Washington and Lee University student Leah Gose supported the Camden Coalition of Healthcare Providers, which works to lower the amount spent on healthcare and provide better care to Camden residents the unemployed with job training and procurement as part of the 2013 Shepherd Internship Program. Gose is a sociology and German language major and a poverty studies minor in the Class of 2015.
Leah Gose, right, interns with the Camden Coalition of Healthcare Providers
I grimace. I have now wasted 11 minutes waiting for water to boil so I can poach eggs for breakfast. My two housemates and I have been well provided for in Camden, NJ, on the Rutgers campus—we have all the amenities sans a television and microwave. I would say the worst aspect was not being able to open our windows, but in Camden that may have been a good thing.
On average, a homicide occurs every 33 hours within the city limits, many times related to the prevalent drug market that caters to locals and the less crime-ridden neighboring towns. After race riots in the ’70s and ’80s resulted in the burning of multiple buildings and White Flight, travelers were grateful for the Benjamin Franklin Bridge that bypassed Camden towards its final destination, Philadelphia across the river.
Most of the homes that were destroyed have not been rebuilt and are sitting empty, uncared for, boarded up, and covered in weeds. Children do not play outside on the streets and the doors are tightly locked.
I finish my eggs and head downstairs past the security guard who mans the desk at all hours—an anomaly for most Washington and Lee students who do not lock their doors or worry about their safety. I flash my residence card so she knows I live there and head out into the university district of Camden on my short walk to work. The eight minutes I spend walking five blocks is normally a pleasant one. I pass the charter schools that have sprouted up in the last 10 years in attempts to save the corrupt public school system, and a homeless man who always wishes me well.
I have to be careful to avoid puddles and potholes where the sidewalk is closed off due to construction. Camden’s roads are terrible, and a car ride feels like a poorly given massage. The drainage and sewage system run together and when flooding occurs (and it always does after a rainstorm), wastewater overflows into the streets.
I breeze into the office building on 8th street and hit the button for the 7th floor. Today I feel like I fit in—I easily enter the door code and greet James at the front desk. Dr. Brenner, the founder of the Camden Coalition of HealthCare Provider, flies past me out the same door. Eleven years ago he started this non-profit on grant money that works to lower the amount spent on healthcare and provide better care to Camden residents. The work the Coalition does is taxing, but so important. Health coaches (most of whom are recent college graduate AmeriCorps members), LPNs, RNs, and local primary care offices work together to provide high-utilizing patients with the attention and resources they need to stay out of the emergency department (ED).
“High Utilizers” is a common term in the office for patients who visit the ED so frequently that the top one percent of these patients make up 30 percent of healthcare costs in Camden emergency departments. Along with having personal care teams, the Coalition offers pregnancy and parenting classes through its P3 program and diabetes self-management education classes in Spanish and English.
I sit down at my desk and begin data collection for Dr. Michael’s primary care practice. The project consists of recording the diagnoses of each patient visit for the last six months. I crank away at the computer with ease, the identification numbers for uncontrolled diabetes (250.02) and back pain (724.5) slowly etching themselves into my mind. Upon completion, the Coalition’s project managers will able to create an “Open Access” system for the practice in which patients can call in and get appointments easily the same or in the current week. This system has been shown to keep more patients out of the ED and prevents no-shows.
It’s lunch time and my newly found culinary skills result in a salmon sandwich and rice pudding to keep me full until dinner. Conversation in the kitchen is fresh and so is the coffee. I read another chapter about data collection in an office book—more proof that healthcare in the future will be deeply rooted in numbers, information, and analysis.
I get through about 350 more visit records before I leave for the diabetes self-management class at which I assist the diabetes educator, Carol. The class is at a community center, a building we have to fight for to use—getting space and help in Camden requires connections and trust. I set up the rubber food we use to show portion size, the sign, and posters crossing my fingers that the patients I called yesterday will attend. At times, patients will not show up, or say they were too sick to come. If it rains, no one ever shows up.
Five patients are present along with the community health worker, Patricia. Community health workers (CHW) are so important in providing new care methods to patients who normally distrust the system or do not follow doctor’s orders. CHWs are trained to provide advice, attend doctor’s appointments with patients, and encourage lifestyle changes while offering culturally congruent examples and life experiences.
Isabella, a 32-year-old patient is having trouble seeing today. She had to take the bus because her eyesight is so deteriorated due to hypertension and the side effects of diabetes she cannot drive or read small fonts. Frank, the lone man in the class, continues to offer answers to questions Carol asks, but his knowledge of healthy eating choices is skewed and limited, and I am not certain if he is understanding that sugary sodas have calories.
The class comes to a close. I pack up the food examples and weighing scale wishing and hoping that the massive amount of effort Carol and Patricia put into the classes pay off for the patients. My experiences this summer in Camden have shown me that healthcare failure is in large part due to the fact that we do not care for patients in a way that encourages lifestyle changes—we currently are placing a Band-Aid on a gaping wound.
Organizations like the Coalition are sprouting up across the country in attempts to rebrand healthcare as preventive rather than reactive. In 20 years the hope will be to catch diseases before they become dangerous or costly, to manage mental illness and depression for all patients, and have a sustainable healthcare system for years to come.
As Carol drops me back at the apartment building, I am once again caught in my thoughts regarding the stagnated state of care in Camden—a city so broken by drugs, crime, and fear there seems to be no solution in sight. But each day a story of success shines through the dark clouds that cover the city—a child learns to read, another basketball camp is bustling in the Rutgers gym, a dance class performance is done in the park, a mother of four gets her LPN certification.
Camden is a city on the rise. Yes, it has a long was to go, but for too long America has been shoving it to the back of our minds. The courageous and hopeful people at the Coalition are the perfect example of the faith that persists, and the patients they serve are never without a flair for optimism. Change is happening every day in Camden. As I sit down to watch an episode of Friday Night Lights after the gym with a plate of (hopefully delicious) sesame tofu, I feel so be grateful to be a part of that change for even just a summer. It is time for America to open the window for Camden and let in the fresh air, the sun here is shining and the atmosphere is ripe with hope.