2018 Week 1: Healthcare and Health Policy
“What exactly do case managers do?” This was, in fact, my first question to my supervisor who has been working at Chase Brexton for the last ten years. She described the job of a case manager as an individual who helps people help themselves. I really liked this definition because being a case manager means being a person who patients can rely on and it also encourages patients to become more responsible for their well-being. I have only been an intern in The Case Management and Outreach Department at Chase Brexton for a week, but I have already seen these guiding principles in action.
This past week, I have been shadowing triage, which involves assisting patients with insurance, housing, and transportation fees, and the POWER clinic, or Protecting Ourselves With Every Resource, which provides services for HIV prevention, testing, and treatment. After every visit, I would open up the patient’s chart and document the current assessment of the support the patient was seeking, such as health, housing, and transportation, as well as the projected goals and interventions. However, what I did not expect was that I was advised to not bring a notepad into the appointment because it could make the patient feel uncomfortable. Creating a safe and accepting environment for patients is so important, and I realized that I need to be more aware of how seemingly inconsequential actions can affect patients.
The team at Chase Brexton has been incredibly supportive and welcoming and I can’t wait to learn more in the coming weeks. Happy Pride weekend!
“Harm reduction is about meeting people where they’re at, but not leaving them there.”
Preparing to co-facilitate a naloxone training, I had asked my supervisor, Harriet, how she liked to describe harm reduction. She had heard that definition from earlier on in her years of social justice work, and it resonated with me. Meeting people where they’re at is accepting that people come into each part of their lives with different experiences, background, motivations, beliefs, and goals for themselves. To me, not leaving them there means that as a resource, a supportive figure, and an ally, I should use my privilege, active listening and understanding, access, and resources to help people reach whatever goals they’re working towards in the best way I can.
While reflecting on my own, I found it really helpful to frame my goals for the summer, as well as some of the events each week, with this idea. Hopefully I’ll be able to continue this as the summer goes on!
Be more open and willing to learn about different perspectives on social justice issues, rather than disregarding a thought because it’s different.
Meeting people where they’re at:
I need to keep in the forefront of my mind that some of the communities I may be training within vary in their understanding and awareness of the opioid overdose crisis. If a person doesn’t feel as though they need to be trained because they believe opioid use doesn’t happen in their circle, that is understandable. Acceptance and visibility of substance use varies. It is not my job to change people’s minds.
Not leaving them there:
Though I’m not there to change people’s minds, I do hope that the educational resources and conversations that come from tabling and trainings will spark new thoughts and dialogues around substance use. I want to be challenged, to listen, to learn more. Continuing to educate people, especially around the stigmatization of substance use and how they simply may not know that someone in their life has used or continues to use substances, is necessary.
I was helping to table about harm reduction relating to sexual health and substance use at the STAR TRACK Free Ball for LGBTQ youth. Though we stayed for a few hours, few people came over to talk to the tables at the resource fair.
Meeting people where they’re at:
Talking with Harriet and one of BHRC’s volunteers, I understood that this wasn’t a reflection on our work, nor on the people attending. It was understandable that talking about substance use, overdose, sexual health, etc. wasn’t what everyone was at the ball for; they are sensitive, personal subjects. The ball was an amazing, fun outlet for people to enjoy themselves and de-stress. For many, maybe it just wasn’t the time to think about these things. We were there as a resource, but not someone’s reason for attending, and that was okay.
Not leaving them there:
Although naloxone and harm reduction may not have been at the forefront of the minds of the attendees, the three of us talked amongst ourselves about how the syringes in our naloxone kits could mean very different things to some of the attendees, since they could also be used for hormones for people who are transitioning. Part of being an effective resource in this setting meant that we understood that different motivations may bring people to our table, and that helping them meeting their own needs is valid and valuable. Training someone to administer naloxone could play a different role, in providing someone with an extra syringe they could use.
By the end of my first hour at Keswick, my supervisor and I were already running around to multiple residents, flipping through files and records to sort out what each patient needed, and making phone calls to family members. Somewhere along the line someone made a threat that they would sue the center. Another individual had stayed in the center past their discharge date and had to deal with non-coverage from their insurance. I wondered if every day would be this hectic and whether I could deal with this much disarray for the rest of the summer.
My supervisor assured me this was not the daily routine and that this first day really was a trial by fire. Looking back, I am grateful that I was exposed so quickly to factors affecting the healthcare of the elderly. The elderly, especially in healthcare, are often swept under the rug and forgotten about. I had never been exposed to this population in a healthcare setting and it was evident from day one that this process was much more intricate and complex than I had ever thought. Each person has their own care plan, their own medical conditions, a long list of medications, and therapy treatments. In the beginning, there appears to be so much to keep up with for each patient. Fortunately, Keswick is relatively well equipped to handle elderly care but not everyone is able to afford the care that is provided there. I cannot help but think about all those who are not able to be admitted into a facility such as this one.
However, I am genuinely enjoying working at the Keswick Multi-Care Center and each day I learn so much from both the staff and the residents. After a day or two of learning the ropes, I settled in much more and got to have more one on one time with residents and listened to their stories and experiences. I am grateful that in my position as an intern I can act as more of a liaison between the residents and staff/administration because I have more flexibility in my duties and job description. I can venture outside the box of conventional office procedure and offer improvements and voice the residents’ concerns. Bit by bit, I am becoming more comfortable in my role and am looking forward to improving the process through which the residents receive care. Hopefully, by working in a facility like Keswick, I can understand the healthcare system better and apply what I learn to other facilities, organizations, and most importantly the people who are at the heart of it all.
I was so lucky to be able to attend and help out with a variety of events and projects this past week. One of the most memorable and enjoyable was helping with the last-minute organization and execution of a pilot cooking class by CCCC and Baltimore Food Rescue at a Pleasant View Gardens, a public housing unit for elderly Baltimore residents. It was set for 4pm on Saturday, meaning that we’d leave clinic a bit early to attend the event and that I’d need to take all my things with me (as I was taking a bus back home afterwards). I wasn’t especially excited about the timing and was a bit stressed when we got to the Pleasant View Gardens site. But the site was incredible—so many of the residents were genuinely interested in learning more about the food we’d brought for the giveaway (which included a jackfruit that caused quite a stir with one woman who had just heard about a recipe for pulled pork sandwiches that used jackfruit as a meat substitute). We had 8 participants already signed up for the class and were able to squeeze in 5 more as we’d brought extra ingredients. After initial introductions, the first small activity was to take a look at nutrition facts labels. We compared two different barbecue sauce bottles that had very different serving sizes—one was 1 tablespoon and the other was ¼ of a cup—and used that as an example of how important it can be to first look at the serving size before you judge anything else on the food label. After that, each of the 3 representatives from charm city and the 1 representative from Baltimore Food Rescue sat at a table and started going through the recipe of barbecue chicken and cole slaw. I appreciated that small-table atmosphere—it gave me an opportunity to really connect with the three residents at my table as we struggled through making barbecue sauce from scratch on a portable gas-powered camping stove. I’m already looking forward to next week’s class.
I have learned quite a bit during my first week at Shepherd’s Clinic. Most of this learning has come from asking questions to clinic staff and speaking to patients both in person and over the phone. The clinic staff has been supportive and helpful (they even bought me pizza on my first day). Working at the front desk of the clinic has been an eye-opening experience, since I get to see/talk to every single patient who comes through the clinic doors. One of my goals I set for this summer was to become more comfortable making business phone calls. By the end of my second day at the clinic, I had made enough phone calls to satisfy this goal. While at first I was nervous each time a call came in, by the end of the week I was grabbing the phone within seconds of it ringing. It also makes me proud to work at a clinic that offers free mental health services to uninsured patients. Mental health is often not addressed in communities with less access to health resources, and it feels good to know that Shepherd’s Clinic is making a difference.
With each day that passes at the clinic I am learning more about how medical records are organized, the laws surrounding releases of medical information, the process of obtaining Medical Assistance, and the eligibility requirements for receiving care at the clinic. I’ve slowly started to get to know the staff, and I’m hoping we’ll grow closer as the summer progresses. Likewise, I hope to get to know some of the patients at the clinic. So far I’ve had fairly limited interaction with them in person, and I’m excited to get more experience interacting with patients face to face. Overall, my first week at the clinic was a great introduction to the work I’ll be doing the rest of the summer and I’m ready for week two.
We often read about how people without insurance wait until they have an emergency to seek healthcare, and statistics about how even with insurance there is limited access to primary care, but such shock value numbers fail to convey their full reality.
On my first day of work, I walked into Esperanza Center’s clinic expecting to be asked to file paperwork and help patients navigate a foreign language. I was, after all, an undergrad with no clinical background or professional experience in administering healthcare. Instead, I got rapidly trained un understanding medical histories and symptoms and their most likely causes to help quicken the pace of consultations by the professional staff. Indeed, as soon as the clinic opened its doors at 9 a.m., the waiting room was filled with new and returning patients, seeking care for themselves, their kids, or their visiting family members. My inexpert hands were needed.
Not all days were as buzzling as Monday, but there was always at least one patient turned away to come back to try to be seen another day, and many more that should’ve been treated in the ER. After a week, the importance of the clinic to the local community was crystal clear to me, such that when on Friday a white man walked in demanding an antibiotic prescription, I paused. Esperanza Center runs on grants that seek to provide care for those that are not insured and could not qualify for insurance, an elaborate way of describing undocumented immigrants. We thus interview all patients at the front desk to learn about their status, so when this man approached us with his immaculate English we had to ask, “Are you a U.S. citizen?”
Unfortunately, being a citizen does not imply you have insurance, but we could not take him given our limited resources. This was not a policy that he was expecting and my coworker let out a nervous laughter at his surprise. “So you only treat illegals?” and my coworker took a step back at the derogatory term. “You’d expect it to be the other way around. This is discrimination!” We couldn’t tell if he was half joking, so my coworker took another step back and laughed again, this time more quietly. I tried to explain the grant and the gap we were trying to bridge (the one that the government wouldn’t), but he didn’t agree and it wasn’t my place to argue. He was seeking care and we were providers, so I smiled and directed him to other places that could help him. When he left, my coworker’s smile dropped. Turning patients away was never easy, and after a week of many intakes, one visit reminded us of the reality of the shock value numbers.
This week, I had the amazing opportunity to attend a health forum co-hosted by The Atlantic Magazine and Johns Hopkins about health care access in Baltimore called, “Healing the Divide”. The event included speakers ranging from health care professionals treating members of the Baltimore community, community-activists and grassroots leaders, and non-profit experts. At the center of the forum was Kiarra, a resident of Sandtown-Winchester who was featured prominently in journalist Olga Khazan’s striking piece about the healthcare disparity among black Americans due to racial and economic factors. Kiarra, along with the president of the Penn-North Recovery Center, discusses Kiarra’s journey through recovery from a drug addiction and her dreams for the future. Kiarra spoke passionately about her work advocating for body-positivity and her desire to help others in her current role as an assistant at Penn-North. The rest of the forum featured discussions ranging from food access in Baltimore which covered the topic of food deserts, housing and homelessness, and the role of medical professionals in the community. I truly appreciated this opportunity to participate in an academic and professional discussion about the implications of racialized economic and social oppression on the Baltimore community, as it is a relatively recent development in current politics to even publically discuss these issues. As one of the speakers noted, although the Trump administration recently recognized opioid addiction as a public health emergency, the opioid crisis has been present in Baltimore for several decades. This trend in refusing to recognize public health crises that only affect minority communities is reflected in historical events such as the willful ignorance of the United States government in relation to the HIV/AIDS epidemic in the late 1900s that predominantly affected the LGBTQ+ community, until it began to affect cis-gender white Americans. It’s frustrating that these critical issues only really reach public attention when it is popular and politically advantageous to do so. Another frustration that a different speaker noted, is the popular tendency for media outlets to only address the negative events and developments in Baltimore, rather than highlighting the beautiful people and vibrant culture of the city. I similarly identify with this struggle, as I frequently encounter questions from friends and family in New York about the dangers and tragedies of Baltimore. To them, Baltimore is a city of violence, danger, and death. But to me, Baltimore is a rich city full of history, conflict, beauty, and change. It is important to highlight all aspects of a community, not just the negative and click-worthy topics, but also the heart-warming and significant occurrences.Tags: 2018, 2018 CIIP, Baltimore Food Rescue, Baltimore Harm Reduction Coalition, Boone Street Farm, Charm City Care Connection, Chase Brexton POWER Project, CIIP, Esperanza Center, Keswick Multicare Center, Shepherd's Clinic, STAR TRACK, Week 1