Everyone Has a Story

            Paola is an 81 year old Ecuadorian woman who I met for the first time 6 months ago.  Today, I noticed her enter the shelter and eye the clinic sign-in sheet from a distance before proceeding to the breakfast line.  Wondering if Paola had a medical issue but was too reticent to sign up, a common situation among some of the homeless women, I approached her in line and asked her how she was doing.  She gave me a big smile, and exclaimed, “Doctor, you remember me? That is so nice!” 

Turns out, Paola did had a reason to come see us.  She reported itching of her both feet that started 2 months ago with burning when she takes a shower.  In the clinic, her foot examination revealed bilateral clearly-demarcated, erythematous, plaques with central clearing on the soles of both feet extending up the medial aspect of the feet.  She had associated thickening and cracking of her toenails characteristics onychomycosis, a fungal infection of the toenails.  The diagnosis was tinea pedis, more commonly known as Athlete’s foot, which is a fungal infection of the feet readily-treatable with antifungal cream and hygiene.

            While applying Paola’s cream and helping her put on a new pair of socks, I took the chance to get to know her better. I found out that Paola came to Boston close to 20 years ago with her husband for tourism.  They did not speak the language, nor did they have families in the country, which made it extra devastating when her husband became ill and required a long hospital stay that they could not afford.  By the time Paola’s husband had recovered, they had used up all their travel money and were without means of returning home.  As such, this brave elderly couple remained in the Boston, in and out of homelessness, until they were able to learn English, apply for a Green Card, rent an apartment in their ethnic neighborhood, and establish medical care at a prestigious hospital. 

            Beyond being an inspiring story of overcoming adversity, Paola and her husband are an example of the cycle of homelessness.  Traditional teaching delineates personal versus economic reasons for homelessness.  Personal factors include mental illness, substance abuse, domestic violence, and illness itself while economic factors include extreme poverty that makes rent and health insurance out of reach.  However, I think the most important thing to understand is that all these factors are interlinked.  Paola and her husband lack most factors leading to homeless, but an acute illness resulted in enough financial destitution to render these two people helpless and homeless.  Six months ago, I had no idea where Paola came from, but I am so grateful to have been able to hear her story.