I’ve lived in New Jersey for my entire life, and so when I broke the news to my family that I’d be living in Camden for the summer, their responses were less than thrilled. Not only is Camden notoriously known for its issues with drugs and violence in the state of New Jersey, but it is also ranked in the top 3 most dangerous cities to live in throughout the whole country. Building up to the start of the internship, I became nervous if it was the wrong decision to live in an area with such a negative reputation. However, I was pleasantly surprised to find some of the most hopeful and inspirational people I’ve ever met.
I worked at the Camden Coalition of Healthcare Providers, which is an Accountable Care Organization tasked with providing high quality care to all Medicaid patients in the city. They manage all 13 primary care providers throughout the city along with the 3 hospital systems. A staggering 40% of Camden residents have Medicaid, while others have no health coverage at all. Along with the high percentage of Medicaid patients comes significant extra costs for the city to cover medical bills that very often go unpaid. While there are 13 primary care providers throughout the city, many patients avoid these office visits and go to the emergency room for all levels of care. This clogs up the emergency room and also creates huge amounts of charges to the hospital because of the high quantity of unpaid bills. I was shocked to learn that the number one reason for admission to the Emergency Room in the previous year was for the common cold. Decreasing hospital admissions and readmissions and increasing patient visits to primary care providers for cures of illnesses and preventative care is among the principal initiatives of the Camden Coalition.
The seven main initiatives in the Camden Coalition are all tailored toward the population of Camden. Learning about the workings of each department gave me insights into the daily struggles faced by many of the people throughout the city. For example, the Care Management Initiative team works directly with 40 patients at any given time to walk them through the hoops of the healthcare system. They select patients who have frequent hospital admissions and at least five diseases and social barriers to care in order to identify and resolve their largest barriers to effective care. One story that helped me to understand the impact of poverty in the community was about a man in his 50’s. He struggled with schizophrenia, which made it difficult to keep a job and a home. He was often living in the streets or in shelters. Throughout the years he developed high blood pressure and diabetes, and did not manage them properly. He had neither the knowledge nor the resources to manage these health problems. When someone from the Camden Coalition of Healthcare Providers made her first home visit to this man, she asked to see how he injected his insulin everyday to determine if there was a problem. She found that he did not fill the syringe properly. Further investigation revealed that he was going blind and thus could not see the container from which he was drawing insulin in. This is just one of many stories that I heard that showed me the importance of the accompaniment method adopted by Camden Coalition Care Management Team to walk its patients through the process of understanding how to better manage their health.
I worked for the Clinical Redesign Initiative team and was involved in their annual data collection for information about patient satisfaction at each primary care provider. This data collection required me and seven other interns to sit at one of the thirteen primary care providers each day and ask the patients in the waiting room to take a survey that asked many questions revolving around their satisfaction with their current doctors. This job provided the opportunity to speak one-on-one with many patients battling the many problems that accompany living in poverty. One of the primary care providers, called Project HOPE, worked primarily with the homeless population in Camden to provide equitable care. While I greatly appreciated its mission because of the difficulty of working with this population, I heard many negative stories from some of the Spanish-speaking patients sitting in the waiting room. The patients included undocumented immigrants, who noted their frustration that the clinic got rid of their immigrant-liaison. As a result, the patients lost coverage for many of their medications and also had difficulty speaking with their doctors. Following conversations with these patients—and especially these immigrants—I concluded that a large issue facing the impoverished population of Camden involved a lack of dignified care. Many of their personal stories revolved around their feeling that they were looked down upon by doctors and the patients did not feel that their voices were heard, which led them to visit their doctors less frequently. This lack of respect for the patients’ dignity was undermining the project at the Camden Coalition, because one of its goals is to increase attendance at primary care providers to increase the practice of preventative medicine. Speaking to these patients brought me back to many of the service seminars and poverty studies classes I had taken at Notre Dame because of its relation to a focus on keeping Catholic Social Teaching principles in mind during everyday life. At their heart these principles recognize and focus on universal human dignity.
In reflecting on my summer, I learned that working with a population largely comprised of individuals living in poverty requires a commitment to living out these Catholic Social Teaching principles because the impoverished population often gets ignored. I remember fondly the many conversations I had with Camden residents while sitting in the waiting rooms of several primary care offices and will keep in mind the lessons I learned from them while pursuing my future in the public health and medical fields.