Bend over, por favor.

Once a week I volunteer at a free clinic here in town. We take the poorest of the poor, no copay required.

Though I usually feel a little in the way as I am only a medical student, I do have a talent which occasionally proves useful--I have a faint grasp of the Spanish language. Enough, anyway, to serve the purpose of explaining hypertension, understanding that instead of what I said in Ingles, the interpreter just told a patient I'd like to practice a gyn exam before the real doctor came in (NO is the same in both languages, by the way), and once, to explain a digital rectal exam. Though to be honest, that was more a matter of hand gestures. It's not really something one learns in Conversation Spanish class.

Senor, mi uno necessito ir en su....ahem....

Anyway, I was tasked to get more history from a man brought to town by the local meat processing plant. His address was a motel, the usual one the plant puts its workers up in before they start work. The problem? His blood pressure was so high I'm surprised his eyeballs hadn't started to bug out. Almost enough to put him in the hospital right there. (>200 systolic or >100 diastolic).

From talking to the nurses who had been there awhile, and to the interpreter who clearly cared more about the patients than the providers, I learned that's generally par for the course. The plant brings workers, often with no English, often with no Social Security number, to their plant. Once they have them there, THEN they do a health screen for a work release. Fail the health screen? Oh, well, you can't work. That's it. No job, no home, no bus ticket back to where you came from. This clinic could give the man medication, and I could interpret that he had been controlled on drugs before. But what if we weren't there, and supported by public funds? Imagine the drain on the town's resources. Workers with no jobs brought into a town and dropped there. What happens when the motel kicks them out? What happens when their English isn't good enough, or their immigration status isn't legal enough to get a job? What happens when they are hungry?

High blood pressure blows. I'm sure I'll preach more about that later. But high blood pressure in a foreign place with no money, no job, and no language skills is a teensy bit worse. I wish I knew more about the meat processing company to stop it. For now, I just hand out HCTZ and hope it makes enough of a difference to get the man a job. And then, maybe we can work on his health.