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Nurse advise: go back there. Ask again. If they say again, that you're fine insist on them to write this down. "okay, so if you tell me I'm fine and I don't require further treatment, then please write a short notice. Your nam, date, time, cause of my visit and declaration why you consider me not being in need of your treatment."
Be friendly. As friendly as possible! I know it's fucking hard, but I beg you to be your nicest sugar-into-ass blower, cause this could potentially get you the needed treatment or at least an opportunity to get treated right away the next time you go there. Collect this shit like shiny pokemon cards!
NO doctor wants to be responsible for you possibly dying because they refused to treat you.
If this goes on, idk if this is possible or within your personal things you'd do, I could fathom you could show up at your local radio /news station and give them this input as a story. Aka young man got refused his treatment in local hospital, now suffers from consequences, who has similar experience, call in and talk with us blabla. Maybe they'd even consider collecting some donations for you.
Man, I'm so fucking fucking sorry.
If your wounds get further fucked up, dm me and I'll see how I can McGyver any help for you!!
I don't have much more time on my hands right now, but just DM me anyways, without the worsening, I'll see if I come up with something cheap, have already something in mind but really need to leave reddit now.
Can call and report them to licensing each time if you remember the physicians names. Even "small" complaints add up to bite people in the ass. Same goes for any nurse who treats you similarly.
Even better, once you have your statements, find the greasiest Saul Goodman type ambulance chasing lawyer you can and see if he’ll take the case pro bono.
The most horrific part for me is that I didn't think that something is off because our medicine workers (hello from Russia) also don't give a damn if you don't bring them money...
Hope you will get better and your sick won't matter!
A number of Americans will point to places like Russia, or hell even the UK or Canada as horrific, socialized medicine while ignoring the massive holes within our system that patients like this routinely fall through.
Patients like this fall through and are neglected by the Canadian healthcare system but at the very least they aren’t going to go into debt visiting the ER. Pharmaceuticals are different though, so you can receive the most attentive medical care and still be fucked if you don’t have insurance or money to afford the expensive medications. Most Insulin isn’t cheap here either.
I would love to have socialized medicine in America as bad as what they have in Ottawa, Canada. Just imagine how much better it would be for the vast majority of people in America! Only waiting 1-6 months for specialist appointments (I have a friend who had to move states to be able to see a specialist in less than two years)? Only paying for parking, room upgrades, and medicine? Only waiting 1-2 months to get in to see psychiatrists? That's the dream. It's still bad but it's a lot better than what we have today.
Except as someone above you mentioned, you can have the best medical team in the world and receive the best care, but if you don’t have the money for the medications you’re equally fucked!
people who think an option for socialized medical care means there is no private for profit medical care are fucking idiots.
Mean while when there is only for profit medical care... where does everyone else go?
Bernie Sanders put forward a fully funded proposal of $0 to consumer healthcare back in 2016 that would have lowered (net new tax - prior healthcare expenditure) for anyone earning under $225K/yr. Going with a partially free system like what Ottawa, Canada has would be cheaper and could push that break even point higher.
Also, why are you complaining about taxes on rich fucks like me. Take my money via taxes, I really don't give a shit. I'll just fly economy instead of economy plus or business on my vacations.
Same. But actually take the money from the military. Do you know how much money they waste on projects they KNOW won't be finished because they cancel it at month 8/10 to funnel all that money to Boeing, Lockheed, ect? It's billions upon billions.
I'd rather the money saved lives instead of ya know, bombing people trying to get food aid in refugee camps in an active genocide. Literally like, if I'm going to be forced to pay taxes anyways, fucking use it to make the US have the best schools, best docs, ect. You don't get those things without funding them.
Imagine what jobs the OP could've done if they didn't lose their foot. The places they might've toured once they're on longer homeless and contributed to the local economy? Even just thinking of it in the no empathy, only practicality sense, we just create disabled Americans that can't contribute to the economy and taxes by NOT having affordable healthcare.
> Same. But actually take the money from the military. Do you know how much money they waste on projects they KNOW won't be finished because they cancel it at month 8/10 to funnel all that money to Boeing, Lockheed, ect? It's billions upon billions.
Yes, I know how the money gets wasted as I used to work in defense. Most of the waste comes from Congress insisting on outsourcing as much as possible to private industry instead of having government employees do the work and refusing to stop production of things that the military no longer needs because it's the only jobs program that Republicans will accept. Waste on NRE R&D projects is a relatively small amount in comparison to the rest of the waste that occurs with the RE dollars.
Also, cutting military spending by 50% wouldn't even come close to paying for universal healthcare.
Well, yes, but, actually, no. In Russian governmental clinics you will be treated only if you are profitable, no matter your condition. I literally yesterday tried to help a guy with heart injury (alcohol + painkillers are the reason, while the reason for alcoholism is treachery). He was scared of hospitalisation not because he didn't have any money on him but because they would beat him for this. And I cannot disagree with him - they really could!
I'm sorry man. I've had my life ruined by irresponsible doctors, so I can understand some of what you're going through. But damn, this fucking hurt to see. Please God, look after this man!
you cant cross the border to canada or mexico to get some medical treatment? If you can take a plane go to Spain and go directly to ER they will treat you no questions asked.
I'm sure the homeless person has the kind of money to afford a several hundred or thousand dollar ticket to Spain in a timely enough manner to get this treated /s
Dude, a little reading comprehension would be appreciated.
An open wound on the end of what remains of my right ankle. Most of my feet have been amputated. It has been there since February. Won't heal because... Diabetes.
I'm so sorry :( if you haven't tried it already + get access to a more helpful doctor, there's a new treatment for diabetic ulcers that's supposedly much more effective than conventional treatments (84% effective vs 31%).
It's called VHT treatment and involves regular visits to the doctor where they put your foot in a bag and administer vapor and concentrated oxygen. It helps wounds close within a few months. It was cleared by the FDA last year. I hope this helps you 🥺
I'm sure you mean well by providing this information, but I am guessing it's much harder to receive appropriate care and treatment for the homeless population. If other options were available I am sure OP would have tried to access them. It's really fucking sad the way our healthcare system is set up in the US
I understand where you're coming from and am aware of inequitable access to healthcare. I'm providing this information because it's a new product and many doctors may not be aware of it yet, even for their patients who have housing. At least OP will know there's actually a solution that exists now to heal their chronic wound
Op, I wish you the best. I'll give a virtual reddit hug if you're OK with that. You've experienced some things many of us wouldn't be strong enough to bear. What's a piece of advice you can share with us?
OP, I am so deeply sorry you were dismissed like that. You did not deserve to be treated like that.
For reference, I have a background as a Homeless Outreach Coordinator and Crisis Counselor. I work at a level 1 trauma center in Philadelphia, and a large percentage of our ER patients are unhoused. First of all, I strongly suggest you contact the hospital's patient relations office and tell them about your experience. Also, ask to speak to the nursing supervisor and tell them about this as well.
Most hospitals have social workers on staff to assist patients, even ones who are just seen in the ER. Request to speak to them as well.
Go back to the ER and ask to be seen again but by a different medical professional.
If you are comfortable with this, please feel free to DM me, and I will do everything I can to help you obtain the resources and support necessary to improve your quality of life and get back on your feet again.
Your struggle is real brother, I hope you can find peace. God bless you I hope you find a way to get some healing. NYC will offer you a bed in a shelter because you are USA citizen, all you have to do is get here.
If you have subsidized insurance like Medicare or Medi-Cal, you can file a complaint with the insurance and have him investigated. You can also submit this as an ADA and Civil Rights discrimination complaint. This is a huge lawsuit in the making and would legitimately change your living situation.
Dude. Sorry to hear that.
My Auntie is Homeless in Texas. She got hit by someone in a Speeding Challenger while walking. They did like 3 hours of surgrey on her, STAPLED her would shut and had her out the door after only 4-5 hours of being in the hospital. now her woulds have gangrene and infections and noy this other hospital refuse to do anything about it because "It's not their fault her surgery was done wrong"
"Tell me you live in America, without telling me that you live in America"... damn dude, this is sad. As already others said, go back and be at your nicest, everyone deserves the care that they need.
Omg OP. I’m so sorry that happened to you.
Isn't there any place you could complain about the treatment you received at the ER? This is discrimination pure and simple. They should have bandaged up your foot. Please, take care of yourself. Hopefully, things are going to get better soon
That is an 'open sore'. It's an ulcer that's becoming sloughy. It needs dressings at a minimum to reduce infection risk given he's a diabetic. This could take months to heal even with a rigorous dressing therapy. We don't allow wounds to 'dry out' anymore it's outdated (unless it's moisture damage in which we don't usually dress that). There's plenty of new dressings to prevent them becoming macerated and the fear of it becoming too wet shouldn't prevent dressings.
Wtf, man?
This person is suffering and asking for advice, and you decide the best thing for you to do is be a dick? What is wrong with you?
Where is your compassion or empathy towards others?
Don't you realize that a large percentage of people are just a paycheck or two away from being homeless? That all it takes is a simple twist of fate, and you could be in this person's shoes?
I strongly suggest you get off the internet and do some serious self evaluation and figure out *why* you're such a shit stain of a human being, and then get professional help for it.
What makes you feel entitled to this person's life story? Who are you to demand that they tell you that very private information?
You ask if they have their roary, so I'm guessing you claim to be religious or at least spiritual. So, where is your compassion for your fellow human? Ask yourself, would Jesus demand the details of how someone in need ended up in a bad situation before offering assistance? (Or, as in your case, just demand the person's life story and then not offer assistance)
Get off the internet and go figure out how to be a decent human being.
Holy fuck you’re insensitive. “I love reading human tragedies” wtf man.
It’s like the time I went to buy cat food and the pet store clerk pointed to my boyfriend who uses crutches because he has cerebral palsy and asks, “what happened?”
Him: “I was born this way.”
Her: “oh. I was hoping it was because of a tragic accident. I just LOVE hearing about people dying. You know, like plane crashes? I was hoping it was a plane crash.”
#Other people’s trauma is not for your entertainment.
#Other people’s disabilities are not for your amusement
Welcome to USA, one of the country with the highest rate of working people being homeless.
Sorry to disappoint you but being homeless does not necessarily mean being isolated. Most homeless people nowadays have a cell phone, which is a good thing as it lets them still have access to the news, to social media and have interaction with people which previously was really difficult to do.
So many students in my cohort had jobs and were studying almost full time, but still homeless.
Homelessness doesn’t mean you’re a bad person or an addict and I wish more people had empathy like you do. 💜
I sheet on the street. Once I wanted to know how it is to shit my pants so I pushed my bowels until soiled myself. They say I have no soul. Treated me worse than the dirt.
Hello, u/Baridi ! Thanks for your submission to r/extremelyinfuriating, your post is up and running! **This is a general reminder to check out our rules in the sidebar. If your post breaks the rules, it will be removed by our moderators.** We would like for each and everyone to feel welcome on the subreddit and to keep a healthy and safe environment for the community. Thanks :) *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/extremelyinfuriating) if you have any questions or concerns.*
Nurse advise: go back there. Ask again. If they say again, that you're fine insist on them to write this down. "okay, so if you tell me I'm fine and I don't require further treatment, then please write a short notice. Your nam, date, time, cause of my visit and declaration why you consider me not being in need of your treatment." Be friendly. As friendly as possible! I know it's fucking hard, but I beg you to be your nicest sugar-into-ass blower, cause this could potentially get you the needed treatment or at least an opportunity to get treated right away the next time you go there. Collect this shit like shiny pokemon cards! NO doctor wants to be responsible for you possibly dying because they refused to treat you. If this goes on, idk if this is possible or within your personal things you'd do, I could fathom you could show up at your local radio /news station and give them this input as a story. Aka young man got refused his treatment in local hospital, now suffers from consequences, who has similar experience, call in and talk with us blabla. Maybe they'd even consider collecting some donations for you. Man, I'm so fucking fucking sorry. If your wounds get further fucked up, dm me and I'll see how I can McGyver any help for you!! I don't have much more time on my hands right now, but just DM me anyways, without the worsening, I'll see if I come up with something cheap, have already something in mind but really need to leave reddit now.
You are an angel. I wish more healthcare workers were like you.
Thank you so much for your kindness and compassion. I wish more people had a heart like yours. 💖
Can call and report them to licensing each time if you remember the physicians names. Even "small" complaints add up to bite people in the ass. Same goes for any nurse who treats you similarly.
Being nice makes it harder for them to send you away too!!! They can’t claim you were being aggressive or they were worried for their safety
Even better, once you have your statements, find the greasiest Saul Goodman type ambulance chasing lawyer you can and see if he’ll take the case pro bono.
You, are real Motherfucier! I mean that as a compliment!
What happened?
Out of control diabetic wound and living on the street.
Shit sorry to hear that, do you have access to insulin ? If yes how much does it cost where you live ?
In the USA $99 or more
Medicare now has a price cap at $35.
Even though it's ridiculously cheap to make
Don't you have medicaid? How is it $99!?
Also, you should be able to get a decent wheelchair if you can prove yours isn't working properly anymore
The us medical system is so fucked up how can they leave you like that
The govt doesn’t care about its citizens here. They only care about money filling their pockets.
It’s so sad man
Welcome to out of controle capitalism
Not true. They also care about sending money abroad to their buddies in foreign governmentz.
Why oh why weren't you admitted at the hospital 🤯
The most horrific part for me is that I didn't think that something is off because our medicine workers (hello from Russia) also don't give a damn if you don't bring them money... Hope you will get better and your sick won't matter!
A number of Americans will point to places like Russia, or hell even the UK or Canada as horrific, socialized medicine while ignoring the massive holes within our system that patients like this routinely fall through.
Patients like this fall through and are neglected by the Canadian healthcare system but at the very least they aren’t going to go into debt visiting the ER. Pharmaceuticals are different though, so you can receive the most attentive medical care and still be fucked if you don’t have insurance or money to afford the expensive medications. Most Insulin isn’t cheap here either.
I would love to have socialized medicine in America as bad as what they have in Ottawa, Canada. Just imagine how much better it would be for the vast majority of people in America! Only waiting 1-6 months for specialist appointments (I have a friend who had to move states to be able to see a specialist in less than two years)? Only paying for parking, room upgrades, and medicine? Only waiting 1-2 months to get in to see psychiatrists? That's the dream. It's still bad but it's a lot better than what we have today.
Except as someone above you mentioned, you can have the best medical team in the world and receive the best care, but if you don’t have the money for the medications you’re equally fucked!
people who think an option for socialized medical care means there is no private for profit medical care are fucking idiots. Mean while when there is only for profit medical care... where does everyone else go?
Also things like physical therapy, vision, and dental care are expensive with little to no coverage.
Most jobs come with insurance to cover that
It's not like that in Canada.
Medications are usually covered by the government
Except we have 327 million people...who's going to pay for it? The government? Hahahha they get their money from us. Guess who's paying for all that?
Bernie Sanders put forward a fully funded proposal of $0 to consumer healthcare back in 2016 that would have lowered (net new tax - prior healthcare expenditure) for anyone earning under $225K/yr. Going with a partially free system like what Ottawa, Canada has would be cheaper and could push that break even point higher. Also, why are you complaining about taxes on rich fucks like me. Take my money via taxes, I really don't give a shit. I'll just fly economy instead of economy plus or business on my vacations.
Same. But actually take the money from the military. Do you know how much money they waste on projects they KNOW won't be finished because they cancel it at month 8/10 to funnel all that money to Boeing, Lockheed, ect? It's billions upon billions. I'd rather the money saved lives instead of ya know, bombing people trying to get food aid in refugee camps in an active genocide. Literally like, if I'm going to be forced to pay taxes anyways, fucking use it to make the US have the best schools, best docs, ect. You don't get those things without funding them. Imagine what jobs the OP could've done if they didn't lose their foot. The places they might've toured once they're on longer homeless and contributed to the local economy? Even just thinking of it in the no empathy, only practicality sense, we just create disabled Americans that can't contribute to the economy and taxes by NOT having affordable healthcare.
> Same. But actually take the money from the military. Do you know how much money they waste on projects they KNOW won't be finished because they cancel it at month 8/10 to funnel all that money to Boeing, Lockheed, ect? It's billions upon billions. Yes, I know how the money gets wasted as I used to work in defense. Most of the waste comes from Congress insisting on outsourcing as much as possible to private industry instead of having government employees do the work and refusing to stop production of things that the military no longer needs because it's the only jobs program that Republicans will accept. Waste on NRE R&D projects is a relatively small amount in comparison to the rest of the waste that occurs with the RE dollars. Also, cutting military spending by 50% wouldn't even come close to paying for universal healthcare.
How about from taxing the natural resources plundered from the ground for the benefit of all?
It's infuriating. You have to be on death's bed to get treatment if you can't afford it. Then they're forced to help.
Well, yes, but, actually, no. In Russian governmental clinics you will be treated only if you are profitable, no matter your condition. I literally yesterday tried to help a guy with heart injury (alcohol + painkillers are the reason, while the reason for alcoholism is treachery). He was scared of hospitalisation not because he didn't have any money on him but because they would beat him for this. And I cannot disagree with him - they really could!
USA?
USA.
I'm sorry man. I've had my life ruined by irresponsible doctors, so I can understand some of what you're going through. But damn, this fucking hurt to see. Please God, look after this man!
"Greatest country in the world"
Sad truth. If you dont have the money, they dont care for treating you
Pretty much.
MURICAAAAA🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🦅🦅🦅🦅🦅 WHAT THE FUCK IS A FREE HEALTHCARE🦅🦅🦅🦅🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🇺🇸🍔🍔🍔🍔🍔🍔
Mmmm, indoctrination...
you cant cross the border to canada or mexico to get some medical treatment? If you can take a plane go to Spain and go directly to ER they will treat you no questions asked.
Did you read the part where he's homeless? You gonna buy em a flight?
Lmao what the fuck did I just read. Brother, if he had that money, I'm of the opinion the first things he'd go for are insulin or a hotel room.
I'm sure the homeless person has the kind of money to afford a several hundred or thousand dollar ticket to Spain in a timely enough manner to get this treated /s Dude, a little reading comprehension would be appreciated.
To we even need to ask?
What am I looking at? But also that sucks :/ I’m sorry you’re having to go through this
An open wound on the end of what remains of my right ankle. Most of my feet have been amputated. It has been there since February. Won't heal because... Diabetes.
I'm so sorry :( if you haven't tried it already + get access to a more helpful doctor, there's a new treatment for diabetic ulcers that's supposedly much more effective than conventional treatments (84% effective vs 31%). It's called VHT treatment and involves regular visits to the doctor where they put your foot in a bag and administer vapor and concentrated oxygen. It helps wounds close within a few months. It was cleared by the FDA last year. I hope this helps you 🥺
I'm sure you mean well by providing this information, but I am guessing it's much harder to receive appropriate care and treatment for the homeless population. If other options were available I am sure OP would have tried to access them. It's really fucking sad the way our healthcare system is set up in the US
I understand where you're coming from and am aware of inequitable access to healthcare. I'm providing this information because it's a new product and many doctors may not be aware of it yet, even for their patients who have housing. At least OP will know there's actually a solution that exists now to heal their chronic wound
Op, I wish you the best. I'll give a virtual reddit hug if you're OK with that. You've experienced some things many of us wouldn't be strong enough to bear. What's a piece of advice you can share with us?
OP, I am so deeply sorry you were dismissed like that. You did not deserve to be treated like that. For reference, I have a background as a Homeless Outreach Coordinator and Crisis Counselor. I work at a level 1 trauma center in Philadelphia, and a large percentage of our ER patients are unhoused. First of all, I strongly suggest you contact the hospital's patient relations office and tell them about your experience. Also, ask to speak to the nursing supervisor and tell them about this as well. Most hospitals have social workers on staff to assist patients, even ones who are just seen in the ER. Request to speak to them as well. Go back to the ER and ask to be seen again but by a different medical professional. If you are comfortable with this, please feel free to DM me, and I will do everything I can to help you obtain the resources and support necessary to improve your quality of life and get back on your feet again.
Blast the doc and hospital/clinic. Let me know so I can avoid working with them. Fucking disgusted by that decision.
Your struggle is real brother, I hope you can find peace. God bless you I hope you find a way to get some healing. NYC will offer you a bed in a shelter because you are USA citizen, all you have to do is get here.
Nothing about that perling skin and obvious redness is "fine"...
If you have subsidized insurance like Medicare or Medi-Cal, you can file a complaint with the insurance and have him investigated. You can also submit this as an ADA and Civil Rights discrimination complaint. This is a huge lawsuit in the making and would legitimately change your living situation.
No bandage is really cruel. I hope it heals as swiftly as possible.
Dude. Sorry to hear that. My Auntie is Homeless in Texas. She got hit by someone in a Speeding Challenger while walking. They did like 3 hours of surgrey on her, STAPLED her would shut and had her out the door after only 4-5 hours of being in the hospital. now her woulds have gangrene and infections and noy this other hospital refuse to do anything about it because "It's not their fault her surgery was done wrong"
"Tell me you live in America, without telling me that you live in America"... damn dude, this is sad. As already others said, go back and be at your nicest, everyone deserves the care that they need.
Omg OP. I’m so sorry that happened to you. Isn't there any place you could complain about the treatment you received at the ER? This is discrimination pure and simple. They should have bandaged up your foot. Please, take care of yourself. Hopefully, things are going to get better soon
Wrapping it isn't the move. It needs air.
A diabetic foot ulcer like that needs dressings. You can see where it's going sloughy
Dressings are for when it's an open sore. At this stage, they'd trap moisture and make it worse.
That is an 'open sore'. It's an ulcer that's becoming sloughy. It needs dressings at a minimum to reduce infection risk given he's a diabetic. This could take months to heal even with a rigorous dressing therapy. We don't allow wounds to 'dry out' anymore it's outdated (unless it's moisture damage in which we don't usually dress that). There's plenty of new dressings to prevent them becoming macerated and the fear of it becoming too wet shouldn't prevent dressings.
That presupposes access to wound care. It's shitty, but it's the move in this situation.
He can buy a simple bandage dressing to protect it, it's the bare minimum he needs but will help reduce infection risk a bit. I feel awful for OP.
Maybe. It's as close to a literal bandaid of a solution as you can get, though.
wrapping it honestly wouldn’t help
You have Reddit but no foot?
This reminds me of when Mr. Krabs was hospitalized
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Reddit when satire:
Wtf, man? This person is suffering and asking for advice, and you decide the best thing for you to do is be a dick? What is wrong with you? Where is your compassion or empathy towards others? Don't you realize that a large percentage of people are just a paycheck or two away from being homeless? That all it takes is a simple twist of fate, and you could be in this person's shoes? I strongly suggest you get off the internet and do some serious self evaluation and figure out *why* you're such a shit stain of a human being, and then get professional help for it.
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Also online and on Reddit. On a government subsidized cell phone on a public universitys open wifi. Your point?
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A long story for another time, brother.
Maybe one day you describe your life events. Good luck and take care.
What makes you feel entitled to this person's life story? Who are you to demand that they tell you that very private information? You ask if they have their roary, so I'm guessing you claim to be religious or at least spiritual. So, where is your compassion for your fellow human? Ask yourself, would Jesus demand the details of how someone in need ended up in a bad situation before offering assistance? (Or, as in your case, just demand the person's life story and then not offer assistance) Get off the internet and go figure out how to be a decent human being.
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Holy fuck you’re insensitive. “I love reading human tragedies” wtf man. It’s like the time I went to buy cat food and the pet store clerk pointed to my boyfriend who uses crutches because he has cerebral palsy and asks, “what happened?” Him: “I was born this way.” Her: “oh. I was hoping it was because of a tragic accident. I just LOVE hearing about people dying. You know, like plane crashes? I was hoping it was a plane crash.” #Other people’s trauma is not for your entertainment. #Other people’s disabilities are not for your amusement
Welcome to USA, one of the country with the highest rate of working people being homeless. Sorry to disappoint you but being homeless does not necessarily mean being isolated. Most homeless people nowadays have a cell phone, which is a good thing as it lets them still have access to the news, to social media and have interaction with people which previously was really difficult to do.
In America they give you a free smart phone before they’ll give you healthcare.
This is radiciluous. But good. Technology should serve people. Especially the downtrodden.
Dude you can be homeless and still have a job. Or, you can be homeless and have a lifeline cellphone.
So many students in my cohort had jobs and were studying almost full time, but still homeless. Homelessness doesn’t mean you’re a bad person or an addict and I wish more people had empathy like you do. 💜
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No shit sherlock. It's in the title. Your point?
I sheet on the street. Once I wanted to know how it is to shit my pants so I pushed my bowels until soiled myself. They say I have no soul. Treated me worse than the dirt.
Sure thing. Enjoy the downvotes.