By Tierney Wolgemuth, Washington and Lee University (2016)
A lot of words come to mind when people mention Camden, New Jersey. Vibrant, growing, and healthy are usually not among them. Although once a thriving industrial town, economic downturn in the 1970s resulted in “white flight” and widespread unemployment. Since, the city has continued to struggle with poverty, crime, and increasingly poor health.
2015 summer interns at Camden Coalition of Healthcare Providers, including two SHECP interns, Tierney Wolgemuth and Michael Sullivan (both WLU 2016), second and third from the right.
However, I found that this dismal picture typically painted of Camden is far from accurate. This past summer I had the opportunity to intern with the Camden Coalition of Healthcare Providers, an organization that seeks to “improve the health status of all Camden residents, by increasing the capacity, quality, and access of care in the city.” My team of interns worked with the clinical redesign initiative, administering patient satisfaction surveys to 700 patients at primary care practices. We spent an extensive amount of time visiting with patients at practices and discussing their healthcare experiences.
This time with patients allowed a window into many of their lives. I was able to hear their individual struggles, disappointments, and triumphs as they related to both their healthcare experiences and the rest of their lives. This was a humanizing experience, and helped me realize my incorrect assumptions about the “impoverished” individuals I met, about their attitudes, their goals, and their capabilities. I often underestimated those I encountered, assuming uniformity in how they conceptualized and complacency in how they reacted to their life situations. Instead of my misjudged expectations, I found many of these individuals positively inspiring. They are advocates for various social issues, insightful in describing the struggles of their city, and innovative in their suggestions for action. I realized that those of us wishing to aid in poverty alleviation serve best by listening to and supporting the individuals experiencing it.
Similarly, I found that people experiencing poverty in Camden—as in other areas—are not homogenous. Discussing a “stereotypical Camden resident” is neither fair nor useful. People are individuals who, although caught within the structural inequality of the same system, come from various backgrounds and are headed in different directions. They have distinct aspirations for their lives. In other words, there must be somewhat of a separation between the issue of poverty and our conceptions of people experiencing it. Making assumptions about “impoverished” individuals serves only to further disadvantage them and undervalue their potential.
I found that the barriers faced by patients trying to access healthcare are more varied than I would have expected, and much less easily remedied. For example, many patients explained that their Medicaid-provided transportation (put into place to address patient’s lack of transportation) was often late, causing them to miss appointments and be dismissed as patients from their primary care practice. Other patients discussed the difficulties of attending appointments while having no one to care for their children and very little time off work. Still others talked about trying to navigate the schedules of dependent family members, or frustration with the lack of continuity of care. In order to address inequality in Camden, these barriers must also be diminished.
As the barriers inhibiting care are diverse, addressing healthcare inequality must also be multi-faceted to be effective. Even if individuals are able to obtain health insurance, they may not have stable food, housing, and social support, and thus, it will be nearly impossible for them to satisfy the physician’s prescribed treatments. Over and over, I found that “fixing” (or bandaging) just one aspect of an individual’s life is not useful when stability in other areas is not achieved. I saw this cogently while observing Diabetes Self-Management Education classes. Students frequently talked about the struggles of managing their blood sugar and body weight without having appropriate food in the house. However, selecting appropriate foods proved extremely difficult, particularly when it’s more expensive and vastly different from what the rest of their household is eating. In these cases, both lack of financial means and social support inhibited proper diabetes management. The Coalition therefore addresses poor healthcare outcomes from multiple standpoints, working to improve stability by both providing care teams for individual patients, as well as by partnering with organizations that can offer stability in other aspects of the patient’s life (such as housing or legal advice).
In order to gauge the magnitude of some of these non-medical issues, the study that my team administered throughout the summer asked several questions about food insecurity. We found that nearly half of patients surveyed either worry about not having enough to eat, or actually experience running out of food. (See the essay by my Camden colleague, Sneha Modi.) This number is likely lower than the city’s true food insecurity, because it represents only patients who were actually able to attend a doctors’ office during the time of our survey. These striking statistics further illustrate the need to consider the many facets of a healthy lifestyle when addressing healthcare inequality.
Beyond learning from the patients with whom I interacted, working at the Coalition also taught a great deal about the traits of organizations that effectively aid in poverty alleviation and healthcare justice. Primarily, I found that working to alleviate poverty requires a wide variety of skill sets. I believe that the strength of the Coalition comes from its multi-disciplinary approach. A doctorate statistician works next to a social worker who works next to an MBA. Likewise, several different teams—including clinical redesign, care management, data, and legal advocacy—address issues at a variety of levels, from providing stability to individual patients to working on new legislation. Each of these individuals has a distinct background and perspective, but is brought to the office by the Coalition’s common mission.
Finally, my time at the Coalition illustrated the importance of strong leadership in any organization. Making serious changes to large and complex systems requires mobilizing the masses. It takes individuals who are able to organize people, to capitalize on their diverse sets of skills, and to inspire them to persist in the face of disappointments. I observed these traits in the Coalition’s director, Dr. Jeffrey Brenner, both in full staff meetings as well as in the several times that he sat down with my team of interns. These observations encouraged me to think about my own leadership style, and consider ways in which I can continue to develop these skills for my future in medicine.
My time in Camden considerably improved my perception of the city. This change was wholly driven by the capable individuals whom I met. I found that each patient I encountered had a unique story and distinct healthcare needs. And importantly, I observed the Coalition addressing a variety of these needs at both individual and structural levels. Of course, one organization cannot repair an entire community, and the Coalition in many respects is stretched thin. However, I was encouraged by the Coalition’s success in both acknowledging these distinct needs, and in partnering with other organizations that can best address them. I am incredibly grateful for my time in Camden. I gained a perspective that will be useful for both my career in medicine and future work to alleviate poverty.