Feature
In Their Shoes
What's it like to live in poverty? Internal medicine residents found out.
About 60 internal medicine residents and a handful of faculty members got a glimpse into the challenges of life in poverty during a poverty simulation held in August at Lincoln Land Community College’s Trutter Center. The Departments of Medical Humanities and Internal Medicine produced the event using the Community Action Poverty Simulation program kit provided by the Missouri Association for Community Action. SIU is one of the few medical schools to present the model.
“This is for you to walk a mile in the shoes of the poor,” said Ross Silverman, J.D., MPH, professor and chair of the SIU Department of Medical Humanities, as he introduced the simulation. “Try to think as a person in poverty would think.”
The residents were each given an identity and placed together in low-income families. Each unique family situation let the residents experience the daily stress and struggles of meeting basic needs and interacting with community agencies. According to the U.S. Census Bureau, 13.3 percent of the Sangamon County population lives below the poverty level.
“At SIU School of Medicine, our philosophy is to treat patients as people, not their disease,” Silverman said. “Teaching our residents a greater awareness of the issues facing those living in poverty will help them understand how their patients’ lives affect their health. The simulation helps physicians consider all factors in their patients’ lives and formulate reachable goals for them.”
Each family had to provide food, shelter, other basic necessities and interact with community resources. Low-income volunteers from The Springfield Urban League, Habitat for Humanity of Sangamon County, and M.E.R.C.Y. Communities role-played staff at a utility company, food store, bank, mortgage firm, quick-cash, and others. Sabrina Nudo, a custodian at the Early Learning Center and mother of two, played the part of a pawn shop owner. “This is what it’s like,” she said of the representative agencies. “It’s not easy to live poor, but it’s real life.”
The identities included single parents raising their children and senior citizens trying to maintain their self sufficiency on Social Security. “Your goal,” Silverman said, “is to keep your house secure, feed your family, get your kids to school and get to your job if you have one.”
Some unexpected situations arose: some got robbed, many evicted, some labored with unanticipated bills such as dental work, car repairs or illness. Others got good news such as getting a job or finding money. Others were stuck at their “homes” because they didn’t have any transportation. That scenario rang true for Heather Sims, a client of Habitat for Humanity: “Once I had to go pay bills, but my car was out of gas, so I couldn’t go anywhere.”
At a post-simulation discussion, the group related the stress and struggles that they faced, using words such as, “We survived.”
“It seemed unfair what happened to my family,” said Christine Todd, M.D., an SIU hospitalist. “The line between what’s the right thing to do got blurred; we were desperate for money.” Dr. Todd role-played a 17-year-old boy who had no transportation and no money.
“It was frustrating trying to get enough money to pay the bills,” said another participant. “Our refrigerator broke. Next month, we won’t make it.”
Others brought up parenting situations that led to increased stress. When a student was expelled from the “school,” instead of being caring and compassionate, the “parents” reported they were annoyed that now they had to figure out what to do with the child during the day. “There was no time to parent,” agreed another resident. “We were just trying to figure out how to pay bills and put food on the table.”
Others reported that some of the community agencies were rude to them – which actually happens, according to some of the community members. “It was a struggle to find housing,” said a resident. “It was the families around us who helped us.”
Another resident role-played an 85-year-old man. “I had enough money,” she said, “but I was lonely.”
This is one experience that will stay with the physicians for quite a while. “I’ve had patients tell me that their electricity had been cut off,” one resident said. “I listened, but until today, I didn’t know what services were available. Now I know how tough it is.”
The simulation will become a core part of the Department of Medical Humanities’ curriculum. Plans are in the works to integrate the simulation for fourth-year medical students in the spring.