Anusha Sarkar | CIIP 2023 Blog Portfolio

Week 1

Shepherd’s has developed systems for keeping records and collecting information that are uniquely suited to the individuals working there and their preferences. Understanding where I fit into these systems and how I can be most helpful vs. where I should take a step back has been somewhat difficult. For example, the current front desk coordinator prefers to keep records on paper and wants to print everything before going further. This isn’t something I’m used to at all – I am more accustomed to keeping things online/as streamlined as possible to make sure things are easily accessible through technology. This more paper-based system is something the staff is very comfortable with and finds most convenient. I’m learning to navigate this unfamiliar system and doing my best to remember that what works best for the medical staff is what is most important, even if I don’t find it to be the most convenient or efficient. I think it is especially important for me to remember that I am young, and the things that I find best aren’t necessarily in line with the older staff’s preferences. They’ve been at this for a lot longer and I still have a lot to learn from them.
A lot of my work is self-directed and involves finding things that haven’t been addressed because of the limited capacity of the volunteer staff. Not being told what to do and navigating these systems to see where I can be of use is also really different from what I’m used to as a younger student. In my courses or other workplaces, I am often told what to do and expected to do so in a very streamlined, technology-based way that places more responsibility on the customer/patient than Shepherd’s does. For example, I volunteer at another clinic where we schedule appointments with patients to address their social determinant of health needs. At this clinic, there is a greater emphasis on the patient doing things in a timely manner and recalling their appointments. Shepherd’s provides more guidance and support than this in certain areas, and less in others. There is so much background to why this is the case, and it is based on what is historically optimal for the clinic and patients. I’ve been enjoying taking a step back and learning about these details.
I’ve also found that the clinic often has issues with reaching out to Spanish-speaking patients and providing them the same support as they would with other patients. At first, I found this somewhat upsetting given that the clinic has an interpreter line. Instead of judging, I tried to better understand the situation. I found out that the interpreter line is very expensive and the clinic has had difficulties finding grants to cover it. Based on this, I’ve tried to use my knowledge of Spanish to provide translations of the documents and forms that are sent out and worked as an interpreter. Because I took the time to listen and kept my place in the clinic in mind, I got to be more helpful while also developing a better understanding of the clinic.

Week 2

In a typical day of work at my placement, I come into the clinic and call our patients and referral offices to confirm that they are available for their upcoming appointments. After working through the confirmation calls, I work on various administrative projects and build resource lists for the clinic. This week, I have focused on organizing some of the systems and documents the clinic has. I have also been developing a list of dental clinics that accept Medicaid, and working on compiling immigration resources for undocumented immigrants that might need legal assistance.
While at the clinic, I also have the opportunity to speak to various patients and providers and learn a bit more about them. I’ve particularly enjoyed speaking with some of the staff recently, as I have gotten to learn more about their current interests and career backgrounds. Settling into my routine here has been a process as I get more familiar with the systems and people that work at the clinic. Building relationships with the staff has been really helpful and I’ve become a lot more useful here as the staff feels more comfortable delegating tasks to me now.
I’m excited to continue with the immigration resources project, but I want to be sure I’m doing so in an effective way for the people we are trying to serve. At the most recent board meeting, the staff discussed the fact that they have had a recent surge in undocumented patients. These patients would be eligible for medical assistance based on their income, but cannot access it because of their legal status. The goal is to help them become documented, but I worry that this might come across poorly. This is a sensitive issue as many people worry about their legal status and there is so much history behind every person’s decision to live here without immigration documents. I am hoping to have a focus group and discuss what resources would be useful for patients, so I am able to ensure that we are best serving them without making them feel nervous regarding their status. I think it is crucial to approach this with the community perspective in mind, and I hope that I’m able to do so effectively. I am nervous about even the initial communication with patients about this, because it is such a sensitive issue. I’m also a bit nervous about discussing my plan with the clinic, as I am not sure if this is the approach that they would typically take.

Week 3

On a typical day of work, I spend the first part of my morning on a routine set of administrative tasks. I call patients and referral offices to confirm their appointments and work through other outstanding tasks, such as calling patients to confirm their information or schedule them for appointments. Beyond these things, I also complete vitals sheets for the next day and print out provider schedules to help things run more smoothly in the clinic. After I’ve worked through these tasks, which can vary extensively, there is a list of larger projects I can be working on to support the clinic. For example, the clinic wants us to reach out to our undocumented patients to have them complete Medicaid applications, even though we know they will receive a denial. Having this denial letter in our records makes it easier for us to apply for pharmacy assistance programs to better support the individual patient and the clinic, as it better expresses why our patients cannot otherwise access their medications and vaccines. I only recently started working on this, but I am quite nervous as I know this is a delicate topic for many. I don’t want any of these patients to feel uncomfortable or worried about the privacy of their information.
Throughout the day, I can also help in other ways, depending on the needs of the staff. Sometimes I help complete screenings to determine if someone is eligible to be a patient of the clinic. I have also been able to serve as an interpreter in more sensitive medical situations. For example, I was an interpreter for a few hours this week as the gynecologist wanted to ensure that the interpreter was someone the patient would be comfortable expressing more personal and sensitive information to. These types of tasks vary extensively – sometimes I work as an interpreter and other times I am helping with filing or sending out mail.
I particularly like working as an interpreter because I enjoy hearing the stories of patients and being able to communicate with them. Some of the patients I’ve worked with only recently immigrated to this country, and I’ve really enjoyed connecting with them about adjusting to this country and finding their way in Baltimore.

Week 4

When I first started working at the clinic, I was excited to compile lists of resources for the clinic so we could better assist patients with needs we cannot directly meet. Over time, my perspective on this task has shifted. Originally, my goal was to be better able to help people when we turn them away. While this is still a very important goal of mine, I also view this as a way to build connections with community partners. I get to call the resources we are recommending to collect information and explain that we are hoping to refer patients there. In the process, I have realized the importance of interconnection in community resources and am excited to hopefully facilitate building these connections. I feel like I am on track to start exploring this goal, though I still have much to learn about the partners and connections that already exist.

I also realized that I want to prioritize working directly with patients. I didn’t think this would be as important to me at the beginning of the summer because I am not looking to work directly in the clinic. Through my experiences to this point, however, I have really enjoyed working with patients directly and my definition of “clinical work” has shifted. I used to feel that clinical work was restricted to the more conventional medical appointment. I now feel like it can involve much more, and I’ve been enjoying speaking to all the different staff members that are involved with clinical work in different ways. I really like being able to translate for the gynecology patients – they feel more comfortable being candid without needing a family member to translate or potentially having a male interpreter. By translating, I have been able to form really nice relationships with certain patients and I look forward to translating more particularly because of this. I would hope to get more involved with this sort of thing, but I need to speak with my supervisor about how to do so. I only translate as needed and don’t shadow beyond that, but I can pursue the goal of patient interaction by shadowing different providers and talking to more staff members about their professional experiences. This feels very doable though, and I am excited to explore it.

Week 5

By working at the clinic, I have solidified my interest in combatting language barriers. Prior to working at Shepherd’s, I hadn’t seen such a diverse population in terms of native language spoken. Working here, I’ve been able to use my knowledge of other languages as well as recognize my limitations and the importance of translation services in healthcare.
Beyond this, I feel like I have been better able to recognize the power of connections within communities. For example, we are trying to revamp our screening process – we usually request proof of income, proof of address, and ID. This has posed some unique challenges as the population we serve often has difficulty providing such documentation and we weren’t sure how to go about this. My supervisor recommended that we reach out to other organizations that have screening procedures to see how they circumvent these problems. She emphasizes the importance of connecting with other clinics and resource providers in general when we are doing things like compiling lists of resources to give to patients. I used to think of these lists as a way to redirect patients when we couldn’t meet their needs, but this approach has made me rethink and recognize the importance of connecting with other organizations. Even talking to other CIIP interns about how things operate at their organizations and using CIIP to build connections between Shepherd’s and other places has shown me how important this intra-community connection is. I am excited to seek this out and encourage it in my own work in the future.
In a more broad sense, working at the clinic has shown me how valuable it is to hear the stories of others. I feel like I’ve learned so much about Baltimore and been better able to connect with and help patients because I’ve been focusing on listening better. I hope to work in a setting where I will also have this privilege of getting to listen to such diverse stories. Whether it is hearing a patient talk about their experiences in managing their diabetes, or speaking to a young mom about her difficulties balancing her own health with her role as a mother, the stories I’ve learned here are my favorite part of the CIIP experience so far.

Week 7

This week was a very intersectional week! I refer a lot of interested patients that aren’t eligible to be seen at Shepherd’s to other organizations in Baltimore that are also placements, like the Esperanza Center or ERICA. Someone from ERICA actually called the clinic this week because she was looking for a clinic for 2 refugees that need to be seen before the school year starts, and we were able to enroll them as patients here. Immigration issues are often at the forefront of our work here, as immigration status determines so much of eligibility for things like medical assistance or government assistance more generally. I’ve also been talking to my CIIP supervisor about how Shepherd’s is hoping to collaborate with Esperanza to coordinate vaccinations and potentially provide our patients with better legal assistance resources.
Because Shepherd’s is specifically a patient for the uninsured, I’ve had the privilege of seeing the intersection between many issues that Baltimore residents face in accessing healthcare. They have issues because of eligibility, language, and legal barriers, as well as things like transportation.
One of the things I’ve really enjoyed about working with my supervisor is how passionate she is about building connection between resources in the Baltimore community. She wants us to reach out to other organizations to learn more about what they provide and how we can better collaborate to meet our patients’ needs. Realizing that we can collaborate in a fruitful way with such a wide range of organizations shows the relevance of intersectionality in healthcare. I would be really excited to see us follow through with the Esperanza collaboration – we were told they don’t have a medical director and we have a good amount of nursing availability to provide vaccinations. At the same time, I know they are able to offer legal support to patients while we are not. If we were able to use these strengths and fill in each other’s weak spots to better serve our patients, that would be really cool.