Reopening the medical clinic five years after it was controversially shut, will offer a fresh start from its stigmatised history, said a physician who worked at the facility.Stanley James said he welcomed news of Government’s pledge to bring the clinic back, but advised learning from the “baggage” of its past.New Health Minister Patricia Gordon-Pamplin aims to reinstate the medical clinic, which provided Government-funded care to vulnerable patients .She conceded that its 2007 closure was also well-intentioned.Said Dr James, who worked at the clinic from 2005 until it shut: “I agree with Minister Gordon-Pamplin who recently stated the intention behind closing the clinic was laudable.“It would appear that the decision to close the clinic was rooted in a search for dignity, not just for patients but for the society-at-large, for no man is an island.”For three years after the medical clinic shut, Dr James tended to its former patients at the Mid Atlantic Wellness Institute.He said: “If only to get a fresh start and erase the stigma and the legacy of the clinic’s history, closure may eventually prove to have been a good thing.“Now we have an opportunity to evaluate the success or failure of both approaches and pave a way forward without some of the previous hang-ups.“At the same time, we can find the best way professionally to address some of the unintended consequences that we have recently inherited.”He advocates “a hybrid system with the best of both worlds” going forward.“As such we may have a system where everyone gets treated equally, those who need the most help get it and nobody is mistreated,” he added.Patient dignity is key for Dr James, who has training in theology and medical ethics as well as medicine.Currently on a sabbatical at Andrews University Theological Seminary in preparation for service in Bermuda, he is fond of quoting from the Bible’s Book of Matthew: “Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.”Asked if he welcomed the news that Government intended to reopen the clinic as quickly as possible, Dr James noted that Bermuda Hospitals Board CEO Venetta Symonds had said increasing numbers of uninsured patients were turning to the Emergency Room services at the hospital — and that the new Minister suggested many former patients had gone without treatment in the clinic’s absence.“It seems that there is a need to have a system in place to compensate for these unexpected consequences of the new system and the impact of the worsening economy,” Dr James concluded.“The options are to improve on the system that exists, revert to the old system or develop a cost-effective way to have a hybrid between the two systems.“Such a hybrid would help those who want to stay with their current care providers to do so, while those who are better served at a central medical clinic can have that benefit. All of this can be based upon their specific needs or preference.”He added: “Yet this must be done economically. At the end of the day, patient care comes first and Mrs Symonds has always been a strong advocate for compassionate, cost-effective, quality care, so I defer to her judgment as she has the utilisation data and knows what resources are available.”Considering the defects of the former medical clinic, Dr James said the facility had been saddled with negative associations.“Historically, the politics of economics and race in healthcare negatively affected the perception of the clinic and its productivity.“Over time it was deemed that innocent people were mistreated and well-intended efforts were misunderstood. I think it was a well-run clinic that simply carried a lot of old baggage.”Former Minister Zane DeSilva recently questioned why the new Government sought to “go backwards to an archaic United Bermuda Party policy of herding poor black people — and a few white people — into the most expensive place for their medical care”.Said Dr James in response: “He reflects the opinion that a segment of the society has about the clinic.”Dr James pointed to a 2007 document by Ombudsman Arlene Brock which explored shortcomings and racism at the hospital.The report gave “stark insight into the history of racial strife and division in healthcare”, he said.“This strife manifested itself in a variety of ways. Needless to say, attitudes surrounding the treatment of the poor did not escape its provinces.“Historically, the indigent clinic patients were mostly the black poor. There was a perception by some, that poor and unwanted black people were sent to a clinic called ‘indigent’,” he said.“In some quarters, it was felt that over the years the harm being done to these black patients was not physical, instead it was emotionally insulting, psychologically scarring or morally degrading.“At the same time, many patients were glad to get the care for free, and therefore they never said a mumbling word.“While this was not an issue for some in the medical community, for others it was a matter of serious racial and economic injustice. All of these non-medical issues were bad for the clinic.”In switching from the old Indigent Clinic to the medical clinic, the facility was upgraded to “a first-class facility”, Dr James recalled.“The name was changed, the volunteers were pleasant, the nursing staff was excellent, and the doctors were the same as those who serviced the general population in private offices.“In addition, the office space was extremely well kept and the administrative staff went to painful lengths to protect the privacy and respect the dignity of all patients that were serviced there.“The patients were well-known and well-cared for based upon their special needs.”He added: “Yet, the history of being the ‘indigent’ clinic shaped the way it was viewed by some in the public.“Notwithstanding, there were certain patients who disrespected and abused the noble efforts made by the community and this did not help either.“The whole image and scent of economic discrimination and its troubled history of being an ‘indigent’ clinic lingered despite efforts to redress that.”Asked what could be done to make the new clinic effective, Dr James called for close monitoring and follow-up of patients to keep them from falling through the cracks.“There would be a tremendous benefit to a prevention component of the clinic, too,” he said. “Many of the patients are highly-functioning and desire to do well for themselves.“With the correct education and support, these patients can engage in self-care and cultivate less dependency on the system and avoid worsening disease.”A transition programme could guide patients without coverage back into the mainstream, he said.However, he cautioned: “This is only one perspective among many — each of which has its own merits.“I agreed to speak to the issue because it is a matter of social justice which should escape the prism of politics and be guided by the principles of justice and beneficence. It deals with the voiceless and vulnerable of our community, who should be protected.”