One diabetic and asthmatic patient of mine arrived to the senior center sweaty and dizzy, with a blood sugar of 59 and a roaring headache, but it was nothing that a little Eskimolito couldn't cure.

And the temperatures will only rise tomorrow.
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