Measuring Success

It is often difficult to measure the success of much of what we do at Tom Waddell. We have little quantitative data about health outcomes and quality of care. We simply don't have the resources to do many of the studies we want to do.

We do however have a great deal of qualitative data: Discussions with IV drug users that have administered narcan, show that the drug overdose prevention trainings we provide have saved numerous lives. The transgender-specific care we offer, including assistance with injecting hormones, has prevented deaths and serious injury that would have resulted from use of hormones on the black market.

In other words, while many of the harm reduction approaches we employ may be difficult to analyze quantitatively, we certainly see qualitative evidence to support these approaches.

On the other hand, there are certain initiatives that might require more evidence to show their efficacy: HIV testing in the urgent care clinic has been useful in detecting a few unknown positives, but without adequate time for counseling, I wonder if the more frequent HIV negative result is validating risky behavior amongst our patients

Hydrocele

A victory was had at Transgender clinic the other day. One of our male to female transgender patients was diagnosed with a hydrocele--a benign but painful fluid accumulation in the scrotum that is often removed surgically. One of our providers seized this opportunity to recommend that the surgeon actually perform a bilateral orchiectomy at the patients request. A bilateral orchiectomy is the surgical removal of both testicles, which for transgender male to female patients is an elective surgery not covered by their insurance.

Fortunately, the surgeon realized the strong desire of the patient to have this surgery done, and sure enough performed a bilateral orchiectomy to "ensure that the hydrocele did not reoccur"

This certainly was a victory in a system that makes it difficult for transgendered individuals to even get hormone therapy covered by their insurers.

The Road

I often visit our patients at the hospital or at their homes (if they have one) to see how they are doing. I will see them on the street or at the Martin De Porres soup kitchen. I never quite know what to expect.....

I have had a patient offer me weed and asked me on a date for chicken and waffles 

I have had a patient run out of his room with no pants on (or underwear) to change his cat's liter box

But I have also...

Visited a patient in the hospital who was bone thin and being worked-up for leukemia. 

I have seen patients curled up on the streets in the freezing rain. Another, in the hospital detoxing from alcohol and on so much ativan she didn't know where she was. 

Like I said,  you never know what to expect, and you never know what emotion is going to hit you next.......