HEALTHCARE & HEALTH POLICY

ANUSHA GOLLAPALLI | SHEPHERD'S CLINIC - WEEK 2

MR. & MRS. K--

“…and she hasn’t been doing too well.”
“All right sir, in order for your wife to become a patient here, I’m going to have to ask you a few questions to see if she’s eligible – does that sound okay?”
“Yeah, of course.”
“First of all, does she have insurance?”
“Nope.”
“Can you tell me what zipcode you live in?”
“21234”
“Great.. so our clinic only accepts patients in thirteen zipcodes in the surrounding area, and you fall in that range. Next is an estimate of yearly household income. How many people are you supporting?”
“I’m earning about X per every two weeks, supporting my wife and our daughter, we live with my parents.. is that okay? I’ve been paying all the bills, my father earns about $ per month, and my wife receives $ in social security checks… I don’t know exactly how much per month or year, it depends on my hours, I…”
“That’s fine Mr. K. Let me look at this for you.. can I put you on hold for a minute?”
“Of course”
“Mr. K?”
“Yes ma’am?”
“So it looks like you’ve just passed the eligibility cutoff for Medicaid - which would make your wife an eligible patient at Shepherd’s. I can go ahead and schedule your appointment, sound good?”
“Yes. Thank you”


MRS. D--

“…it’s urgent.”
“Ummm, I’m not sure what I can do about that.. Can I put you on hold for a minute?”
“Yes.”
“…All right, so I talked to our nurse coordinator, who said that the swelling could be normal, and you’re going to need to elevate your leg and keep it iced. If there’s still swelling on Tuesday, then call back and we’ll schedule a doctor’s appointment.”
“It’s not going away, I’m not sure what to do… it’s been hurting, and I don’t know what to do..”


MR. B--

“…sorry, can you repeat that?”
“So we’re located at 2800 Kirk Ave., I think you’ll need me to help find you directions?”
“Yes please, I.. am new here, I don’t know the directions, I have to take the bus.”
“Well, the bus schedules are actually changing on Sunday, so why don’t I give you a call back on Tuesday and help you then? Funnily enough, I don’t actually know how I’ll get home from work yet, haha.

---------------------------------

I met the Mr. and Mrs. K at the clinic today – they asked for my name upon entering, and I made conversation with them as they signed in. Mrs. D was more difficult. I had to ask our nurse coordinator what to do about her swelling, since we don’t really do walk-ins. If this was an emergency situation, then I should help her find urgent care. Hopefully the swelling goes away by Tuesday – I think she’d just had knee surgery. The Mr. B was my favorite. He was new to the US and I spent about an hour and a half on the phone with him over two days, just trying to make sure he’d be able to reach the clinic. I got to meet him in person on Wednesday. The sweetest success.

AMI MANGE | BALTIMORE HARM REDUCTION COALITION - WEEK 2

Although I had done quick, 5 minute long trainings outside Red Emma's, which were in a quite informal setting, I hadn't delivered a presentation yet. What I love about the trainings, every time I observe them, are the great questions that people ask. "What happens when you inject Naloxone in case of stimulant overdose?" "How long does Naloxone last in the body and what happens if the drug's half life is longer than the medication's?" I am always impressed by my supervisor's thoughtful and clear answers. She is always calm, prepared, and confident, and has a breadth of knowledge about the subject. My first solo (supervised) presentation was at AIRS, a housing program, and I had the amazing opportunity to train an inquisitive, smart group of individuals. I was nervous about answering questions, but I approached the training with confidence, hoping to carry it out the way my supervisor does. However, I could not have anticipated the challenge of training others. "Is it possible for fentanyl to be cooked in home labs, similar to methamphetamine?" I had no idea. I had this idea that I would be able to address questions confidently, but I froze for the five longest seconds, and all I could say was "I'm not sure". Then, I looked to my supervisor, and of course, she had the answer. In retrospect, I am glad I was faced with questions I didn't know about, because as I have been told, it is important to be able to say "I don't know". I don't have the experience of a seasoned trainer yet, but that is another goal I am going to set for myself this summer.

EILLEN MARTINEZ | THE ESPERANZA CENTER - WEEK 2

06/22/2017

I didn’t show up for work today. Yet I experienced an intimate insight into the lives of our patients that I wouldn’t have had otherwise.

I spent the day at the hailed Johns Hopkins hospital.
Cue the trumpets and fanfare! Ah, let us bask in the glory of that resplendent name.

Let’s applaud for the worst experience I’ve ever encountered in healthcare. And I wasn’t even the patient. Slow clap.
For the past 12 hours I have been here in this freezing, white-walled hallway accompanying my friend who had a medical emergency last night. He’s been waiting longer.

I had the urge to ask around to make sure I was in the emergency room and not the sit around, lounge, and passively wait for your desperate illness to swallow you room. I shook away the thought. Psh, Eillen! That name doesn’t have a ring to it! And Hopkins is all about looking good and sounding good on the exterior.

For a place crawling with nurses, there doesn’t seem to much patient care going down. Plenty of insulting and ignoring of patients though.

The nurses were speaking offensively about my friend and other patients in French. Sneaky. You know what’s sneakier? My friend speaks French. He politely made his French acumen known. I guess the look on their faces almost made that horrendous wait bearable. Almost.

My friend came into the emergency room at midnight. He wasn’t seen by a doctor until 1 pm. I guess if your head isn’t hanging from your body by a thread of flesh, you’re not important. And even dying status might not guarantee attention. At least that’s how it felt. You go in, expecting care--instead receive delayed attention and a hefty bill that can only be scoffed at. I get it. The hospital is overwhelmed. There are no physical hospital beds available. The staff works tirelessly patient after patient. They do what they can. Sure. But this does not detract from the fact that the system seemed to dehumanize the very people it was supposedly constructed for. This does not take away from the suffering that people endure when they’re told by desensitized nurses whose eyes are always fixated on another patient’s file or computer screen that they just have to wait their turn. That there's a process for each case. I can’t help but wonder, what happened to addressing the human attached to that case?

Most of the patients that enter Esperanza with pressing issues have been to the Johns Hopkins Emergency Department multiple times. I've seen it in their files reduced to a single line.
In the paperwork we have for patients to complete, there’s a checkbox corresponding to the following: “Check if Esperanza Center were not here, would you have gone to the emergency room?” No box has been left unchecked.
After this experience, I’m slightly more in tune to what our patients have faced or are willing to face. Except there’s a difference. They deal with situations like these and worse, every day. Some of our patients have survived stab wounds, assaults, separation anxiety in their countries and here without formal treatment. They won’t complain. They’ve been conditioned to remain silent. For protection.

I now keep that in mind when we leave our patients waiting for hours. I remember that although the filing is important, each file is a human life. And each deserves that regard. I now understand better that while Esperanza is a source of relief and hope just by existing, we must work to remember that each patient that walks into our clinic matters and we need to express that. It’s easy to become numb to other people’s pain when it becomes your everyday.

I know I just spewed a bit of a rant. But sometimes there’s got to be complaint. I am a Hopkins student. I love my institution. I love what Hopkins has done by supporting the TAP program. To have programs like CIIP. Which puts me in an even more prime position to criticize and desire for the quality of our institution to improve. Because I am a Hopkins student, I am privileged. So I will complain. It is my privilege to complain and rant to urge my voice to be heard for those that are not. I’d rather have some ruckus than fanfare.
 

YAMINI PATIBANDLA | CHARM CITY CARE CONNECTION - WEEK 2

Community outreach is a funny phrase. Everyone throws it around, I was guilty of it too, but I didn’t realize how complex this term was until I started my second week. A big part of this week involved attending community health and wellness fairs around the city to represent my community partner, Charm City Care Connection. So we would drag our outreach bin with us to a table, pull out our materials, place a collection of 200 or so rocks to beat the wind and sit in the sun while waiting for community members to approach us. Pretty soon, after hearing my supervisor repeat our mission statement a few times I got the hang of it, and I liked our elevator pitch. We received the same questions and our answers were always the same. But the number of community members we spoke to was greatly overshadowed by the number of other nonprofit vendors who passed around to learn more about other groups in attendance. At all of the events I visited, I saw a very similar picture - vendors sitting and speaking with each other. I met some of the vendors and realized that within the health care and health policy field there were few that provided overlapping services. As my supervisor described it, these community outreach events were a good way to witness the oversaturation of nonprofit organizations in Baltimore. The question remained however - was the low community response to each of these events a result of all of our hard work? Were the community’s needs being met? Or did we need to do more community outreach to see a better turn out? Maybe instead of more outreach, we needed to try another type of outreach. I learned the answer revolved around this funny word. And it continues to be a tool to be explored in the coming weeks.
 

CORINE PEIFER | CHASE BREXTON LGBT RESOURCE CENTER- WEEK 2

PRIDE was truly an incredible experience and I highly encourage everyone try to attend it eventually. From the people I bonded with to the bright colors and smiles I saw, I was in awe of the entire community coming together and embracing their true selves. Having the ability to walk in the parade with Chase Brexton and table with them on Sunday in Druid Hill Park was an honor and an experience that I will cherish. That being said, I am excited it is over and can relax again. However, I realize I used the term “relax” loosely because there is never a dull moment in the office.
On Monday and Tuesday, I went with my supervisor to two different LGBT informative trainings and it was interesting to see the composition of the groups, the interaction level, what topics were being discussed, and read the non-verbal cues that filled the air since the trainings were different, but not in ways I primarily expected. For example, the training that I thought would be the more excited and engaged seemed more reserved and with less of a desire to be there.
For the first training, I was inspired by the gentleman who brought us in to talk. He told us about his efforts regarding developing a new rainbow logo that the organization can use and bringing everyone in the office together to walk in their first PRIDE parade. He was so passionate about making a positive difference and one could see that his feelings were contagious with his fellow co-workers.
Also, one of my co-worker’s last day was Wednesday. As it is sad for everyone to see her leave, I also find myself nervous as some of her primary responsibilities involving the SAGECAP program will fall to me since the office is already understaffed as it is. However, I am excited to help, learn, and grow from this experience while attempting to make the transition a smooth one.