Review of “Health Care Off the Books: Poverty, Illness, and Strategies for Survival in Urban America,” by Danielle T. Raudenbush, 2020. Oakland: University of California Press, paper, 171 pages.
Raudenbush here gives us a very revealing story of the ways in which poor urban dwellers in a project navigate the challenging world of health care, some with insurance, some without. Raudenbush shows us there are three different levels of approaches to getting the needed pills, bandages, and even medical equipment whether patients follow the formal approach to getting their healthcare—or not.
There is a huge informal network of helpers—as StreetSense articles show on a regular basis—for poor and homeless persons to get pretty much whatever they need on the streets. Raudenbush acknowledges this particular qualitative study, done over time, focuses very much on healthcare issues and does not address food, money, rides, or other items very much.
The author shows us there are those three different approaches, first formal: going to one’s doctor, buying medication and/or using insurance to do so, and then taking all of the medication/following all the doctor’s orders, and convalescing as directed. There is also informal—and this is the one that seems to be of most interest to the author.
The informal approach is using hook or crook to get the pills, bartering for the pills, lending other needed medical supplies and goods, or purchasing these items from a helper in the project. It is very interesting how the author is able to get so much information, and she has established very good rapport, it seems, with the residents of the project. Like her subjects in the study, the author is African-American, and this connection helps her to get the trust of the people she interviews. She also conducts focus groups with the residents.
There is also the hybrid approach—and the author reveals how much the residents of the project bend rules, make important connections, share resources, and make use of the people who serve as “helpers” in that community. Doctors and other medical personnel are also involved in the hybrid approach in various ways—and in the informal approach too.
To understand the real world of the projects and the very challenging work it is indeed to get access to healthcare in this country is important for policymakers, voters, and of course the “helpers” we often talk about.
Helpers provide the backbone for the poor to get access to so many services, and to food, and to medication, and even to walkers and wheelchairs. There are all kinds of helpers—some freelance, some hired by the city, some who are teachers and social workers and just plain people who are concerned. They have a huge and positive impact in the lives of many people, indeed. They get all kinds of requests and predicaments.
Often heard among helpers and their networks for the homeless, also, are these kinds of questions:
— Who is giving away winter coats?
— Who has free dinner tonight?
— Is there any place with decent sack lunches by my spot where I stay now?
— Where can I get some gloves and underwear on a Sunday?
— How do I find that lady who has the phone chargers for sale?
Add to these questions those dealing with social security application rules, where to get free aspirin, how to get disability checks, how to find a good dentist who takes XY or Z insurance, and other needed information. As in this book, one will find out the streets have helpers who are constantly assisting those in need—and who are well-known among the street networks that are up and running most any hour of the day.
Raudenbush has a very good handle on the healthcare needs of persons in this particular setting. She provides a great deal of information to all helpers who need to better understand how such networks function.