Sarah Marquez | CIIP 2023 Blog Portfolio

Orientation Week

The CIIP orientation for me was an excellent space for bonding, reflection, and growth. Not only did I meet amazing people with core values that align with mine, but I was able to participate with them in various community-building activities that made me think about my role within Baltimore. Through these activities, I thought about the aspects that make up my identity and how these (especially being a Hopkins student) affect how Baltimoreans perceive me and how I approach my internship this summer. It also made me think about how different aspects of my identity result in different privileges depending on the context, and how we should use those privileges to change the system until those privileges aren’t there anymore. Jessa’s talk was particularly helpful in making me understand the turbulent relationship between Hopkins and Baltimoreans and how this past makes it so we must enter our places of work with humility, understanding, and willingness to listen more than talk.
For me the biggest challenge this week was to be honest and open with myself and my peers about my views on the world, Baltimore, and world issues. Although I am usually shy, I tried my best to participate and add meaningful commentary to conversations. It was hard to reflect on how, while attempting to multiply love and support within a community, I could unintentionally be doing more harm.
This is why I am happy to have participated in the orientation. The talks we had were powerful and emotional. I particularly loved the “Leveraging your privilege for justice” talk by Reverend Dr. Heber Brown III from the Black Church Food Security Network. His passionate speech showed me the power of really submerging yourself in a community to understand its needs and working with them instead of doing what you believe a community needs. I also loved the scavenger hunt where we visited historic places around Baltimore and got to see first-hand the beauty and assets that Baltimore has.
After orientation, I feel equipped to start my internship and I will do my best to apply everything we have learned so that the work I do comes from a place of love, understanding, and loyalty to Baltimore and its growth. After meeting with my supervisor and talking about our paths in life and how we ended up where we are, I am certain that the Esperanza Center was a great placement for me and I will go to work every day with a disposition to hear, learn, and help wherever I am most needed.

Week 1

This week I’ve spent most of my time completing pre class assignments and zoom sessions for an EPIC training. EPIC is the healthcare portal we, as well as hospitals, use to keep track of our patients, appointments, referrals, and basically every task I will be working on for the rest of my internship. This is why we have devoted so much time this week to get me familiarized with all its details so that I can be helpful to the front desk, create appointments and send referrals.
Nevertheless, I have still done some patient work this week. At the Esperanza center all workers are incredibly busy so they rely on volunteers to keep the backstage of patient interactions going. One of my tasks has been to listen to our voicemails (because we don’t have enough staff to have someone pick up the phone when it rings) and log their information in our call excel sheet and then call them back to solve whatever situation they needed help with. Sadly, we have so many patients at the moment that we don’t have staff or enough volunteer doctors to receive new patients so most of my calls were to inform patients of this and based on their situation give them other resources or clinics they can call. Having to make dozens of these calls made me aware of the huge problem that Baltimore and the US have with unequal access to healthcare. Many of these people had urgent health concerns that would not be considered emergencies but do hinder their ability to work and provide for their families. Being undocumented means they face countless obstacles when trying to obtain basic healthcare. This is deeply saddening because healthcare is a fundamental right and charities like the Esperanza center can’t raise enough funds or find enough volunteers to help everyone. Therefore, changes at the root level, that of laws and legislation, must be made to protect the dignity and wellbeing of migrants.
I have also worked a lot with Latino populations this week which means that I have put my Spanish speaking abilities to good use. Another big issue I have come to notice through my work with patients is that majority of them don’t speak or understand English well. Despite writing that they need translators on their charts for hospitals to give them procedure instructions and reminders in Spanish, hospitals almost never do. This means that many of our patients lose valuable appointments or procedures because they didn’t have access to the instructions. This is an accessibility problem where hospitals aren’t taking into account the needs of the diverse populations they serve and where once again migrants face another obstacle to receive healthcare.
At the Esperanza center, to avoid these language barriers, we try to make sure that all staff speaks Spanish so that patients can feel welcome, understood, and comfortable. One of my tasks to try and facilitate this is to be a translator for Friday psychiatry sessions once a month. Unfortunately our volunteer psychologist does not speak Spanish so she needs someone to translate her sessions. This week I shadowed and helped translate the sessions which will be my duty next month as well. These sessions were very emotional and heartbreaking because you hear firsthand all the trauma that comes with building and sustaining a family in a country that is not yours. Many of these patients, apart from healthcare problems, deal with immense stress, responsibilities, trauma and hardship on a daily basis. Mental well-being for these populations is not often seen as a priority but I believe it should be. This week has been filled with moments where I feel out of my comfort zone. That has been good because it means I am challenging myself and learning. I am excited for what is to come.

Week 2

This was a short week due to Monday being a holiday, Thursday being a virtual EPIC training day, and Friday being the day I work from home. This means I was only in the clinic Tuesday and Wednesday. Nevertheless, this week I feel like I have learned a lot and I finally feel like I am having a positive impact on the community. This change happened because I was taught how to work at the front desk to check-in and check-out patients for their appointments. This means I also got more contact with patients this week which makes me very happy as it was one of my priorities coming into this internship. The past week I also spent a lot of time on the phone updating the clinic’s call log because we don’t have enough staff to have someone pick up the phone throughout the day. This means that people leave voice mails, and someone records the call details on an Excel sheet and calls the patient back. My main duty so far has been focusing on this call log but last week I didn’t know how to make appointments on EPIC so I couldn’t solve many of the patient’s requests. This week, I was finally taught how to use EPIC to make appointments and work at the front desk. Therefore, I feel like now my work actually helps the other secretaries and workers because I can keep things moving when they are understaffed, and I can help patients with whatever they need when they are busy.
As a student who has never worked in a clinical setting, coming into this internship I was scared that learning how the setting works would take me too long and that I would actually become a burden at my placement. Last week I struggled with those feelings and it was challenging to have to work on simple administrative tasks because I did not know how to do anything else. But, with the help of my amazing mentor, Yane (who is incredibly friendly and a great teacher) I have gotten the hang of the clinical setting and working with patients. I have also received a lot of help from other volunteers who have been at the Esperanza Center for longer, secretaries, and even doctors. Everyone has been incredibly friendly and with most of them being Hispanic I feel the warmth of being back home in Latin America. My co-workers have taught me how to best talk with patients so that they feel welcome, the process of obtaining appointments and having procedures seems less scary, and they are open to asking for help or sharing concerns. This is very important because having an appointment at the Johns Hopkins Hospital, one of the best hospitals in the world, can be scary for someone who barely speaks English. Having us explain instructions and advocate for accommodations like translators or correspondence in Spanish, makes all the difference in the experience our patients have with the healthcare system. I am incredibly happy and honored to be part of this team and I hope to continue learning from my co-workers and patients as I become even more knowledgeable of the healthcare system.

Week 3

This week I finally finished my (very long) EPIC training. I’m very happy about this because it means I will start next week with full access to our patient records and I won’t rely on someone else’s login or help to work. This week was also full of learning because Dominique, our most knowledgeable volunteer, is leaving so she tried to transfer as much of her knowledge to me as possible. So, she taught me the full process of referring one of the patients our doctors see at the Esperanza Center to a specialist at Hopkins. Between the moment our patient arrives at a visit in the Esperanza Center and when we call them back to tell them about an appointment they have at The Hopkins Hospital many things have to happen. First, the referral that our doctor input into EPIC has to be approved. For it to be approved we check in the system that our patient’s TAP is working. TAP is the financial assistance partnership the Esperanza Center has with Hopkins hospitals through which our patients receive free care in their facilities. However, for patients to have TAP they must qualify (have no social security number, no insurance, and income below 200% of the poverty line) and they must create a notarized proof of income with our front desk notaries. Then, in the system, we go patient by patient and approve their TAP and ask them to come and renew it every 6 months. After we verify their TAP, the referral is printed and someone calls the Hopkins department where the referral appointment is needed to schedule the appointment. Although this sounds simple, it is the most stressful part of the process because often the Hopkins lines are backed up so it can take up to 40 minutes to schedule each appointment. Additionally, we have to advocate for our patients so they have translators present for their appointment, transportation aid is provided, and all instructions are sent to them in Spanish. This request, despite our incessant asking, is not always met causing our patients to lose appointments because they couldn’t understand the preparation instructions, they could not get to the hospital, or they could not communicate with doctors and providers. After that, someone calls the patient and informs them of their appointment and we must log all this information in our REDCAP system. This concludes the process of a referral.
This week I learned how to carry out this entire workflow so I can now create referral appointments for patients and help patients with any need they have. I am very happy to see how much I have learned. From not being able to answer basic questions on the phone to being completely comfortable with the clinical setting, EPIC, and the workflow of the clinic. My days mostly consist of being on the phone with patients, fulfilling referrals, or greeting patients at the front desk. Sometimes I help our dentists sterilize equipment or assist in procedures by holding instruments or uploading X-rays. My duties are incredibly diverse and that means that I spent all hours of the day busy and that my knowledge is diverse thanks to my mentors here at the clinic. I can’t wait to see where these new skills take me, especially because I can apply them to any other clinical setting in the future.
Regarding bigger projects, right now I am investigating resources like other free or low-cost clinics in counties surrounding Baltimore County so that new patients (which we can not accept at the moment) have somewhere else to go. We receive calls from people all over Maryland so having this sheet of other resources with information for pregnant women, kids, homeless people, people with substance abuse disorders, etc can really make a difference in those people’s lives. For example, last week I received a call from a man who said burglars had broken into his home with hammers and attacked his kids. After this traumatic experience, the children were having trouble in their daily life because they were always scared. His dad called us inquiring about psychology appointments and although we are not accepting any new patients right now, I was able to communicate them with MVOC (Maryland Victims of Crime) where they will receive not only psychological help, but economic, legal, and healthcare assistance better than what we could have provided here at the clinic.

Week 4

When the summer was about to start I felt overwhelmed by what was about to come. I would be starting my first job, working a 9-5, walking every day to a part of Baltimore I barely knew and on top of that, I would be meeting 49 other interns. To say I was scared is an understatement. However, I can’t deny that a lot of excitement was also there. When I arrived at the Esperanza Center, in the first few days, I realized I had found a family. That Hispanic community feeling I missed so much, with the jokes and the warmth, greeted me in the form of the strong Hispanic women who work relentlessly every day to keep the clinic going, and to make healthcare available for hundreds of uninsured migrants.
One of my main goals coming into this internship was “to learn from the incredible team of people I will be working with as they show me through example what it means to be devoted to strengthening the Baltimore community” and I have definitely achieved this. Sitting down with my co-workers and learning about how they each got to the Esperanza Center has been one of the most touching activities of this internship. People from incredibly different paths of life, countries from all over Latin America, and age groups have taught me about the downfalls and strengths of our health system. They have taken me by the hand and helped me navigate referrals, approach patients, translate sessions, physical exams, and the very complicated system EPIC. Every single day I am doing many different things and this way I have slowly but surely learned the working of the health systems from a myriad of perspectives, that of the patient, doctors, administration, and sponsors. It is a system of incredible complexity and every day I get to make connections between healthcare and communities. After all, I believe medicine should be focused on honoring the dignity within every single person. Listening to the stories of co-workers and patients has been an honor and it has also fulfilled another one of my goals: to learn what it means to be a Baltimorean.
Being a Baltimorean looks different for everyone. In the clinic, I have seen how hundreds Latinos of have claimed Baltimore as their home with great pride and love. This has also helped me in my journey of calling Baltimore home, something which I struggled with ever since I moved here from Colombia a year ago. It is Baltimoreans that make this city such a great place and I am humbled every day to be able to learn from my patients. Like one of our doctors said today, they are our greatest teachers.
I feel like I’m on track to meet all my goals and even more goals I didn’t know I had. I have made connections at the clinic that I know will last my entire undergrad career. I have also become painfully aware of all the faults in the healthcare system and I hope that my work is helping bridge the gap between undocumented migrants and basic human rights. This is a very vulnerable population because they often don’t have the language means to advocate for themselves. I am still working towards my final goal of having a personal project that can outlive my internship and have a lasting impact on the Esperanza Center. This project will address these issues faced by Latino Migrants in Baltimore.

I have countless personal stories from my day to day at Esperanza and I wish I could narrate them all here. Some are painful to remember due to how tough they were, and others are filled with joy and passion. Journaling them down and talking with my CIIP peers is the type of reflection that solidifies the meaning of these experiences.

Week 5

This week was pretty calm. The primary care provider who sees most of our patients was out on vacation therefore the patient volume was lower. The clinic felt very lonely. However, the work is never-ending and we took this as an opportunity to catch up on clinic tasks that we usually don’t have time to get to due to helping patients. One of these was learning how to authorize referrals on EPIC and print them so that they can be scheduled. My supervisor does this every couple of weeks and its what keeps everything moving at the clinic so now that I know how to do this I (in theory) know every single step from the moment a patient walks in the door to the moment they come back for a follow up after seeing a specialist at the Hopkins hospital.
This will be very useful in my future because my dream is to be a doctor so now I am incredibly familiar with the way a clinic runs and the incredible amount of effort and money it takes to make healthcare accessible to vulnerable populations. This also means that in the future I will face med school and any type of patient work with humble and compassionate eyes. I have witnessed firsthand in this internship the hardships that each patient faces and how they impact their ability to access healthcare. From illiteracy to lack of transport, fear, or trauma, there are hundreds of reasons healthcare is not available to immigrants in the US, and having worked with people in these situations before means that in the future I will be better equipped to connect them to resources that will help bridge these gaps.
This internship has further confirmed that medicine is my passion and what I want to pursue. From getting a team of people together to create a plan for patient care, to listening to the stories behind every chart, I will always advocate for a more humane medicine. A medical practice that is patient-centered and holistic. The Esperanza Center has humane medicine at its soul so it has been an absolute pleasure to learn here every day.

Week 7

Recently, in my placement, I have been helping translate appointments for one of our CRNPs. She is leading a program that tries to educate patients on the causes and effects of obesity, diabetes, high blood pressure, and cholesterol. By shadowing these appointments I have come to notice that education is deeply tied to healthcare in the sense that prevention is an incredibly powerful tool to maintain populations healthy. If we are able to carry out more projects where the focus is to educate the Baltimore Latino immigrants on how to maintain a healthy diet and exercise habits as well as inform them about the possible health issues they could face if they don’t could help unburden the healthcare system and increase the wellbeing of our communities.
This means that there are many possibilities for collaboration between my placement and other organizations that focus on education outreach. Whether that means teaching children about healthy habits and providing them with the tools to develop these, or prevention programs that target low-income adults, education can be incredibly powerful in preventing future health issues.
Additionally, I also have seen a very strong relationship between legal/administrative issues and healthcare. Access to health insurance and documents are directly related to the types and quality of healthcare people have access to. This is why, organizations that work on changing legislation regarding healthcare access and those that provide legal consulting to Latino Immigrants can deeply shape the experiences these people have when it comes to accessing healthcare.
All these reflections stem from what I have witnessed at work and from what I have gathered listening to the patient’s stories. I believe there is still a lot of work to do to ensure equal access to healthcare and this internship has shown me that this work is not limited to the healthcare area. Legislation, the legal and education system are also incredibly important and hold a lot of space for positive change.