At this holiday time, when we focus on gift-giving, and celebrations, it is also good to reflect on those for whom gifts and celebrations are almost impossible. A few short weeks ago, Queen’s medical students participated in the Poverty Challenge which allowed them to experience living with less.
The following article was written by Dr. Jenn Carpenter and Dr. Melanie Walker who brought the Poverty Challenge to Queen’s School of Medicine.
On December 2nd2014, the first year medical students participated in a Poverty Challenge, organized by Judi Wyatt and Craig. The Poverty Challenge provided them with the opportunity to experience first-hand what some of their future patients live through on a daily basis. As part of their Population and Global Health Course, the students spent the afternoon playing the role of Kingston residents living with less and trying to solve a multitude of daily issues including access to transportation, housing, food, employment and medical care.
Throughout the fall term, the students have been learning about the Social Determinants of Health, their role as Advocate, social accountability and the fact that health is a human right in the Population and Global Health Course. The course stresses the fact that Global Health is local and that there are under-served populations in their own community as well as overseas. Students have learned about the fact that living with less increases one’s chances of ill-health and can also hinder an individual’s chances of success in many of the other social determinants of health such as education, early childhood development and positive social support networks. The Poverty Challenge was an opportunity for experiential learning of these concepts and was a way to put the knowledge that they have gained through their readings and in-class discussions into practice.
Prior to the event, each student was given information about the life and struggles of a person that they were going to role-play. They knew some of that person’s life history, why the person found themselves in the cycle of poverty and what specific obstacles the person was facing at the time. For example, one woman, who had a child at 16 and had no family support, had her child taken away by the Children’s Aid Society because her housing situation was deemed unacceptable. This, in turn, led Ontario Works to reduce her income because she was no longer supporting a child. The students assigned to this woman’s profile were tasked with visiting the appropriate social services agencies (stations located throughout the School of Medicine building and operated by community volunteers) to find employment and affordable housing while undergoing discussions with the Children’s Aid Society to get her child back.
Other students role-played the life of a women who was obese and living in an abusive relationship and was unable to find a family doctor who was willing to accept her as a patient. In addition, due to an undiagnosed learning disability, she was illiterate. The students were tasked to apply to Ontario Works for financial support (remembering the woman’s inability to read and complete necessary forms) and to go to a Temp Agency to apply for work. In addition, the students profiling this Kingston resident had to go to Legal Aid for help to leave her abusive relationship.
Over 20 local agencies were represented in stations throughout the medical building. At each of these agencies, the students encountered roadblocks similar to what the Kingston residents, of their profiles had encountered during difficult times. However, they also found out about the wonderful things that each of these agencies were able to do for them and were able to revel in the feeling of success, if and when they actually found the correct path.
Not only did the students learn important lessons about the barriers to health that people living with less face, but they also learned about community agencies that exist to help lift people out of the cycle of poverty. The feedback from the students was overwhelmingly positive. 96% percent of the students felt that the experience taught them about the challenges faced by people living in poverty and, despite the fact that the event was timetabled for the week prior to exams, 93% percent of them said that they were very glad that they took part.
A sample of the narrative feedback received from the students follows.
- “In general, the whole event was surprising in terms of the impact I noticed and what I heard from my classmates”.
- “I thought this was a terrific event. The experiential aspect really drove home just how many challenges (and of what magnitude) those “living with less” really face on a day-to-day basis […] Sometimes it is easy to forget that poverty is a problem that affects Canadians, not just those living “elsewhere,” and that many of our perceptions of and assumptions about poverty are inaccurate and based on the false assumption that “it couldn’t happen to us,” that poverty is something that one “allows” to happen rather than something that can happen to us in spite of every best intention and effort. I leave today remembering that I am very, very lucky. Thank you for reminding me of that.”
- “I came into the session feeling quite stressed about upcoming exams, and ambivalent as to the potential benefit of taking part in the Poverty Challenge. After […] experiencing (very briefly) some of the frustration involved with truly living in poverty, I’m very glad to have had the opportunity to participate. I have learned more about the holistic nature of suffering in poverty and also about the complex issues that give rise to difficult financial situations. This is an extremely well done event and I will take these lessons with me into the next few years of medical school and beyond. Thank you.”
Doctors are considered to be one of the most important advocates for their patients’ health, but this is a very difficult task without understanding the greater context (physical, emotional and environmental) in which their patients live. Our hope is that by providing these doctors-in-training with a more first-hand experience of some of the hardships that many in the community face and their implications on health we will encourage more open dialogue between doctors and patients and consideration of patient context when planning treatment.
Photos by Dr. Melanie Walker