An Interview with Dr. David Hilfiker


A graduate of Yale College, Dr. David Hilfiker left his northern Minnesota medical practice and moved to Washington, D.C. in 1983 to live and work among the inner city poor.

Through Church of the Savior, an ecumenical religious community, he became director of the Community of Hope Health Services and later a staff member of Christ House, an infirmary for homeless men too ill to recuperate on the streets.

His book, 'Not All of Us Are Saints', was published in 1994 and chronicles a decade spent in a world of poverty. Dr. Hilfiker now works at Joseph's House, a Washington residence for homeless men with AIDS which he helped found.

Jeanne Grunwell, Village Life's Interview Host, recently discussed homeless issues with Dr. Hilfiker. A transcript of that interview follows:


VILLAGE LIFE:
The first thing I want to ask you, since I just finished reading your book, is: What was your aim in writing it? What did you hope to achieve?

DR. DAVID HILFIKER:
I think if there was a primary goal, it was to let people know that poverty is not nearly so simple as people have made it -- that there are many more complex realities and reactions going on that most people simply aren't aware of. Just the degree, for instance, of brokenness that some very poor people experience, especially after generations of poverty. It's almost beyond our imagining.

VILLAGE LIFE:
You mentioned in your book that you tended to focus on the people who touched you most profoundly, and those aren't necessarily the most uplifting or inspiring...

HILFIKER:
I think if we can look square at the hardest problems and people who are "the worst, the most hopeless" and begin to understand where that comes from, then we can understand the others very easily. It's not difficult to deal with a poor person who's got it together -- all they need is a decent job. But how do you deal with a person who really is broken? The idea really was to talk about the worst cases and still show that there's a whole lot more going on. There's actually a whole lot more hopefulness than one would guess, too. As I said in the epilogue, by the time you've been there 10 years, a whole bunch of the people that you started writing about as hopeless are now clean and leading productive lives. I would never have thought that even possible, and that happened. Not that I particularly (was responsible), but I think the ministries I was involved with had something to do with that, by giving them unconditional love and unconditional forgiveness. Often that makes a difference in people's lives.

HILFIKER:

In the fall of 1993, (I was very depressed). I brought it up at one of the meetings. The response of the men was really very profound. There wasn't any pity or any embarrassment, or any trying to fix it. There was just a real simple acceptance that I was having a hard time. That there might not be any cure for it. That there does exist brokenness, which doesn't get fixed -- which they knew about real well. And they would just be present for me. What was happening was my being very straightforward about the depth of my brokenness, and it not affecting their feelings for me one iota.

VILLAGE LIFE:
Can you talk a little bit about how you got involved in ministering to the poor? Do you feel that it's a calling?

HILFIKER:
Yeah, very much. I had been in practice in seven years in Minnesota -- kind of an ideal practice. I burned out up there. Marja, my wife, was a good deal ahead of me in this. But we both knew somehow that we needed to be with the poor and couldn't articulate much more than that. It wasn't so much that we needed to be doing for the poor, but somehow we needed to be in relationship to the poor. And now what I understand is that when we're middle class folks, we have our position of privilege by virtue of structures that oppress other people. And whether we like those structures or don't like them, whether we're for them or against them, they are what give us our privilege nonetheless.

VILLAGE LIFE:
Such as?

HILFIKER:
A decent educational system. A capitalist system. A system that has always given me health care. Why is it that people with little education who work as cleaning ladies and work very hard get $6 an hour? And a person who has had four years or five years of education at one point in their life now gets not 10 times as much, but 50 times as much, for what isn't any harder? It makes sense in a certain bizarre way to us, but in fact it is just the way we've chosen to structure our society. So it's worked very well for us. It also oppresses other people. So, what happens in that situation is that one experiences an alienation from oneself and from God. And this isn't my thinking, this is the thinking of Dorothy Sölle, who's a German Christian Marxist theologian. And she says that the only way to resolve that alienation from God is to be on their side -- to see the world from their point of view. And once we can do that, then all of the alienation starts melting away. And it's been true. When you put yourself in a relationship with the poor, you begin to see the world in a very, very different way. That's what Jesus is all about.

VILLAGE LIFE:
One thing that I found interesting that you discussed in your book was your family and your struggles with figuring out what was best for them -- balancing that with what was best for the people that you were working with. How do you think that that affected your decisions, and how did it affect your children?

HILFIKER:
As opposed, I think, to lots of missionaries, we were really aware that the kids got to choose -- they didn't have to come along on our trip.

I mean, they got us as parents. But, for instance, when we first moved here, we moved into a mixed neighborhood. We didn't move into the ghetto.

Brokenness is not pretty.

Poverty isn't pretty. I didn't want my children to live with the danger down there. That can damage children. And it damages poor kids, and it isn't fair. But I have a choice and decided to make the choice that my kids would live in a place that was safe and a place where they could get to a decent school. Poor kids don't have a choice.

We've tried to get quite a few kids into the good schools. Most of the good schools will say they're open to kids from disadvantaged areas. Well... yes and no. They're open if those kids know middle class culture and are ready to act as middle class kids. But that's a pretty high expectation, and so a fair number of kids drop out, because they don't give them any help once they get there. That's one thing, and the second thing that seems to happen is that the kids are really forced to make a choice between their neighborhood and that school, and they're not getting any help in that. Just getting in (to the better schools) is much more difficult than I thought it would be. They have to have the top grades in their school to be considered. I've tried to get several kids in, and they haven't made it into the top schools. I was really surprised, because what the administrators have been telling me is,'Yeah, we really want them. We can't get them.'

Well, something's a little different than what they're telling us. But it's certainly true that we could get our kids into those schools. And we did sometimes and sometimes we didn't. My son has gone all the way through public school. My daughter who went to (the school Chelsea Clinton currently attends) actually wishes she hadn't gone there, because she's very much aware of the sort of homogeneity of the children in the school. My first daughter clearly blossomed at the parochial, private school where she went. In terms of how it's affected the kids, (my oldest daughter) after graduating from college spent two years as a case manager at a shelter in New York and now is in her second year of graduate school getting a master's degree in social work. (My second daughter) is a dancer who just got out of school and joined a dance company here and has to make money, so she got a certification as a personal care aide.. She works two days a week at Joseph's House and is taking care of another invalid. She also walks dogs. Probably all of them are too youngto know yet how it will ultimately affect their lives. But as I say in the book, there are dangers to this, but there are a lot of dangers to growing up in the suburbs, too, which have to do with ignorance and a set of values... I think my kids will be better prepared (for the future).

VILLAGE LIFE:
You live in Washington, D.C. where so many decisions are made about everything that's going to affect all of us. Does it strike you as ironic that this is one of the most violent and scary cities to live in in the country?

HILFIKER:
Does that strike me as ironic? No. That's what our country is based on. And so it's really quite fitting that that is who we are. For the last 20 years, the group that we've chosen to exclude and scapegoat has been the poor. And that's getting worse and worse. What's happening in the criminal justice sector of society is really a deep sin, and Christians don't seem very concerned about it.

VILLAGE LIFE:
What do you mean, specifically?

HILFIKER:
First we need to realize who gets sent to jail. Poor people get sent to jail. Over the last five or six years, all possibilities for forgiveness have been removed from the penal justice system. It used to be that judges could decide who was sent where. There were some mistakes made, but still, it was a human decision. For many of the crimes, there are mandatory sentences now. A number of places don't allow parole. Three strikes and you're out -- that's another example. Out in California, one of the first guys to be sentenced to life -- he got into a fight, which he actually lost; then a house burglary, in which no violence was involved; and the third (offense) was stealing a bicycle. And he was sent to jail for life. Those kinds of changes are directly aimed at the poor, and that's a huge sin. It's in principle no different from the Germans in the '30s and '40s. It's trying to get rid of (the poor). Do you know the statistics on capital punishment? The only people who are executed, basically, are black men, basically for killing white people. One of the big things that's been happening over the past five or six years is limits on appeals. (In a case in Texas this year), enough evidence got presented that even the prosecuting attorney said, 'I don't believe he did it,' (but due to the inability to appeal), the guy was executed. If you see all that as part of the scapegoating of the poor, which is very clear to me that that's what it is, it makes you realize the steps to which we'll go to express our hatred and fear of the poor.

VILLAGE LIFE:
Do you have any idea as to what a possible solution may be?

HILFIKER:
How do you mean 'solution?'

VILLAGE LIFE:
I mean ways to make things better in this country, so that people don't grow up in poverty, so that people aren't persecuted, so that we can take steps toward healing the brokenness.

HILFIKER:
That's actually the easy part. The hard part is convincing the rest of the people that that's worth doing. We now -- I say 'we' -- don't believe that's possible. It's rather clear what needs to be done. The problem is of such magnitude that it would take a long time for that to have the kind of results that people want, and it isn't going to be easy to do. Well, there are a number of things that are easy that we still haven't done. For instance, it would be very easy -- cost no money -- to provide universal access to health care for everybody in the country.

VILLAGE LIFE:
It would cost no money?

HILFIKER:
It would cost no more money than what we're now spending on health care. The plan is a plan very similar to the Canadian plan. It's called the single payer plan, in which the government becomes not the owner of the health care, but the insurer and takes the place of the insurance companies. It turns out that because you've got all these insurance companies, there's a huge inefficiency written into the system. There's about 20% that the government accounting office has figured would be saved by going to a public plan, and that's just about the amount that would cover all the uninsured people in the country.

VILLAGE LIFE:
Of course, in Canada there are complaints of people having to wait six months for surgery...

HILFIKER:
Right. But you need to talk to the Canadians. I was on a board with two Canadians, and we were just talking about this. By the time the complaints get down here, they are blown out of proportion. There are waits, and any system will have rations. The way we ration here is by money. If you've got money, you can get whatever you want. If you don't have money, you don't get anything. The way the ration up in Canada is by a decision made by physicians as to what's important to have and what isn't. For things that can wait, up there you will often wait.

VILLAGE LIFE:
Isn't it also true that some experimental and possibly life-saving procedures that may be done here might not be done there?

HILFIKER:
That's really not true. The point is that there's no Canadian that would trade their system for ours. There are Canadians who want to buy into our system and will come down and buy certain care. But when you ask Canadians if they're satisfied with their care, only 3% will say no. We can do that here. But politically, it didn't even get on the table. So there's a simple (step) that we won't take. When you talk about what could we do -- there's just so much that we could do. What the welfare system needs to be reformed is a system that gives people enough money so that they can live -- not so that they can't live. And at this point, even with the best welfare systems in the country, you cannot live off of welfare. All of your energy needs to be going into living. So there isn't any energy for getting a better education or finding a better job. If you get a job, you're not going to get a job for $15 and hour. You're going to get a job for $6 an hour. That's going to give you $600 take-home pay, which is going to cover your apartment. And now you don't have food stamps. You don't have health insurance, which is $300 a month. So a real welfare system would first of all create a (benefit on which one could realistically live), and then they would create incentives so you wouldn't lose all your benefits (immediately upon finding a job).

VILLAGE LIFE:
But how would we pay for that?

HILFIKER:
You need to realize that our tax rate has declined over the last 20 or 30 years to the point where it's really silly. This is another statistic I just read -- if we had the same tax rate that we had during the Eisenhower administration, we would not have a deficit in this country. All that $5 trillion. We need to have more taxes. Much higher taxes. In Finland, they pay 45% percent. Around the world, a much higher percentage of private income is not private. It's public income. We believe in this country that income that comes in needs to stay private, and that somehow that will be better for everybody. It's a nice theory, but it doesn't work. There have to be taxes to pay for this. Again, it's a question of are we willing. And the answer is no.

VILLAGE LIFE:
We were just talking about debt. I was reading that your average medical school student graduating in 1994 was $70,000 in debt. Is it realistic to expect people in that much debt to say, 'I want to go into poverty medicine?'

HILFIKER:
You need to realize that that was a conscious decision made in the late '70s by the government to make medicine into a business. When I went to medical school, I graduated in 1974 with a total debt of $3,000, all of which was forgiven for working three years in this beautiful place in northern Minnesota. And what happened shortly thereafter was that doctors were perceived -- rightly in many cases -- as abusing the subsidized education that they'd been given. And so they made them pay for it. And so they then put people into the place where they basically have to capitalize themselves in order to get this education, and now they're coming out of school with $100,000 debts. And no, I don't expect people (with high debt to take low-paying jobs). But I do blame us as a culture for that decision. There are ways of saying to people, 'If you want to work with the poor, then we will make sure that you can do that.' That would not cost the government very much money, because not very many people want to do it anyway. It would be very easy to say, 'We will forgive that debt.' And there are ways that you can arrange it, but it's quite difficult. And it could be made easy, if the poor were important to us. Any solution is going to cost money, and we're not willing to do it. It isn't really so much a matter of not knowing what to do. It's a matter of not being willing to do it.

VILLAGE LIFE:
Do people on welfare come to expect something for nothing?

HILFIKER:
When you structure a program so that people can't get out of it, when there's no incentive to get out of it, then you're going to have people who not only feel entitled to it, but are going to be angry. Because they're always told they're getting something for nothing, and yet they're not getting enough to change where they're from.

VILLAGE LIFE:
And plus they don't really have a way to get something for something.

HILFIKER:
Right. So we blame those folks because we've created a very inadequate system. But to then make the assumption that any system that gives people something is going to lead to dependency... My belief is that people are entitled to basic food, basic housing, and basic clothing. And from that point on, their incentive and their ability and willingness to work will make a difference. The problem is that we've got a system that's structured so that neither of those things happens. They're neither given the basics that they need, nor are they part of a system that allows them to get out of it. The problem isn't that we have a system that gives people something for nothing. The problem is that we've got a lousy system that doesn't have enough money in it. There was a very interesting study done -- in the papers about two years ago, I remember seeing it. They gave these people job training and sent them out, and there were 100 people. Out of the 100 people, one got a job that paid more than $15,000 a year. Two got jobs between $10,000 and $12,000. All the rest were being paid less than $10,000. When you have a minimum wage that isn't enough to live on, then to say that people can go get jobs and be out of poverty isn't true. The minimum wage in the late 1940s, when it started, was 60% of a manufacturing job. It's now under 30% of a manufacturing job. $5.25 is a big jump up from $4.25, but it's not enough to live on. It's nowhere near enough to live on. Especially when you consider that people have to pay for their health insurance. But in our country, we blame the poor for their situation. That is who we blame. And it's simply a misunderstanding of what poverty is about in this country. I don't know what it's going to look like, but it's very clear that some kind of radical politics is necessary. It's hard for me to believe that intelligent, educated people don't know any better than what they're saying.

VILLAGE LIFE:
Such as?

HILFIKER:
All these folks who are saying that we need to stop the programs, let the poor take care of themselves, and they'll be able to lift themselves up. That's cruel. No question that the programs have to be changed. But to stop them? To say they can be on welfare for five years? There are a whole bunch of people who will never get off, no matter what you do. There are people who have been broken so deeply that they themselves are never going to be better. They are incapable of holding jobs. There are lots of those folks around. We've got thousands of people on the streets who are mentally ill. That's not all the poor people. But there's a big subset of folks out there that we simply have a responsibility as a society to take care of.

VILLAGE LIFE:
What do you think that you've learned from your patients?

HILFIKER:
I suppose the deepest has been a faith in God. I'm always asked whether we evangelize these guys. If I were honest, I'd say, "Us, evangelize them? Are you kidding?" Most of them have a faith that is profound. Howard (a resident of Joseph's House who recently died) -- if anybody knew what he'd done, he'd be canonized. He used to be a burglar. But the last six years, he simply changed his life around and has done more good to more people than anybody I know. All we do is take the worst people -- drug addicts who have AIDS -- off the street, and put them in an environment in which they're loved. And within that environment, we see who they really are. And I'm absolutely convinced that had they had that kind of love and forgiveness since (chilHilfikerood), then they'd be pillars of society. In fact, what they've learned is even more valuable, because they have this sense of forgiveness, this sense of love, this sense of deep faith in God. I've always had trouble with faith in God, personally. It's not been easy for me, and they've really taught me a lot about that.

VILLAGE LIFE:
Is there anything you want to say that I haven't asked you?

HILFIKER:
Jesus' main point, I think, was that any society in a sense creates itself by excluding certain groups of people. Those groups vary from time to time, but the poor are almost always among them. The kingdom that is here is available by including those groups. It's not so much a matter of doing something for their benefit as it is trying to open the door for oneself to be in the kingdom. All the passages in the gospels about invitations to the banquet and nobody comes -- that's really what the situation is. There's this open invitation to be in this banquet where the kingdom is, and it's right here. And so few come. I guess on one hand, it's disappointing. But I just wish that more of us understood how wonderful the banquet is and how wonderful the life is, and how much richer it is than this running after money and prestige and all these other things. The game is over here. Just come on in.

Order your copy here of 'Not All of Us Are Saints' by David Hilfiker. Village Life is an associate of Amazon.com, the Internet's largest bookstore.







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