Creepy-crawlies on a homeless man

It's been a long time since I've written. So many stories, so much snow, so little time.

Our nurse practitioner came to me yesterday in a panic because she couldn't figure out a way to get a homeless man some medication to get rid of his scabies. He obviously can't afford any medication. I reminded her that our clinic can write off the cost of a medication through the public health pharmacy I've written about. (An update on the pharmacy to come). I've seen scabies quite a few times in our clinic. Scabies is a parasite that burrows under the skin and causes severe itching. Burrow markings and scratch marks can usually be seen. I've never actually seen the parasite as they are as small as the head of a pin and they hide. I've read it's possible to see 3 or 4 on somebody.

The NP told me there were so many scabies on this man and she'd never seen anything like it. She asked me to come and look. When I went into the clinic room, I saw a man who looked to be in his 70's but was 52 years old. He wore a blue knit cap, a flannel shirt with a T-shirt underneath. His jeans were stained with urine. His face was very red, perhaps from drinking but I don't know. He was asked to open his flannel shirt to expose his T-shirt. There on his shirt on his chest were literally hundreds of scabies parasites, crawling all around. He rolled up his sleeve and his arms were bleeding from his scratching. He thinks he was infected from a mission shelter he stayed in when it was very cold.

I apologized to him that the pharmacy he need to use was closed until Monday, two days from then. I assured him the medication would be ready for him to get on Monday morning. I couldn't even Imagine having to wait two days in his state but his response was, "Ok, That's all right. I can wait". He demanded nothing, expected nothing. I told him it was very important to wash his clothes in hot water and dry them on a high heat. (He really should throw his clothes away but it's all he has). I instructed him how to use this cream all over his body and told him he must put on clean clothes afterward. I asked him if he has access to any other clothes. He told me he has a friend he stays with every once in a while who could give him some clothes. I reminded him of the protocol again before he left that he needs to follow but wondered if he could really follow it. Would anyone actually let him into their house? Can he wash his clothes? Can he find clean clothes? Can he follow the medication instructions?

As I was pondering these questions, I made sure our clinic room was disinfected, and made sure the chair he was sitting on in the lobby was disinfected. And I said out loud once again, "We don't treat our poor very well".