Public Health Nursing and the Myths of Poverty

As a public health nurse I receive referrals for a myriad of reasons. I work with families at what is likely one of the lowest times of their life. They are nearly all living in poverty- that is pretty much universal.

Before becoming a nurse, I was blind to the pervasiveness of poverty. I think that I believed in the abundance of Iowa, of America- and surely all who wished to be would be sheltered and fed. I was so very naïve.


Today, my work days are filled with visiting the homes of families living under the shoddy umbrella of poverty. I slog into low income apartment buildings bearing my nursing bags, hoping not to bring any of the cockroaches, bed bugs and such that often permeate these buildings back home with me in one of my bags. I am saddened that I worry about bringing these things back to my home when my clients are so used to living this way. I advocate for them with their landlords, knowing that many times my words will fall on deaf ears. I realize that bugs are often the very least of my client's worries.

I am sometimes scared. The hallways of these buildings are often dark and smell of mold, cigarette smoke and other unknown, and I fear-unspeakable, things. I am going into these places in the light of day and often wonder what it would be like to stroll this hallway under the cover of night, with my children in tow. How scared I would be. I wonder if my clients are also scared, or if they have become so accustomed to this way of life that it is no longer scary. I wonder what is worse- dropping your guard so that you may become an unsuspecting victim or living a life of fear? I shudder away those thoughts, because they make me feel helpless. I spend so many of my work hours feeling helpless.

I know things now that I often wish I didn't know. How often children go hungry in this country. How prevalent abuse is. Just how little we actually help those in need. How low we often make those living in poverty feel.

My fears seem very small compared to my clients. I fear that I can never do enough to help them. When I lay down this nursing badge- this false badge of courage, and undrape my stethoscope from around my neck at the end of the day I am often saddened by how little I could do for them. I hope that it was enough.

On a daily basis, I hear the stories that my clients entrust me with. The stories that are only told behind closed doors. The stories that curdle my blood.

Refugees tell me of the horrors of their former country and I try not to weep unabashedly as though the pain was my own. They tell me of the gratitude to be in this country, but-if only it were safe again- how they would rush back to their home. They tell me that they cry themselves to sleep in longing for what once was. They dream and hope for their children to never see the horrors that they have seen in their lives.

Single mothers tell me of their past. Abusive boyfriends/husbands. The need to receive love, which they have often found in the arms of someone that never really loved them. The constant exhaustion. The struggle to work and provide for children with no help at all. The deep desire they feel that their children should have a better life than they have, without the constant struggle.

The parents who have spent time in prison tell me their stories. They are often brutally honest of their past transgressions. They have served their time but live in a society that no longer allows second chances. Something that was done in their youth may haunt them for their entire lives. They want their children to learn from their mistakes, to go to college instead of being locked up. They beg for opportunities to prove to society that they have changed, so that their children can have a better life.

Addicts tell me of their stories. Of how young they were when the struggle with addiction began, often as children. They tell me of their mother's/father's/grandparents addiction and how they once promised themselves that they would not be like them. The shame that they feel that they are repeating an egregious cycle. The fear that they feel that they will not overcome it. They tell me the importance of taking it day by day, but that a single day can feel so very, very long. They pray at night that their children will have better lives than they.

The abusers/neglectors tell me their stories. These are often the hardest stories to hear. The thought of anyone hurting a child makes a pit the size of a black hole in my stomach and it is often hard to remember not to judge. Then, you hear the stories of their childhood. The stories of their own abuse and neglect as children. These stories are most likely the hardest I have ever had to listen to-let your imagination run to the bowels of what you believe a human being can be capable of, and then go deeper-the stories take me to a place that I wish did not exist. What has been done cannot be undone. The shame they feel that they have subjected their children to the same. The shame they feel often permeates everything around them- I cannot leave these visits without feeling that it may have permeated me, as well. They want so desperately to be better parents and for their children to live a life without any further pain. They cry, screaming into their pillows so that no one can hear, for forgiveness and for their children to have a better life than they have.

I hear the stories of those who are here, in this bleak place, because of the mistakes of others. The teen mother parenting the child of the man who raped her. The family who lost their lovely home after the loss of a job, and are now living in poverty for the first time ever. Those whose medical condition leaves them unable to work any longer, and who squeeze by on that tiny disability check. Those who have lived a life of poverty and know nothing else, have lost hope for anything better.

Each one of us has a story within us. Many of my clients have stories that would be far too gritty to be shown on even the most liberal of television stations. The ever more violent media has nothing on these stories. Nothing. Even my hardened nurse's stomach has threatened to purge at the truths coming from my client's lips.

Long after I have forgotten the names and faces of my clients, their stories will live within me. I am grateful for each and every word told to me in confidence. I carry the words carefully inside my heart.


What I want my clients to know about me:

Our program is voluntary, but I hope you will let me in for just one visit in your home before you decide if you will accept our assistance. So, that you will see that I am not like those who stare you down in the grocery store in anger when you pull out your SNAP card to pay for groceries. To see that I will not judge you and truly only want to help. To see that I will do everything I can to leave your family in a better place than where I found you.

I SEE you. Not just what society sees. They seen a downtrodden human being that they imagine is "screwing the system". They want you to feel shame for every WIC check, food stamp and rental assistance dollar that you take. There will be no shame, no groveling expected from me- that is pure bullshit. I see you. Yes, you. I see how hard you are working to make a better life for your family. I see the love that you have for your children, even if you are sometimes unsure of how to show it. I see you, flaws and all, and am so grateful that you showed me the dark parts of your life as well as the successes.

I can teach you better parenting. I can assist you to find the local food pantries and apply for health insurance and sign you up for classes to learn English. I can encourage you to finish school, go back to school, attend AA/NA meetings, give you lists of current job openings and help you apply for child care assistance. I can teach how to live a healthy life, when to take your child to the doctor, give your information about your child's health care and educational needs. I can do all of this and more. However, as much as you respect me and my job as nurse- it is YOU who is doing the hard work. I will leave you after our visit today and it will be YOU who will stay up with a crying baby all night and apply for jobs tomorrow. It is YOU will administer your child's medicine and take them to the doctor. It is YOU who will make your life better by moving forward everyday in ways that will sometimes feel painfully slow.

I am grateful for you. I am inspired by my clients in a way that is impossible to verbalize. You make my struggles seem insubstantial. You make my life better simply by allowing me to be a small part of your life.

There is a lot of poverty hate in this world. You cannot turn on the television or scroll through social media without seeing the pervasive ideas of people "living off the system". People who want you to grovel simply because you need an occasional hand up. They don't see the truth, but what their every-angry hearts want to see- this misnomer of people sitting on their duffs and raking in the bucks. I see the reality- how you struggle for everything you have. How little we give to those in need. How bare your pantry constantly is, because the food stamps don't cover the entire month. How you go hungry so that your children can eat. How much of your hard-earned income goes to pay for this shitty, low-income apartment that you hate, but are ever so grateful for.

For every client that I have, there are hundreds, thousands more out there living in sometimes desperate poverty. Maybe you are one of the thousands struggling through each day. I commend you on your strength, even as society wants you to falsely believe that poverty equates with weakness. You are so very strong.

So-you there. Yes, you. Struggling just to make it through today. I see you. I commend you on your hard work. Screw the nay sayers- they don't know what in the hell they're talking about. You make this world a better place with your every effort. You may live in poverty of currency, but you are rich in so many other ways. And, those of us who take the time to truly see you- are richer simply by knowing you.

This article was originally published on The Zen RN.