2018 Week 6: Healthcare and Health Policy
On Wednesday and Thursday of last week, I attended a Testing and Linkage to Care training at the Health Department to become a rapid HIV tester. The training was well-organized and insightful and I was able to meet many individuals who were doing great work in their communities. I learned about the effectiveness of different HIV tests and how to administer them, how cultural difference can impact a patient’s treatment adherence, and heard about the experiences of people living with HIV.
Throughout the training, we addressed the stigma associated with being HIV positive and of being in a relationship with someone who is HIV positive. A study that absolutely amazed me was the PARTNER study that followed the sexual activities of monogamous couples for four years. A couple consisted of one HIV negative individual and one HIV positive individual who had an undetectable viral load due to antiretroviral medications. Of the 58,000 sexual acts that were performed without condoms, there were ZERO transmissions of the HIV infection between partners!
We also discussed the importance of healthcare professionals acknowledging the emotional reactions of newly diagnosed patients. One of the guidelines that we discussed was that listening was a way of honoring another person. This was an interesting perspective for me because I am a talkative person and I would much rather have conversations than sit in silence. However, patients often need someone to hear what they are feeling without judgment or interpretation. A comfortable length of silence in conversation is usually six to seven seconds and listening mindfully may prompt the patient to share more thoughts. Listening was just the first step of the LOVER method to problem solving, which consists of Listening, Observing, Verifying, Evaluating, and Responding.
On the last day, we listened to individuals living with HIV speak about their experiences. One question that was asked was what message they had for people who were currently not at the training. They said: “Keep an open mind, always be respectful and understand that we are people. We are people living with HIV – being positive does not define who we are.”
This past Thursday, I was helping to staff the mock safer consumption space (SCS) in front of Simmons Memorial Church, over in Penn North. I had been talking with a younger man who lived near Simmons, and he was asking me about myself. The first question I got was if I was in recovery. When I responded that I wasn’t, he said offhand that I must be someone just coming in from the counties. After talking about how I live here in Baltimore, I’ve been here for 3 years as a student, and I plan on staying here for much longer, he asked me “well, why are you working here?”
Thinking he was asking about what kind of work we were doing that day, I went into my elevator-pitch version about SCS. He stops me midway and says, “No, I said: why are YOU working here? What makes you do this work?”
I hesitated. Why am I here? What motivates me to do harm reduction-focused work, to spend my Thursdays talking to community residents about SCS? I answered him the only way I knew how: by telling him about my values as a person. I believe that everyone deserves safety, dignity, and compassion. I want to help make the world more just, and I am using my time, my resources, and my privilege to support organizations pursuing that vision.
He didn’t really seem satisfied, and I don’t blame him. It’s entirely understandable and valid if he wants people with more of a personal call-to-action to be at the front and center of harm reduction work. I want that too — I hope that one day BHRC will be staffed and advised by people who use/have used substances, people who engage/used to engage in sex work, and people who have been impacted by marginalization, criminalization, and stigmatization. It makes sense that the man I was talking with could have been concerned that by me not having a personal connection, the work I’m doing becomes less about justice for the communities which would benefit from SCS and more about my own idea of what justice looks like.
I’ve been struggling with this underlying insinuation that I need to have a personal connection to be involved at all. I don’t believe I should need to have been through recovery, or have used in my own life, or have been directly impacted by criminalization and stigmatization, to care about SCS. The burden of caring about social justice issues should be shared, not left resting upon the shoulders of marginalized communities. We need to actively create space for, support leadership by, and listen wholeheartedly to members of these communities, and support them in creating a more just future. Care doesn’t need to be conditional.
For most of this summer, I have been wrestling with how my placement is quite different from most of the others involved in CIIP. A lot of my friends are working at non-profits, community farms, or with policy makers. My placement is in a quite well-to-do assisted living and rehabilitation facility that undoubtedly rakes in a large sum of money each year. I was unsure how I would directly be impacting the community by working in such an upscale establishment.
While I knew that the elderly are an underserved and often forgotten population, I did not know the extent to which their care was lacking. At this point in the summer, I have realized that my placement has been a very unique experience and has opened my eyes to the challenges and barriers to the care of the elderly. They are an extremely underserved population and there are not nearly enough people interested in going into that line of work. Most of the nurses and geriatric nursing assistants are some of the kindest people I have ever met and really care about their residents.
However, they often do not have the time to spend quality time with any one resident since they have so many responsibilities and people to take care of. One particular resident this week needed to be accompanied 24/7 and that simply was not feasible for the staff so I spent a decent amount of time talking to him and wheeling him around the building just to keep him entertained. I guess I did not come to the conclusion that these elderly residents are an underprivileged community until these past few weeks. It gives me a renewed sense of purpose at my internship.
My role at Keswick has become more nebulous the more I learn because now I can float from hall to hall, helping any social worker with whatever they need. This has allowed me to create my own schedule and fill in the gaps of care that cannot be covered by the current staff. As long as I get my work done, I am free to interact with residents, give them attention, and hear their stories. I look forward to the next two weeks and hopefully I can learn even more than I already have.
As I walked home from the Health Fair on Saturday, dodging puddles and getting rained on despite my umbrella, my main emotion was gratitude. The rest of this post is my attempt to put that feeling into words. A quick summary: THANK YOU! Baltimore Harm Reduction Coalition, The Chase Brexton POWER Project, Chase Brexton LGBT resource center, the Alpha Johns Hopkins fraternity, my coworkers from Charm City Care Connection (who stopped by even though we were holding clinic that day), and of course the 29th Street Community Center all went out of their ways to support our Health Fair. Not only did it mean working on a Saturday and missing some of Artscape, but it also meant braving a day-long thunderstorm. I can’t thank everyone enough! Another group I truly want to thank is the people who came. Without their willingness to trust two students with little flyers and big promises, the fair wouldn’t have worked. As people entered in varying degrees of drenched, it also struck me that every one of them had also been willing to venture out in the thunderstorm to our event. When we ran out of school supplies, it was definitely a problem, but it was also a huge victory—I was so happy that enough people had come! It was also wonderful to see how much public interest there was in the naloxone training offered by the Baltimore Harm Reduction Coalition. At our fair, 15 people were trained and 17 kits were given out (all thanks to Reah and the BHRC volunteers!). It was great to see the productive discussions going on as people were trained. To leave the biggest thank you for last, I want to express how grateful I am for Bentley, my co-organizer of the fair. I couldn’t have asked for a more reliable, kind, energetic, and ready-to-go-flyer-till-7:45pm on a Friday kind of person than him. I’m so glad we got to work on this together!
This past week at Shepherd’s Clinic was quite similar to the last few weeks. While I do certainly enjoy my time at Shepherd’s, each day plays out more or less the same. My work at the front desk has not changed that much over the summer, which has allowed me to master the responsibilities given to me. This became quite apparent to me when I filled the patient care coordinator role for a couple of hours this week. The patient care coordinator is basically my boss. He runs the front desk and handles most of the patient intake. Most importantly, he needs to know the answer to every question posed by patients, doctors, and other healthcare centers, and he needs to know how to handle any situation that presents itself. I didn’t have much formal training when I started working at Shepherd’s. I mostly learned the ropes by asking the patient care coordinator questions. This week, he had to leave the desk for a couple of hours to take part in an architectural focus group. Our clinic hired a team of architecture researchers from Morgan State to give us an idea of how to improve the layout of the clinic. The researchers have been in the clinic for the past few weeks, giving surveys to clinic staff and patients. This past week they have held multiple focus groups with patients and staff. While the patient care coordinator was at the focus group, I had to be in charge at the front desk. The two hours went by without any difficulty. I dealt with every situation and question that came my way. A few weeks ago, I would not have been able to do this without interrupting the focus group to ask the patient care coordinator questions. This made me proud of how far I have come since starting at Shepherd’s Clinic.
This blog’s submission form has a long text entry, separate from the actual post, that is meant to work as ranting space. I have honestly just used the actual blog post as my ranting space, my little weekly outlet to elaborate on and help me process the challenges and successes of the health clinic. There are also suggested prompts and questions for us to answer to fight writer’s block, but every week I have disregarded these and answered “What’s a typical day like in your organization?” instead. However, I have answered this from a purely task-oriented perspective, when the reality of my day-to-day work is minimally tasks, and mostly relationships. This is partly because healthcare work relies on human interactions, and partly because non-profit organizations generally run on the teamwork of small staffs. It is then only appropriate that I dedicate this post to my beloved staff.
Bibi, the manager of the clinic, is the first person I met and welcomed me to the clinic. She presented me to the whole staff before I even officially got the internship, and immediately wanted to know more about me, gave me her phone number, and got me excited for the summer before it started. When not gathering data for grants or in a meeting, she’s walking around the clinic, checking in on everybody and picking up the slack. She knows the patients even though they technically don’t need to meet her, and betters your meals with daily avocados she brings for sharing.
Wardi, the TAP coordinator, is also leading the patient socialité rankings. Called “doctora” by all patients, she gets qualifying patients specialty care and keeps careful track of their appointments, health updates, and life stories. It is no wonder she is in charge of coordinating specialty care, since her involvement and attention to detail are at the definition of individualized care. When not on her busy schedule, she is host of “tertulias” at hers or anyone else’s office.
Kate, the medical director, is always seeing patients when she can despite her many administrative tasks. She is efficient and attentive, always giving her phone number to patients and taking the time to teach us interns about the biological as well as organizational aspects of medical care. She brings us smiles and vegetables from her home garden.
Billy, the other full-time nurse practitioner, is the jokester of the clinic. He keeps notes on everything from patients’ traits to Spanish phrases he learned from them. He’s the procedure master, and calls us interns in when he needs help as well as when he wants to teach us something. He takes care of the clinic’s plants as well as our staff’s sweet tooth.
Nurse “mother” Theresa is the triaging master. She has been teaching me the art of making a patient feel comfortable, as well as identifying their most pressing wants and needs. She keeps a stash of sugar-free candy and the latest blockbuster’s stickers for the younger patients. When she doesn’t come in on Fridays, you can tell her wisdom is missing.
Yani, the Cuban receptionist, not “almost-Cuban” like she jokingly calls Wardi. Indeed, Yani is full-everything, the strongest and perhaps most loving personality in the clinic. After forgetting my name once, she has baptized me with another two since, Valeria Veronica Victoria, and it has sticked. When not taming the bustle of the front desk, she’s reading the news and having passionate conversations about them.
Tania, the Ecuadorian receptionist, to whom I probably relate the most. On the quieter side but with an appreciation for carefully worded jokes and banter. As the newest staff member, she shares her fresh perspective on the clinic and the country. We exchange knowledge about dialectic idioms and recipes. She looks after me like her own daughter.
Maria, the dental assistant whom I wish I had met earlier. Perhaps I say this with Mexican bias, but truly a sweet soul. She manages the extensive waiting list of dental patients, all of whom she knows as well as she knows every volunteer dentist’s preferences on material and equipment. Just say hello and she’ll tell you her life story and hilarious anecdotes.
This past week, as the days left of my second summer with CIIP slipped away, I felt myself appreciating the small aspects of my internship more. As my time with Boone Street slowly draws to an end, I’m prematurely growing nostalgic of the unique nature of the farm.
It has been an immense privilege to work with the incredibly talented and diverse members of the crew, and an experience which I feel has brought me closer to understanding Baltimore City, and to some extent, myself.
There have been many times when I’ve discovered new ways that I am privileged – from teaching a Youth Worker how to ride a bike (I was stupidly surprised when he asked to ‘pop a wheelie’ and then, with chagrin, admitted that he didn’t know how to ride) – to my sadness when a different Youth Worker mentioned that she had never eaten a carrot. While there are many ways that I feel disadvantaged among my peers and friends who come from affluent backgrounds at Hopkins, I am constantly discovering aspects of my life that I am highly privileged to have.
From my ability to consistently depend on my cellphone and access to a well-balanced diet, to my childhood filled with bike lessons and a kitchen filled with fresh produce, I live(d) a privileged life compared to many Baltimoreans.
However, there is also validity in my own experiences of inequality among my peers at JHU. This summer I have become increasingly frustrated with the affluence and level of economic privilege that many of my friends and loved ones here are afforded. While likely a product of my growing anxiousness regarding my ability to afford a Hopkins education (and the rate at which I am amassing student loans), it has allowed me to view (without the willful ignorance that I allow myself during the school year) the stark class difference present at the university and the different oppressions that students from low-economic backgrounds face. It isn’t fair that I have three work study jobs, stringently spend my well-earned money, and am collecting a terrifying amount of debt while my friends buy Honeygrow and Starbucks without batting an eye, pay off club and sorority fees immediately, and can afford physics tutors on their parents’ dime.
It isn’t fair at all. It isn’t fair that I sometimes can’t afford medication, but it also isn’t fair that my Youth Worker can’t ride a bike. There is inequality present everywhere, even at Hopkins where the automatic assumption is that every student can afford (even slightly) a $60,000 education.
What I have taken away from this adventure of a summer, is a deep appreciation for urban farming and the beauty of cultivation, and the shrinking ability to tolerate ignorance to inequality.
Class is topic that we are socialized to avoid – our parents taught us never to talk about family finances in public for fear of embarrassment. This familial discomfort has led to a trend where we refuse to acknowledge the worlds of difference between people. Whether it is the action of avoiding eye contact with a person experiencing homelessness or the discomfort that arises when someone mentions their bills pilling up at home, the avoidance of class discussions has extended into every aspect of our lives.
In order for barriers to class privilege to be broken, they first need to be made visible. How to do this? I couldn’t tell you. Perhaps discussions need to start among social justice minded students (*wink wink*), to slowly erase our collective societal blindness to class inequality among us.Tags: 2018, Baltimore Harm Reduction Coalition, Boone Street Farm, Charm City Care Connection, Chase Brexton POWER Project, CIIP, CIIP 2018, Esperanza Center, Keswick Multicare Center, Shepherd's Clinic, Week 6