HEALTH CARE/Joan Retsinas

Santa Claus in a Fez

This is Santa Claus season. The rotund bearded man, ho-ho-ho-ing in malls and on sidewalks, wears the standard uniform: white-fur-trimmed boots, a red jacket trimmed with white fur, a floppy hat with a tassel, also fur- trimmed. He sports a wide black belt around his wide girth. He greets admirers with: “Merry Christmas, Happy New Year.”

Even adults who have stopped believing remember the routine: children sit on his ample lap to deliver their wish-lists. The more erudite children write him letters. The more articulate the child, the more elaborate the letter—some include stores and prices. Ultra-precocious urchins e-mail their desires, with jpg-photos attached.

The legend has it that Santa makes his toys with the help of elves in the North Pole, that he delivers them with the help of Rudolph and a retinue of red-nosed reindeer. He shimmies down chimneys, toting bags stuffed with toys. He rewards good children for being good.

I believe in Santa Claus, but I don’t think those omnipresent versions are the real thing.

The real Santa wears a red fez. He greets people with “Es Selamu Aleikum.” He hangs out in temples named “Cairo,” “Damascus, “ “El Katif.” Sometimes these Santas lose their fezes for floppy hats, red bulbous noses, size 23 sneakers, and 2 pounds of grease-paint on their faces. These Santas rarely speak: they are clowns after all, and clowns don’t talk.

When these fezed Santas travel, they go via motor scooters, or in circus-type wagons. These Santas may play brass instruments. They may make balloons. They may do elaborate mime routines.

These Santas have no toys.

Nor do children write letters to these Santas.

Yet these Santas hear children. The pleas come as anguished prayers for help, uttered by children in pain, and parents in despair. The children are neither good nor bad — simply ill, with burns, orthopedic malformations, cleft palates, spinal cord injuries. Toys — the coinage of this season — won’t help. These children need — they want — physicians and nurses and therapists and researchers. They need a medical care system that welcomes them.

In 2008 America, toys are cheap, thanks to a third-world labor-force churning out plastic gizmos. Conventional Santas can pop into Wal-Mart at the last minute to fill most children’s wish-lists.

Health is a harder find. To seek care for ill children, parents must enter Insurance-World, with its ominous warning at the portal: “After exhausting appeals, insurers might pay some, or none, of the mega-bill.” Then there are the roadblocks: pre-existing conditions, prior authorization, experimental treatments, co-payments, limited networks, limited formularies.

These Santas, though, have erected another world, call it Shriner-World, after the generations of Shriners that spearheaded a system of hospitals geared to children with burns, with orthopedic deformities, with cleft palates, and with spinal cord injuries.

An outgrowth of the Masons fraternal organization, the Shriners date from 1870. In 1922 the group moved to establish a hospital for children with polio. Each Shriner pledged $2 annually. The first hospital opened in Shreveport, La. Since then the network has grown to 22 hospitals; the last one opened in Sacramento in 1997.

Endowments and contributions subsidize these hospitals. (To contribute, see

When parents enter the portal of Shriner-World, nobody asks their income. Nobody records their insurance specifics. Nobody arranges payment of bills. Indeed, these hospitals have no billing departments.

Merry Christmas, or, in the words of a Shrine response, “Aleikum es Selamu” (with you be peace).

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, December 15, 2008

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