Providing medical care to underserved populations requires patience, creativity and determination. Dr. Chuck Radis ably demonstrates these attributes in his book “Go by Boat: Stories of a Maine Island Doctor,” a retrospective on the first part of his medical career in the mid-1980s.
As a medical student, Radis was awarded a National Health Service Corps Scholarship, which required that for each year’s scholarship he agree to practice one year in a “health manpower-shortage area.” Many of his classmates receiving the scholarship decided to practice in remote areas of Montana, Idaho or West Virginia – the conventional approach at that time. But Radis had other ideas – and they did not involve remote inland parts of the country.
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“Go by Boat: Stories of a Maine Island Doctor”
By Chuck Radis
Down East Books, 193 pages
$24.95
While an internal medicine resident in the (then) Osteopathic Hospital of Maine, Radis “kept bumping up against a curious reality”: Few patients from Casco Bay islands had primary care physicians, and the sole health care clinic in Casco Bay was only open part time. Radis set out to determine if Peaks, Long, Chebeague and Cliff islands, when taken together, met the definition of a “health manpower-shortage area.” If so, service on the islands would satisfy his scholarship obligations.
First, Radis had to garner support for the idea among the islanders, a task that would require him to navigate the choppy waters of varied personalities on each of the four islands. He was successful in large part due to sage advice he received: “Doc, gotta get some thicker skin if you’re gonna play with this bunch.”
That effort proved more challenging than dealing with the federal bureaucracy – although that was not without its own difficulties. Radis’s idea of combining four islands into a “health manpower-shortage area” ran into a bureaucratic fog bank: It didn’t fit into any of the existing service categories. Radis’s efforts led to creation of new category that enabled him to fulfill his scholarship obligations by serving the four islands. Unfortunately, the new category meant Radis’s program would get no federal financial support.
In the mid-1980s, after he completed a residency in internal medicine, Dr. Radis and his family moved to Peaks Island. His book recounting that time follows the story arc of patients, or composite patients, with chronic, serious and sometimes fatal conditions. We meet a group of proud, stubborn islanders whom Radis describes as “plainspoken, hardheaded and resilient” and who “frequently signed out (of the hospital) against medical advice.”
There was also a silent rising tide of substance abuse, domestic and sexual violence and the early warnings of what would become an opiate epidemic.
The commitment needed to launch and steer the ship of this novel medical practice eventually had a negative impact on his family life, something he and his wife discussed in couples counseling. “What I began to realize was that saying yes to all things in medicine often meant saying no to family.”
Aside from the considerable stress of a medical practice, much of Radis’s time was spent waiting for scheduled ferry service and riding the ferry among the four islands. “I totaled up my weekly commute by Casco Bay Ferry – eleven and a half hours….”
“Go By Boat” is a time capsule view of Casco Bay island life in the pre-gentrifying 1980s through the lens of health care. It provides a nostalgic glimpse at the almost forgotten practice of “house calls” by physicians, in which a doctor would visit patients at their homes – a precursor to today’s telemedicine visits.
Radis shows the importance of creative, out-of-the-box thinking in addressing the needs of medically underserved populations. While all his classmates were going in conventional direction Radis went to the sea – and in so doing he provided medical services to people who may otherwise have been without care.
It also shows the demanding work involve in breaking new ground in providing health care services to underserved populations. He had to negotiate with multiple island constituencies and the federal healthcare bureaucracy. This double-barreled task is not for the faint-hearted.
Finally, Radis shows the importance of meeting medically underserved people where they are and not trying to force them into a model of what a health care delivery system ought to look like.
It is true that many of his patients neglected their health and often disregarded medical advice, but Radis suggests their behavior is a function of being disenfranchised from the health care system for so long, rather than a judgment on their worthiness to receive medical care.
In 1991, Dr. Radis concluded his island medical service and began a private medical practice on the mainland. He continues exploring new ways to provide medical services to people in need through writing about Medicare expansion here in the United States and through his work with public health programs in a UN Settlement in Uganda.
Radis provides an inspiring example creating innovative solutions for existing problems – lessons applicable to health care and beyond.
Dave Canarie is an attorney who lives in South Portland and is an adjunct faculty member at USM.
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