By Zosia Zdanowicz, University of Notre Dame

Camden is under a microscope as a city: ranked as one of the top three most dangerous and poorest cites in the country, many organizations are kind-heartedly attempting to help the city and its residents. However, the residents of Camden are becoming more and more aware of the presence of these organizations, which haven’t made much lasting progress in the city. Companies have come to develop the waterfront real estate, without employing any of Camden’s homeless population. With no grocery stores, a failing school system, corrupt government, and failing infrastructure, Camden is hit over and over again with challenges that seem insurmountable. Camden’s residents have a hard time accepting individuals that have come to the city as part of their job, on a service mission, or for their non-profit. These people, who are quickly recognized as outsiders, who retreat the safety and comfort of Philadelphia at the end of the day, can never possibly relate to the realities of Camden in the same way as its residents. As an intern, I am very aware that I fall into this group; the whiteness of my skin identifying me as an outsider, or as part of the 5% white minority of the city.

"Both doctors and patients are placed in unfavorable situations by the Affordable Care Act: the doctors are reimbursed so little by Medicaid that they often must double-book patients to keep their clinic’s doors open," writes Zdanowicz.

“Both doctors and patients are placed in unfavorable situations by the Affordable Care Act: the doctors are reimbursed so little by Medicaid that they often must double-book patients to keep their clinic’s doors open,” writes Zdanowicz (Pictured with Notre Dame representatives.  She is second, from the left.)

In a community like Camden, where 40% of the population lives under the poverty line and struggles to provide, primary healthcare does not fall very high on the list of priorities for most people. Whether they are uninsured or have Medicare, the trip to the doctor’s office, which often involves multiple buses and a long wait to see a rushed doctor, does not seem like an efficient use of their time. Many turn to the emergency room when they are in dire need of health care, rather than continuing to see their primary care provider regularly. However, the emergency room does not provide time for nearly all of the resources or conversations needed for effective healthcare. The quick-fix method which emergency rooms provide, at an incredibly high cost to the uninsured and to society, does not tackle the deeper, systemic root of lack of affordable healthcare, which often entwines itself with poverty.

Camden is in need of high-quality preventative healthcare administered outside of the emergency room. With 35% of its children overweight or obese, compared to the national average of 21%, Camden’s healthcare system seeks a systemic change and reform. It’s proven that obesity can lead to a slew of chronic diseases, ranging from high blood pressure and cholesterol to diabetes, heart disease, and cancer. If the obesity epidemic is not tackled with preventative health care, the emergency room visits will simply increase with no public knowledge of how to treat the chronic diseases that stem from obesity. This will only raise the patients’ debt from emergency room visits, as well as the fees the hospital will have.

Dr. Jeff Brenner, a Camden native, works to address Camden’s need for affordable, accessible, and good quality health care outside of the ER. Through a mapping technique called “hotspotting,” Dr. Brenner has isolated the eight percent of patients whose medical bills make up 40% of the city’s medical costs. By assigning social workers and nurses to monitor the most common ER “frequent fliers,” he has significantly decreased the amount of times they go to the ER, as well as decreased healthcare costs. His nonprofit, the Camden Coalition of Healthcare Providers, also conducted surveys of patient experiences in primary care clinics this summer, receiving mixed results from the data that has been processed up to this point. Although some patients enjoyed their primary care experience, others complained about long wait times. Others felt that the doctor didn’t understand them or listen to their concerns, or that the appointment in general was rushed. Both doctors and patients are placed in unfavorable situations by the Affordable Care Act: the doctors are reimbursed so little by Medicaid that they often must double-book patients to keep their clinic’s doors open. This reduces the quality of each doctor’s appointment and discourages the patients from returning to the clinic if they feel the doctor does not have enough time to meet with them fully or value their concerns or health.  With the added burden of taking public transportation to the clinic and waiting for hours to be seen, patients may choose to forgo the clinic.

If the Affordable Care Act was reformed so that governmental reimbursement rates were higher, doctors would have the opportunity to spend more time with each patient and administer a more holistic evaluation of the patient’s health, whether physical, emotional, or mental. The doctor would have the opportunity to discuss nutrition with each patient, which is crucial in a city like Camden with such a high obesity rate.

Although nutrition education and healthy eating habits are difficult to promote in any city, the issue is particularly important and challenging in Camden. Camden does not have a single grocery store in the entire city, forcing its residents to shop in corner stores that stock food packed with preservatives and long shelf lives. With no stores available provide nutritious food inside the city limits, the residents of Camden must travel to another town, often by bus, to buy the nutritious food that their physician or other organizations recommend. Although part of the problem in Camden is the lack of nutrition education, it is understandable why the long trip to buy expensive produce that spoils easily is not an attractive option for many residents. The Food Trust works to promote nutrition education by offering monthly classes at the pediatric clinic on topics that have to do with eating healthy, from smart snacking to forms of fruit to the importance of calcium in the diet. The Food Trust also promotes healthy eating by offering cooking demonstrations outside corner stores, which allow customers to shop with healthy eating in mind, as well as offer discounts for healthy items that The Food Trust recommends. Shoprite, the local grocery store in the neighboring town of Cherry Hill, offers a weekly grocery delivery service to a community center near the hospital.  However, it requires that customers come to the center two days a week: one to order the food and once again to pick it up. Moreover, the sessions are only an hour long, so if the customers’ public transportation is late or they cannot make it to the center in time to order or pick up their groceries order, they do not have access to fresh food for a week.

Based on my suggestion, the pediatrics department at Cooper University Hospital has begun looking into options for patients to buy a freshly delivered fruit and vegetable box at a reduced rate for pick up in their local community. Patients would be given a prescription by their doctor to enroll in a program that provides them with a box of fresh fruits and vegetables, as well as educational information and recipes for that week’s box. The program, called FreshRx, would partner with local organic farmers and come with simple recipes using basic ingredients, as well as those provided in the box. This way, individuals enrolled in the program would have access to fresh food without needing to travel, potentially for hours, to pick up their groceries at a community center located near the hospital.

The hospital is in the process of evaluating its funding to finance the program. Campbell’s Soup Foundation—the Campbell Soup Company has headquarters in Camden—has connected with Cooper as a resource for contacts and organizational help as a part of Campbell’s Healthy Communities Initiative. In ten years, Campbell’s hopes to invest $10 million into Camden and its community partnership programs working toward reenergizing the people and resources of the city, eventually promoting its growth and health. It has made meaningful connections with many different organizations including Cooper’s Ferry Partnership, an economic development firm that works to maintain parks, organize community events, consult with construction companies concerning gentrification in Camden, and study the sewer’s system impact on Camden and its environment. Rebecca Orsak, a Shepherd intern from Washington and Lee University, worked this summer with Cooper’s Ferry to promote the company’s multiple projects.

Yet another partner in the Campbell’s Healthy Communities Initiative is St. Joseph’s Carpenter Society, which works to make housing affordable and accessible to the people of Camden. St. Joseph’s hopes to empower its customers through education and assisting with their customers’ finances. Amy Belfer, another Shepherd intern who worked with St. Joseph’s Carpenter Society this summer, states that the Society hopes to create a safe community that would invite its members to come together to have events and feel proud of their neighborhoods. St. Joseph’s understands that by restoring abandoned neighborhood corner houses, it restores the neighborhood’s image to passersby and potential house buyers. A new neighborhood image could help raise the neighborhood’s market value and make it less attractive as a hub for crime and violence. By reducing crime in vacant and abandoned houses, St. Joseph’s Carpenter Society hopes to transform streets, neighborhoods, and eventually the city of Camden.

Although extremely important to the revitalization of Camden, healthcare is just one aspect of the work required to bring the city back on its feet. Campbell’s Soup Healthy Communities Project recognizes the need for collaborated efforts from a variety of organizations: healthcare, food services, economic development, and housing. I look forward to seeing the results of this huge effort in 2020, as it is already apparent that Camden truly is, as Walt Whitman wrote, “a city invincible.”

I hope that the lessons and reflections from this internship remain with me as I continue along the path to be a future doctor. I learned that it is incredibly important for the doctor to be aware of what background each patient comes from and the challenges she faces walking into the examination room. For example, a doctor telling the residents of Camden to eat healthily will undoubtedly face frustration when they see that their patients have not made the recommended lifestyle change simply because their geographic location does not permit them the luxury of easy access to fresh produce. In order to create a more dynamic relationship about health, doctors must have an understanding of their patient’s everyday realities. This will lay the ground for an open and trusting relationship between doctors and patients in the future.

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