#1 Spice

‘Bring the flavour to the fish,

Bring the flavour to the rice

Number one spice’

Queen of Katwe’s soundtrack to Kampala, Uganda’s vibrant capital, is a homily to the flavour-giving qualities of Lake Victoria salt. But the word ‘spice’ has a wholly different meaning in Northern British cities. This kind of spice adds flavour to life for a brief while, before morbidly souring it for some time longer,

I find him slumped on the floor, as if he collapsed whilst cross-legged. His head is on the ground and his tongue lolls outside his mouth. He’s sat in a common begging spot used by various bedraggled, homeless people:

‘Is the patient breathing?’

My response to the 999 call handler is delayed by passers-by yelling ‘Leave him … he’s fine … he’s on spice’

‘Yes, respiration’s a little slow, but usual’

‘Are they conscious?’

‘Responding to voice’

At this point the patient’s head, still not moving or lifted from the ground, cries out: ‘Fuucckk offf. It’s legal’.

I step back.

‘Can you reassure him?’

‘I can, but can you send an ambulance please?’

I don’t know what happened to him. The paramedics most likely calmed him down and – with his permission (likely not given) could have taken him to an Emergency Department where he’d be left to come back to life in the Clinical Decisions Unit.

I do know that it’s not the first time I’ve found someone in this state because of spice, or that passers-by have been so unsympathetic.

Several weeks previous, I find a man slumped on the street in a different city. Every so often he staggers around, confused, and at very high risk of falling onto the concrete side road and sustaining a life-altering head injury. Here too, passers-by shout stronger judgments despite his dangerous and unwell condition:

‘He’s brought it on himself … he doesn’t deserve help … he’s a waste of money and time’

As the patient shouts profane abuse, someone passing by who claims to know him and have worked in a hospital he ended up in shouts at him ‘don’t be rude’ and ‘I won’t tolerate this abuse,’ blind to his fear and vulnerability. Of course he’s not being kind, but what he needs from professionals is support and reassurance.

In Queen of Katwe, a small child runs into a dust-track in the slum and gets knocked down by a motorbike. He is taken to hospital, where he services despite self-discharging early due to inability to pay for treatment. Is the accident his fault because he wasn’t old enough to look for traffics every time? Because his mum took her eye off him for a brief second? Because he is unfortunate to live in a poor area full of risk?

We wouldn’t dream of suggesting such a thing. Now, the situations are on tenuously comparable. But let’s think about our spice men again. One may have been homeless. The other is definitely homeless (as disclosed by the paramedics when they arrive). He looks African, and his handle of English is poor.

Now, he would deserve compassion and care even if he were a privileged white British kid who’d made a few mistakes in life.

But let us imagine for a moment that he’s a recently arrived refugee having fled conflict in his home country only to face racism and homelessness here. Spice guv a him a brief escape from his misery and cold street. A brief escape from himself.

Who are we to judge that? Who are we to say ‘leave him … he doesn’t deserve treatment’?

Do some of us make these judgments because we fear looking someone in the eye who has lost everything, and seeing another possible version of ourselves? A version of ourselves struck by a mixture of bad luck and personal weakness, and punished dearly for them by abject suffering.

The first line of the NHS Constitution begins: ‘The NHS belongs to the people … It touches our lives at times of basic human need, when care and compassion are what matter most.’

We would do well to remember and cherish that when we find someone facing misfortune.

NHS Constitution

#1 Spice

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