Poverty Simulation Challenges Residents to Conquer Real-World Issues in Social Inequity

As part of their orientation, about 100 new residents had difficult decisions to make – decisions some of their patients face each day: When money is tight, how do you choose between paying for groceries and your medication? Do you get docked pay for leaving work early or pay a fine for being late to day care pick-up? How do you navigate medical appointments when you can’t see or walk properly or are pregnant but without health insurance?

“I really hope this helps the residents realize that our families are in great need and that when they come to the hospital all they really need is for someone to care,” said Hazel Morales (seated, left), a heath equity specialist with Delaware First Health, who volunteered at the simulation.

Through an immersive simulation organized by the Office of Health Equity, residents were able to place themselves in the shoes of those who have been in these and other wrenching real-life situations, such as eviction and robbery.

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Life challenges like transportation, stable housing and food insecurity over the course of one month were simulated through the exercise, with each week broken down in 15-minute increments. Residents were grouped together as “families” to try and combat exorbitant fees charged by payday lenders, job losses caused by excessive absences and unsympathetic workers at social service agencies.

Jaki Ortiz, vice president for Health Equity & Cultural Competence at ChristianaCare, reminded participants that eviction means “you’re standing on the sidewalk with your apartment right in front of you and you’ve got all your stuff in there. The little bit of food you have is in there, and you have your kids on the sidewalk with you. What do you do?”

Volunteers from ChristianaCare and other local organizations played assigned roles in the simulated community, including workers from the bank, child care, grocery store and social services. Their roles reflected the obstacles people living in poverty face when trying to get help – bureaucracy, a lack of funding and institutional barriers to assistance.

In a race against the clock, most residents didn’t have the time to access their social service benefits. During a debrief, they expressed frustration at not being able to pay their bills, missing work or being evicted. One resident felt it hard: “In the third week, we got robbed.”

By struggling with the same kind of health barriers, compounding money problems and family dynamics that their patients face, residents learn what it’s like to survive week-to-week as a family living at or near poverty level.

“It’s a miracle that your patients are able to come in and see you. When you’re with them, make the most of every moment,” said ChristianaCare’s Chief Learning Officer Tabassum Salam, M.D., MBA, who participated as a health clinic provider. “Don’t judge people who are running late and, yes, they may need five to 10 things at once.”

Residents assigned to families with diabetes couldn’t make it to the clinic. Another family received a utility shutoff notice. The experiences mirrored the social drivers of health — the conditions and environments that affect health risks and outcomes, functioning and quality of life.

A resident feels what it’s like to wait to be picked up late from day care.

“The simulation really helps physicians understand why patients may come into the office the way they do,” said Michelle Axe, MS, CHES, program manager of Food and Social Care Initiatives for ChristianaCare. “It’s easy to think ‘Oh, they’re non-compliant,’ without understanding that an appointment or medication may be the last thing they can think about.”