By Little Richard
Ed.: When I started this blog, I specified in advance that there would be no posts about politics. However, I recently became aware of an issue of such importance to sexually active New Yorkers that I realized I had to document my experience with it. This piece is a reflection on the downsizing of the New York City Department of Health (DOH)’s free STD clinics and a voice in support of their mission.
Things were going perfectly with a new partner of mine: she had a warm, welcoming personality; we had really connected on an emotional level; and the sex had been awesome. Although we’d only known each other for a month, she already had a box of stuff at my apartment, including (drumroll…) an electric toothbrush! She and I had both been up-front with each other about the fact that we had multiple partners, and we had about the same amount of experience with ethical non-monogamy, though I had more sexual experience overall. We carefully brought up various risk factors and elements of our sexual histories and activities before doing so, but our dovetailing desires and apprehensions eventually led us to forego the use of condoms… just once! (Okay, there was also that one other time, but those were the only two times, I swear.)
So imagine my chagrin when she told me a week later that she had come down with bacterial vaginosis (BV), a condition caused by an imbalance of naturally occurring bacteria in the vagina that nevertheless can be caused by having new or multiple sex partners. Evidently, it can also be exacerbated by IUD contraception, which she uses. Unfortunately, the time before we lost the condoms, she had also suffered a cut during sex with me, which probably also increased her risk. Although BV is not an STD, my partner told me that it can affect males by causing urinary tract infections (UTIs) and balanitis, and for all we know, some bacteria on me could have even contributed to its occurrence. She had recommended that I go to the doctor when I get back from the vacation I was on, but I originally waffled, asking her if she would instead bring me some of her prescribed cream. In fact, I had been experiencing a bit of a “tingling,” stinging feeling on the tip of my penis that had come and gone since the last time we had been together, which had also been the last time I had had sex. I had attributed this tingling to a jiu jitsu-related friction injury and/or dehydration, but I was also aware that these could be UTI symptoms. Further, although my partner said she had BV, I was not sure exactly for what she had been tested and what results had come back. Thus, as soon as I heard and looked up the term “balanitis,” which seemed to match my symptoms I decided to proceed immediately to the New York City DOH Ft. Greene STD clinic to get checked out.
I have had mixed experiences with the DOH’s services overall, beginning with an excellent hepatitis B vaccination I received in 2008. That hepatitis series was my first publicly funded vaccination (my previous ones had been given by parentally funded private doctors in my youth), but it made perfect sense to me that these important services should be provided freely by the government because of their obvious benefits to public health at low marginal cost. Thus, right after I received my hepatitis shot in 2008, I stuck around the same building in Chelsea for an STD test. At that point, they took not only my blood (to test for HIV) but also my urine (to test for gonorrhea, Chlamydia, and—who knows—maybe syphilis too).
I had changed partners relatively infrequently until this year, so I had not been tested since that time. However, after I became non-monogamous, I concluded that the only responsible thing to do would be to get tested regularly. So, I went to the Ft. Greene clinic to receive a similar check to what I had last time. I arrived, filled out the form indicating I had no symptoms, and waited to be seen. When I arrived, the social worker looked up my records in the computer and saw that I had previously received STD screening; then, she immediately launched into apologetics. She explained that unfortunately, budget cuts had necessitated a policy of not performing a full STD screening on just anyone. Though I had received a full screening during my previous visit despite arriving in perfect health, it is now departmental policy to perform only an HIV test on walk-ins unless they present with some kind of symptom.
More after the jump!
Although I was disappointed at this news, I did not want to start an argument with the overworked (and probably underpaid) recordkeeper who processed my initial triage. Undoubtedly, she would have also preferred to give everyone who walked through the door a comprehensive screening, because obviously, not everyone who has an STD/STI shows symptoms immediately (or at all). She worried aloud about the state of her clinic’s funding, plainly recounting the service cuts that have occurred (more on those later) and implicitly wondering where they would end. I proceeded back to the waiting room, went through a highly efficient assembly line of people, and came out 30 minutes later with a signed paper indicating a negative result on a rapid HIV scan with only a tiny prick mark on my finger to show for it. However, the results for gonorrhea, Chlamydia, and syphilis all read, “Not tested.” I was the 48th person the clinic had seen that day, and the day was a little more than halfway over.
From that prior experience, I learned two things: First, if you want full STD screening from NYC DOH, simply go in and answer “yes” to questions asking whether you have some of the more noncommittal STD indications: a “tingling” feeling or burning/pain on urination. It is impossible for them to accuse you of lying, but if you answer these questions, you are guaranteed a full STD screening and doctor visit. Second, Mayor Bloomberg evidently believes that “if it doesn’t itch, it’s not an STD.” The city turns a blind eye and even encourages people like me to go around saying we have “clean STD test results,” when in fact, we have only been tested for one out of myriad STDs.
When I entered the same clinic a month later complaining of tingling and pain on urination, it was 1:53 p.m., mere minutes after I had heard about my partner’s BV diagnosis. As the cutoff for admission was 3:00, I had arrived with time to spare. I hunkered down in my waiting room with the number “67” written on a triage form indicating me as the 67th client of the day. Evidently, the films shown on the waiting room TV were submitted as some kind of student project, so one of them actually listed “Baby Mama Drama,” “Baby Mama’s Mama Drama,” and even “Dirty Dingaling Reputation” as side effects of unprotected sex. As strange a technical term as this is, I can’t disagree: Dirty Dingaling Reputation can be quite a nasty outcome.
As if the movie wasn’t enough, that day’s triage worker also threw me for a loop: that time, as the 67th person seen that day, no slots for doctor’s appointments were left for me! Because the doctor was fully booked for the day, I would have to come back tomorrow. I handed the form to the triage worker, left the triage room, and walked directly back onto the street. (Ed.: What if I had been a sick prostitute or something?) Thusly, I learned a new, helpful fact: appointments for STD services at the city’s clinics are not guaranteed—instead, they are “as available” only. The clinic’s posted open hours are guaranteed for rapid HIV testing only.
That night, I had a gchat conversation with Poppy, who always does her best to make me feel better. I explained the situation, and we reflected on the fact that although it wasn’t ideal, it could have been worse. I would have access to the proper care within hours. She asked me why I didn’t simply use my private health insurance to get immediate care, and I replied that at this point, I might as well go through with the DOH thing in the morning just to blog about it. After all, the tingling wasn’t that bad. Jovially, she wished me the best: “Less tingling and more pingling!”
Like a good polyamorist, I was in line at 7:45 a.m. the next day in anticipation of the clinic’s 8:30 opening. As the second person in line, I was seen quite rapidly after the time when the clinic actually started seeing people (the doctor actually entered the facility at 9:00—maybe they recently shaved another half hour off his schedule). There ended up being two doctors: an older Indian-looking man and an older black woman. I was the Older Woman Doctor (OWD)’s first appointment of the day. She complained through her chubby, wart-covered, bright-eyed face about the fact that her ankles were giving out on her again, whereupon the attending nurse told her to simply yell through the door when she needed the next patient.
I explained to OWD the basic reason I was there: a partner had BV, and I had begun to experience pain and tingling. She took on the knowing look of someone who had obviously dealt with this exact complaint thousands of times before, and she explained to me that it could be some random bacteria causing a common UTI. She would test me for everything and give me antibiotics to treat any infection that could be present. She mentioned all kinds of possible things it could be, listing the standard roll of diseases and trichomonas, one that was new to my ears. The antibiotics, she said, could kill Chlamydia, trichomonas, and other common infections with a single oral dose—more brand new information! Regardless, OWD would test me for everything just to see whether I have it and verify that it’s gone later.
No problem, I thought. On the way in, I had seen a door hilariously labeled “urine room” (Ed.: Greek—urinatorium?), so they’ll just make me pee like they did last time, right? Wrong. OWD told me to stand up and drop my pants as she matter-of-factly shined an oppressive standing spotlight on my crotch like the key grip at a porno set. Then, after clarifying that I needed to drop my underwear further, she took out the specimen collection device: a handle attached to a long, white, plastic protrusion that looked like it might be bladed. What the fuck was this thing? Before giving me a chance to ask, OWD told me, “Count to five, sweetie,” and swiftly jammed the sharp white thing in my pee hole. I don’t know its exact length, but based on its method of introduction, dear readers, it felt like Excalibur.
“One… two… three… four… five,” I counted in the most ill advised attempt at vibrato I have ever rendered. Proud of myself for dutifully inserting a temporal space between the utterance of each number, I agonized through the millisecond-scale time span between the completion of “five” and the removal of the large foreign object from my urethra by OWD. When I gave her the “OMGWTFBBQ” look in response to her knowing grin, she responded that I was done and “the worst [was] over.” I sat back down in the chair, and I thought everything was fine. OWD certainly had no knowledge of how wrong she had just been: as she began to explain the antibiotics I was supposed to take, inexplicably, I began to feel faint.
I quickly rummaged through my bag for food but found only water. After taking a sip of water, I began fading fast: something very, very not good was happening. I felt lightheaded, nauseous, and I was losing my sight and hearing, but inexplicably, I was in full control of my executive faculties. (I attribute this to my ability to soldier on while choked mostly unconscious in Brazilian jiu jitsu.) Regardless, for some reason, less oxygen than normal was being carried to my brain, and I knew that I would soon pass out. Finally, I asked whether OWD had something sugary and informed her that I was about to faint. As OWD ran out of the room on her glass ankles to fetch some little toothpaste tubes full of sugar paste, although I was well on the way to losing consciousness, I remember having the strength to slump over to my right (onto a desk) so that I would not hit my head on the floor. Further, I remember feeling acutely embarrassed. I remember hearing a heavy-set woman named Semi-Retired Clinic Worker (SRCW) yelling “Code Blue” as I fell, vanquished by Excalibur.
When I came to, both doctors and three other workers were standing in front of me strategizing on how to move me onto the gurney. I promptly stood up and walked over myself, as I was ready for combat instantly after regaining consciousness, whereupon the army of people shouted in unison, “NO!” They promptly began squeezing sugary toothpaste stuff into my mouth, and when they realized that I was okay, they pretty much calmed down. They were all required to stay there and watch me eat paste, elevating my feet and fanning me off like the ghetto version of Muslim heaven. After I was done with my paste and felt perfectly alert again, my pulse was still only 56. I can only imagine what it must have been when I passed out.
After the drill concluded and OWD finally got back to dispensing my medication, I was told that I had to stay and chat with a staff member for a while in an adjacent room to make sure I had regained my faculties. Although I was against this, as I would have liked to go and obtain some non-paste food, I was so embarrassed at attracting all of this attention despite my superficially tip-top physical condition that I felt like I had to play along. Thus, I didn’t argue when SRCW sat me down and told me, “You’re lucky I’m a big girl, or else how was we gonna get you on that hospital bed?” Instead, I simply replied, “I could still walk.”
“Yeah, we couldn’t figure out how you done that so soon after wakin’ up,” she continued, and thanked me for saving them from having to do a Code Blue drill for this month. “I was the first person to pass out on you this month, then?” “Yezzir.” During our 10–15 minutes together, the positively delightful SRCW told me all about herself: she was 52 years old but had already been working for DOH for 28 years; as soon as she completed her “30 to life,” as she put it, she intended to move back to her native North Carolina, where her dear mother was losing her eyesight. She also reassured me that a bit of tingling due to a common UTI is nothing about which to be concerned; the antibiotics prescribed by OWD, she told me, are exponentially likely to cure it in a single dose. Further, she handed me a card with an ID number on it, which I could enter on a webpage along with my 6-digit custom PIN in a week to find out the results of my tests for actual STDs.
She also repeated what one of my former triage workers had said about the moribund nature of these clinics and complained about the unfortunate budget cuts from which they are suffering. Even when the public has not seen service cuts, she said, workers like her have been squeezed. For example, she claimed that her overtime pay for working weekends would soon be cut. Further, in addition to the drastic reduction in testing provided to walk-ins, SRCW informed me of overall scheduling cuts in the clinics. In fact, she alleged that recent cuts to Saturday schedules might be expanded and that September 2013 might be the last month of Saturday Service at the Ft. Greene clinic, which of course is instrumentally important for working people. She attributed these cuts to overall belt tightening and the emergence of Obamacare, which she claimed is set to phase out these centers in favor of sending people to their primary care physicians for similar services.
After OWD returned to wish me well and she and SRCW sent me off, I left with a very positive impression of the hard-working people who run these public clinics. They seem extremely capable and experienced at what they do; indeed, if skills can be mastered with experience, they are certainly masters of their craft. Further, these clinics do good for a huge number of people and might even prevent massive secondary costs through early detection and treatment. So, why are these facilities having their budgets cut, when the cuts are so clearly dangerous to public health, and the money saved could only amount to a drop in the Bloomberg Bucket?
The fact that New York City Mayor Michael “Bloomie” Bloomberg sees the world through the eyes of a rich person is no surprise. After all, he is $5 billion richer even than last year. Evidently, he thinks every worker has the mentality of an entry-level Wall Street or startup employee; the unfortunate side effect is that he ends up running society like the salary cap managers of the New England Patriots, who are willing to fire a player for getting diabetes.
Bloomie offered $20,000 salary increases to public school teachers who perform better than their peers in 2012 while having made the lot of them work without a contract since 2009. Analogously, in 2012, he also promised to develop a “new, scalable housing model that is safe, affordable, and innovative,” but that turned out to be just so much window dressing: only 11 units will be available in the $1000/month range, whereas the $1800/month for most of the 350-square-foot dwellings is above-market for the neighborhood and would leave anyone who truly needs “affordable” housing in the cold. These would seem like pretty significant oversights; yet, old Bloomie has no trouble finding the time to advocate for an unconstitutional ban on large sodas (megafacepalm).
Advisability notwithstanding, Señor Bloombergo always seems to have an acute concept of which parts of his messages to keep loud and quiet. Thus, little fuss was made when the Department of Health drastically reduced STD testing services in 2011, with the department releasing the outlandish justification that “The vast majority, more than 90%, of screening visits had no infection detected, yet cost the agency in excess of $400,000 [per] year.” I would contend that even if merely 8% of visits detected STIs, it would be worth the city’s $400,000, but who am I to value New Yorkers’ health at over $400,000? I suppose that on the free market, I could probably get it as an abstract concept for $250,000 at most, so in a way, I see the Department of Health’s point.
However, it was definitely concerning when the Department of Health cut STD clinic hours on Mondays this March, citing staggered schedules and service increases elsewhere. However, the current Department of Health STD clinic schedules show that at least one of the proposed service increases to compensate for the loss of Mondays—a full day on Saturday—has already been cut. SRCW told me that the budget has now been wrung dry to the point where next month might even be the last during which the Ft. Greene clinic is in operation Saturdays.
It is important to mention why these clinics are important. Simply put, they are many people’s only safe option. Many young people are fearful of reprisal upon associating their sexual dalliances with their parents’ health insurance, and many lack the wherewithal to make appointments with doctors at all. With so many New Yorkers uninsured and so many more unable to keep a schedule, it is important to have free STD services available on a walk-in basis. When I went to the clinic, most people there were minorities, and many were plainly from disadvantaged situations. It is difficult to underestimate how many people would simply forego testing if these clinics were to close. Further, their staff members are highly skilled and specialized and have literally seen everything. My father, a specialist physician from the American West, has lamented about the poor quality of care given by urgent care centers, HMOs, and other organizations that do not specialize their care; however, according to SRCW, the writing now seems to be on the wall for facilities like these to be phased out under Obamacare. Nonetheless, it would be difficult to imagine a more efficient setup rendering a higher quality of care than that found at these clinics. It is truly sad that SRCW and her ilk are a dying breed.
This situation is patently inappropriate on its face. Scraping dollars by cutting services to people who cannot afford private medical care is quite a disturbing answer to the city’s problems. Maybe I should simply level with Bloomie and inform him that ambitious, white people use these clinics too—not just minorities—so that maybe he would be more ashamed to siphon money from them. It is necessary to restore the cutbacks that have been made at the New York City DOH’s STD clinics, including comprehensive testing for everyone who walks through the door, a commitment to provide care to everyone who walks in by the officially published closing time, and reasonable schedules to permit visits by working people.