2018 Week 4: Healthcare and Health Policy


I can’t believe it’s already Week 4! The past four weeks have been amazing and I’m so thankful to be a part of the Chase Brexton team.

Last Tuesday, one of the case managers performed a rapid HIV test and the result was positive. This was the second positive that she had ever received and she recounted how uncomfortable she had been the first time she had to break the news. Many of my co-workers agreed that they initially thought they were prepared for such situations, as they had learned what to say during training, however, most relied on improvisation because patients reacted in unexpected ways. This prompted a discussion about their experiences informing patients of their HIV positive status.

In one encounter, after telling the patient that they were HIV positive, the patient became upset and was convinced that the case manager was lying. They became even more frustrated when the case manager suggested that they get labs done if they wanted an accurate result. This patient never came back again.

Another situation involved a patient who was about to start school, had found out that she was pregnant the day before, and also came up as HIV positive. This patient became overwhelmed and although the case manager had other patients waiting, they felt that it was more important to talk to the patient about her options and future plans.

A goal that I had made in Week 1 was to listen and learn from the experiences of my colleagues. Through this discussion, I have realized that it is not possible to plan for every reaction from a patient, despite what the script from the counselor training might say. However, I am grateful that I have a community that supports each other, which makes what I do even more humbling.



I’m sitting outside on my balcony, watching the sunset and trying to figure out how our time has gone by just as quickly. 35 hours per week seems like a lot of time until you add in the wide range of projects waiting to be worked on and the never-ending to-do list–suddenly, 35 hours disappears into thin air. Because of this, each week seems to fly by. The midpoint of our program truly snuck up on me.

I should admit that I’m not the best at proper time management, even outside of work. I consider myself to be passionate, ambitious, and dedicated, but not great at divvying my time effectively. I seem to have never-ending to-do lists of my own: friends I’ve been meaning to grab lunch with, articles I’ve saved on Facebook to (eventually) read, movies to watch, cool classes to take, fiction books to read.

No matter how I use my time, there seems to be 20 other activities, people, or projects that need more of it. Often, I feel myself being pulled in many different directions. The to-do lists never end, no matter how hard I try to push through them.

This has become familiar to me once again with my internship this summer. 35 hours, though it makes for a very long week, doesn’t feel like enough time. Between the many projects I had hoped to work on, research to do for BHRC, community members I wanted to meet, and organizations we were hoping to collaborate with this summer, my head is swimming with the possibilities of what work could be done if I had infinite time.

The more I think about it, the more I recognize that this is part of who I am and how I work. My ambition clears my mind to see the potential positive changes to be made, to break down what my organization needs and how I can be more supportive. My passion and dedication allow me to fully follow through with the projects I’m working on, for my work to continue building upon the great work of my organization.

Though I can’t get involved in every possible project for the rest of the summer, I will set realistic goals for myself and stick to them. I will finish the projects I’m currently working on, or get them to be as close as possible to that finish line. I’ll keep working and pushing forward until the end of our wonderful 8 weeks. My time isn’t up just yet.



It comes as a bit of a shock to think that the summer is half over already; it feels like the internship started only a week or two ago. I told myself at the beginning of the summer that I would try to make positive changes in my work environment and try to work with staff and administration to better the quality of care at Keswick. I feel that I have been achieving my goal both by providing the best support that I can and also by communicating to the current staff any questions I have or any improvements I think can be made. So far, I have worked with rehabilitation patients who generally have short stays at the facility, but for the rest of the summer my workload will also include long term care residents. I am looking forward to the opportunity to interact with a different patient population and delve into a different sphere of work.

The midpoint speaker event was a fantastic experience and certainly one of the most eye-opening talks I have heard. At first, I was very skeptical of the notion that simply telling people to “cease fire” would have any effect at all on the violence and crime in Baltimore. However it seems that over time, it actually promoted more civil resolutions of conflict. I always try to stand by the belief that no one is born evil or angry, and the fact that the simplicity of the cease fire movement was effective only served to strengthen my beliefs. Listening to what Ms. Bridgeford had to say about how the culture surrounding violence was changing in Baltimore makes me want to get involved and do more for the community. I understand that as a Hopkins student from a fairly upper middle class background, I probably would not be the most relatable ambassador for a Baltimore neighborhood affected by gun violence. However, Ms. Bridgeford’s enthusiasm and vision for the future really inspired me to do more and get out of the Hopkins bubble to further integrate myself into the community and hopefully be an agent of positive change.



Your mama may have told you to finish what’s on your plate. She was right. If only we’d all listened. This week, I’ve been thinking about food waste and how big of a problem it really is, especially in the United States. On the local level, Food Rescue Baltimore has been doing some great work to reduce our waste. Food Rescue Baltimore works with local grocery stores to accept and transport their unwanted (but still completely edible) food to a storage facility at Baltimore Free Farm in the Hamden neighborhood. From there, it’s sorted and then regularly distributed to 8 sites throughout the city. The Food Rescue Baltimore organization is run by one full-time employee, Matt, and many volunteers. The potential to expand is limited primarily by the workforce capacity, not by the amount of food there is to pick up. “There’s always more food,” said Matt when I asked him if he ever came up short. But that seemingly limitless area of food waste that Food Rescue Baltimore works to reduce is actually the least problematic area of all of the checkpoints that food goes through in the United States. For us, 33% of food waste occurs in the Agriculture stage, 11% postharvest, 10% in processing, and 8% in retail (the part that Matt helps reduce) and a whopping 39% at the level of consumption. See the article https://www.nytimes.com/2017/12/12/climate/food-waste-emissions.html for more info and great graphics. The largest portion of food waste occurs right at home; we’re all individually responsible for this problem. We live in a culture that sees imperfection and dismisses it immediately. Matt helped show me that I’m not immune to this kind of behavior at all. My coworker and I arrived early to help Matt transport food to Pleasant View Gardens, so we got to help prep some of the food too. It wasn’t exactly pretty. We peeled back the rotting and moldy stalks of corn to reveal perfectly preserved kernels beneath. The impressively fuzzy and colorful mold would have been more than enough of an incentive for me to discard the whole thing. But it was good corn. What a difference we could make if we were all just a bit more like Matt – accepting, willing to give a second chance, and always ready to finish what’s on our plate.



As I spend more time at Shepherd’s Clinic, each day starts to feel more and more like the last. That isn’t to say I’m bored, because I’m not. Rather, the rate at which I’m learning new things has slowed. This isn’t a bad thing; I would hope that by my fourth week on a new job I’d at least have learned the basics of the job and a fair bit more. I still look forward to work each day, and I’ve started to become friends with some of the staff at the clinic. Our nursing coordinator has been giving me diet tips (apparently eating 5 pounds of red meat each week is not a great idea). One of the staff members, our front desk coordinator, has started giving me a ride home after work each day, which has not only greatly decreased the time to commute home, but has also given me a chance to talk to and get to know him better. At the clinic, I have become much more independent compared to when I started. I still need to ask for help occasionally, but for the most part I can handle most problems thrown my way. I also made a pretty cool discovery this week. The software we use at the clinic to schedule appointments has the option to apply different “skins” which change the colors and style of the software. One of these skins, “Pumpkin,” has an awesome Halloween theme, and the front desk coordinator and I were amazed by how much effort had been put into the skin.

Outside of the clinic, the Midpoint speaker we had for CIIP was amazing. To hear the organizer of the Baltimore Ceasefire(s) speak about her efforts to reduce gun violence was a great experience. I’ll admit, I was a bit skeptical of the effectiveness of the ceasefire when I first saw posters for it last August, although I certainly approved of the message. Hearing how the ceasefires have worked to stop gun violence, I’ve now been telling my friends outside of CIIP about the ceasefire.



This Monday was CIIP’s midpoint speaker event. Erricka, who is the co-founder of the Baltimore Ceasefire movement, told us about her experience growing up as what she called a handicapped poor black girl in West Baltimore. An inspiring leader today, people didn’t expect her to “make it” back then.

I remember the first time I heard of the Ceasefire movement and could not believe it could ever work. How could you stop gun violence with no incentive other than to respect an arbitrarily assigned weekend of peace? Call halt to a decades-old public health issue? I was biased in my inability to imagine this ever working at home, but somehow it did in Baltimore. Mexico’s recently elected president has been criticized for his “abrazos, no balazos” (hugs, not guns) promise to deal with violence through conversation. I think that importantly, Erricka didn’t show up to the battlefield as a preacher, or voice of authority, but rather a community member impacted by gun violence.

Erricka encouraged us to talk about the movement to three new people a day. The next day I brought this up to my front desk co-workers, and we had a discussion about the difference between premeditated and fight-or-flight murders and possible ways to deal with each. One of them was particularly skeptical and attributed the movement’s success to luck. “The criminal mind doesn’t just stop for the weekend. It has bigger issues to think of than some peaceful movement.”

When we take a patient’s medical history, we ask whether they feel safe in their new home and neighborhood. In my four weeks working at Esperanza, not one patient has said that they don’t. Perhaps they don’t trust me enough to say so, and it is not the problem bringing them to the clinic. But perhaps Latinamericans truly do experience violence differently. Even I, who didn’t flee anything, feel safer in Baltimore than home. I wish this was something I could dig deeper n without having to ask people about their perhaps traumatic experiences of violence.



I wish that I had a concrete epiphany or stunning experiences from the past week to share in this blog, something akin to the fascinating stories my fellow interns have shared. However, as I sit on my couch, watching the evening sun trickle down through the brilliant leaves of the tree outside my window, I can only think of small everyday events throughout my week. My favorite day of the week was Thursday, when two adorable children from the neighborhood who ran into the farm, seeking fresh snacks and company. One was a friend who I had met previously and shared many adorable moments (making a sprinkler with the hose and harvesting beautiful wildflowers for his mom) who remembered me as ‘Cinderella’ as he couldn’t pronounce Isadora. Him and his brother trailed behind me for most of the day, mimicking my actions and weeding with children’s plastic hoes or harvesting tomatoes with their small hands. I was reminded of the energy and comfortability that children often exude; the ease with which these children wandered into the farm and their ability to quickly make friends to finagle free tasty food.

I was also struck by how mature the two brothers acted for their young years (just two and four), which is likely a produce of their environment. The older brother was in the habit of greeting every person walking down the street by name, causing a bright smile to light up each passerby’s face. On one occasion, I asked him about one of the men he greeted, asking what his job was. My friend frowned at me, and said ‘I can’t tell you that, it’s a secret’. The realization that this young child was privy to community secrets that I as a white outsider could not be trusted with was difficult to reconcile.

My supervisor laughed at my new shadows, telling me that I was finished with harvesting early in the day and to spend the rest of the day with the ‘young ones’. When the kids watched me put sunscreen on (four applications a day!), they asked me if they could try some too. However, the rest of the work crew died laughing when they saw the white cream smeared across the boys’ dark faces, making fun of my skincare habits and willingness to let the boys’ copy despite their obvious blackness. The highlight of this special day was definitely when an older family member collected the two boys at the end of the day, and told me that he had no doubt I would make an excellent mother someday.

It is highly unlikely that I will ever have the chance again to work outside again in this capacity, where I am paid to cultivate and harvest vegetables in the middle of a vibrant yet struggling city. It is with that in mind that I am trying to treasure each back-breaking day on the farm where I leave covered in itchy big bites and soaked in mud; that this is an incredibly unique job that I need to treasure.

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