Testimony

As a Jesuit Volunteer, I have had the privilege to work with the uninsured in Detroit. As with all aspects of the healthcare field, the greatest source of frustration comes from what we can't control. Primarily, the life choices of our partners (I choose to refer to patients as partners). But, this well-thought out post clarifies and reminds me of the realities that people face. It points to the complexities of social realities and the need for a broader holistic discussion on poverty. We need a united voice for systemic change.

I do not know this specific bloggers social life and the veracity of her voice. What I do know is that her words remind me of the realities that I encounter day-in and day-out. 

I plan on posting a few of my own thoughts and about my experience at the Ignatian Family Teach-In for Justice.

Source: Why I Make Terrible Decisions, or, poverty thoughts [I urge you to visit the actual website and learn more about the blogger].

Books

As Jesuit Volunteers, we are placed in communities which suffer under structural violence. Whether they are broken education systems, political systems, healthcare systems, social systems, or economic systems people we work with suffer under systems they have no control over. This is the type of world we live in and the type of world that Suzanne Collins and Graham Greene create in “Mockingjay” and in “The Power and the Glory.” These books resonated with me, not because of how they are written, but because they thrust a knife into my conscience and twist as hard as they can.

What fascinates me about both these books is the fact that I see them both as protest books. In "Mockingjay," Katniss Everdeen is reduced to a figurehead. A bulk of the story revolves around her conflict with being her own agent, but this self-agency is co-opted by both sides of the conflict. Whether as a sacrifice to remind the districts of their weakness or a lightning rod that the rebellion can hang its hopes on, she becomes a pawn in a greater game between political systems. She is no longer a person, but a role that is inhabited. Katniss and the other tributes are sufferers that we as readers get to know rather intimately. But, the reality is that Panem is a world wherein self-agency is reduced to meandering existences of suffering.

Economic inequality reduces people into caricatures of humanity. From the grotesque Capitol to the faceless Districts, we are forced to take a pause in where we are today. How does our life of privilege, with our ability to take a year of our lives to "sacrifice in service," reflect the grotesqueries of the Capitol? How do our day-to-day interactions with our partners and clients, how they sometimes become just a torrent of victims rather than respected individuals, reflect the facelessness of the Districts? Suzanne Collins slides that knife into our consciousness so that we can see our own lives for what they are: privileged consumption.

In "The Power and the Glory," we are introduced to a flawed nameless priest. The bulk of the story revolves around his quest to survive. But, his final acts revolve around answering the call to serve knowing full-well that such service would require his life and would only affect one singular person that did not even embrace his sacrifice. The priest and the sufferer both die nameless and loveless deaths. Both deaths are witnessed by crowds of people that go on about their lives. We have to ask ourselves, how are we all witnesses to suffering in each of our ministries?

The beauty of the story is that compassion grows from a sense of duty and from a sense of suffering. The priest acts only after he has suffered persecution and been witness to it. He himself became a victim and a witness. It brought him closer to a sense of love for all people. How does our year of solidarity and as witnesses affecting us right now? After this year, where will our experiences as guide us? Graham Greene shocks us into realizing that witnesses bear a great responsibility to change the system that has victimized us all.

It maybe flippant to say what I am saying. In all respects, we are afforded the luxury to reflect on suffering as a means to entering a greater conscious morality/spirituality. The suffering that our clients, (I prefer calling them partners) is all too real. I am not trying to reduce such suffering to an academic discussion. But, it would be a disservice to not let their stories shake our worldview. The fictitious characters in “Mockingjay” and “The Power and the Glory” affected me in a visceral manner. Their suffering is fictitious. In a world of self-numbing media consumption, of caricatured human experiences, of narcissistic self-advertisement, we have the ability to bear the stories of this year and learn as witnesses to suffering. What we learn and how we change is entirely up to us.

Healthcare Collapse

For the past few days, weeks, even years, politicians have been battling and debating the victories and the disasters that the Affordable Care Act will bring about. Whether these victories or disasters are fictitious, overblown, or irresponsible is periphery. The fact remains that the debate has divided politics between notions of fiscal responsibility and moral obligation. We're on a fifth day of a governmental shutdown because this complicated question seethes under all these political debates. Although the Act carries funding provisions that should allow for the Act to fund itself, the effectiveness of them can be debated by economists. What I want to discuss is what I believe will be the Affordable Care Act's lasting legacy. I do this without the education in health policy or the experience of healthcare backing my words, but simply with the hopes of a student.

Jen Christensen of CNN wrote an article called "Doctor Shortage, Increased Demand Could Crash the Health Care System." In the article, she argues that the influx of patients that have health insurance will crash the system. Stephen M. Petterson PhD of the Robert Graham Center along with his colleagues notes that "the United States will require nearly 52,000 additional primary care physicians by 2025." Without this increase in physicians, patients who finally have insurance will face another hurdle: finding a healthcare home and provider. As it stands, the uninsured and even the insured use the emergency room as their medical home further straining a system. In the article, Dr. Stanton worries that the Affordable Care Act will further funnel patients to the emergency room. But I ask that should these worries therefore close off affordable health insurance as an option? I say no. Just because we fear that it might ruin the current system as not enough of an argument against the morality of providing care for all. The real discussion is on what should take its place after it crashes as it inevitably will and should.

In response to this fear, the Affordable Care Act has provisions to persuade training physicians to become primary care physicians. There are loan forgiveness and increased wage provisions for primary care physicians that serve in under-served populations. But, I don't believe that this is enough of paradigm shift. Others have pointed to the limitations of medical school slots. Just this spring as I was applying for medical school, I was informed that one of my top choices that I was denied acceptance could simply not cope with the demand. In essence, they only had 140 seats for 10,000 applicants. As per the American Association of Medical Colleges, there are only 141 accredited MD-granting institutes. Assume that an average class is about 140 students then there will be at least 236,880 new MD's by 2025. Is it realistic to hope that more than 20% of them choose primary care? I don't believe so. There seems to be a clear need for an expansion of medical school training. But I still don't think that this is enough of a solution.

The solution I believe in is explained by Celine Gounder in the New Yorker article "The Case for Changing How Doctors Work." Dr. Gounder believes that it is time to reconsider professional roles in healthcare. She poses one question: is 16 years of medical training necessary for a 20 minute patient visit to check vitals and do a medical interview? She believes not. I concur. She notes that " medical assistant[s], who can be trained in as little as a year, or a registered nurse could provide all of these services…[freeing] more time to focus on more complicated problems." This would require an expanded role for nurses, medical assistants, and community/social workers. Many would argue this as a violation of scope of practice guidelines. But, it is time to reconsider these guidelines. Indeed, "the Institute of Medicine has called for dropping regulations that prevent nurses from practicing 'to the full extent of their education and training.'"

Medications can be prescribed by physicians and nurse practitioners. Patient visits can be performed by nurses and medical assistants. Education and outreach can be done by community/social workers. Lewycka and Co published a paper in the Lancet noting how trained volunteers facilitated peer groups that lead to improved mother and child outcomes. Similarly, Aswathy and Co published an article in the Indian Journal of Endocrinal Metabolism about the efficacy of diabetic control through peer support citing evidence from UK and Mexican-American studies. These papers beg the question: are we really suffering a lack of resources or a misuse of resources? Therefore, we need to engage communities, families, and patients. Healthcare professionals need to look at healthcare as a wide communal project rather than a narrow directed chain of command. We need to create a new environment of greater accountability, personal responsibility, and communal investment. The system will collapse; it is up to us to be as open-minded as possible to accommodate such a collapse. 

A Phone Call from the President

I was sitting at my desk at work just going through some paperwork when my boss came up to me and said, "hey, we have a conference call with the president to just motivate everybody right before October 1." In my head I: "well, this will be pretty straightforward with Trinity's president."

In college, one of the more interesting discussions was the inherent inequality of the healthcare system. It was an exercise in compassion and moral discussion. But, all the talk was words in vacuum without action. Yes, something can be said about intellectual growth and paradigm shifts, but in the case of actual work, I can't say that I was involved in anything. I tried to understand the work to change thoughts on healthcare as a product to a right. The best I could do was to learn and better equip myself with the right motivations and emotions for such work.

We settle in her office. I reflect on the past few days for a bit. I remember the conference at Lansing. What I've learned about the people who changed careers to become patient advocates: the PhD that left the research world to be a community organizer, the single mother that at age 40 decided to become a JD that advocates for patients, and the RN that faced forced retirement only to start an organization to serve her patients. Where do I fit in?

My work as an Enrollment Coordinator has been focused on learning more about the Affordable Care Act (through classes, conferences, and seminars), help patients apply for insurance, and foster partnerships will local organizations to better serve the communities' healthcare needs. It's been a lot of phone calls and sitting at talks. Sometimes I wonder if my work makes a difference. I feel like I'm just, although out of college, learning and figuring out what are the right tools for me to use. It's the same as the past four years.

The conference call starts. I didn't hear the first speaker's introduction. I think she mentioned something about being a secretary. She begins to talk about the ACA and the battles it had to go through before and after it became a law. So in my mind, I thought she was simply the secretary of Trinity's president.

The only change in my function is the fact that I get to work one-on-one with my patients. Easily, the most gratifying and energizing part of my days is just interviewing people to figure out their needs. In reality, medical care is only one part of a person's health. Hearing my patients talk about the compassion of the people they meet here at Mercy Primary Care Center and how it has been a blessing for them reminds me of what real healthcare is meant to be.

The next speaker is Kathleen Sebelius, the United States Secretary of Health and Human Services. Again, she expresses her excitement over October 1: the Marketplace opening. She talks about the excitement of seeing millions of uninsured Americans finally be eligible or have access to affordable health insurance. I wonder why the Secretary of HHS would be introducing Trinity's president. Then, to my surprise, she introduced President Barack Obama.

The main problem in healthcare is the fact that it is generally paternal and monolithic in nature. It focuses on the proper medical treatment for the proper disease. Patients become numbers. Communication breaks down. Tests are done for the sake of tests being done. Costs skyrocket while patients stagnate. We pathologize health to the point of morphing healthcare into diseasecare. We look for the next sickness. But, the system of a medical home looks at a patient holistically and treats them with dignity. They are not my patients. We are their partners in their health. It is an intimate human endeavor that requires advocacy and compassion and that is what I've learned as I talk to them day-in and day-out.

Suffice it to say, I was shocked to actually hear the president address a nationwide audience of health systems. I was able to listen to his passion for healthcare equity. He spoke of a multi-level effort from the administration to large health systems to health centers to free clinics to reach out to America to teach them about the reform. I realized I was part of a greater system of care: a face to the system. President Obama's passion and gratitude reminded me of this reality.

The biggest part of this experience is learning how to care, how to smile, how to laugh, and how to listen. My role, I've come to conclude, is not just to help patients get the insurance that will help them get care but to remind them, that within the large system at work, there are people that care for them and will advocate for them. The reality is that not all diseases will have a cure. Therefore, our mission should be to care when we can no longer cure. In the end, simply caring is a form of healthcare and that is where I fit in.

A People and Their City

My first few weeks in Detroit have been quite eye-opening. Prior to orientation, Detroit was in the news due to filing for bankruptcy and the reality of having an Emergency Manager in Kevyn Orr. I have read so much about the decline of Detroit stemming from the inability of local automobile manufacturers to deal with a greater global market beginning after World War II. Most people also mentioned the high crime rates in the city. Suffice it to say, Detroit was as bleak a city as there is in the United States. But, what I've come to realize is that this caricature of Detroit, although having some truth, is ultimately misleading, uninformative, and self-defeating.

All that people hear about is the ugliness of Detroit. This is naturally easy because of our proclivity towards negativity. We, as media consumers, are fascinated by tragedy and failure and dysfunction. This fascination blinds us to the complexity of human experiences. Detroit is filled with broken systems and structural violence, but it is also filled with proud people and vibrant communities.

The first week in Detroit, our community was lucky enough to be welcomed by former JVs, local support staff, and Detroit natives. People are excited for and to serve Detroit. People recounted stories of coming to Detroit for their partner or as JVs and simply falling in love with the city. Their pride is unmistakable and distinct. They stay, not because of economic inability, but because they see the potential and the people of Detroit. They do not shy away from work, but welcome the chance to work for a greater good. But, the city itself is quite amazing.

During our first weekend, I was amazed by Detroit. The Eastern Market shows a local pride for Michigan and Detroit grown produce. Locals see themselves as providers for a healthier Detroit. The Fisher and the Guardian Buildings attest to the potential that Detroit represented in the early 20^th century. Buildings of magnitude reflect the power that once resided in the city. The abandoned buildings littering the city are in stark contrast to the mansions in Palmer Woods and Grosse Pointe. Gross inequality reflects the reality that the entire nation continues to struggle with. The Heidelberg Project reflects a broiling dissatisfaction with urban decay that is channeled into unbound creativity. Refuse is used to produce beauty in what many believe to be an ugly city.

In the end, Detroit is like any other city. Chicago, my adoptive city, struggles with growing murder rates, rampant gang violence, school closings, and food deserts. But, it does not dull my love for its people or its communities. Urban centers will always have their problems. All I'm saying is to never judge them simply based on their faults or what we see in popular media. A city is not defined by its politics or its economy or its failures. It is defined by the people that love it dearly with a vibrancy and a passion that allows them to carry on.

The World is My House

The beginning of my JVC year started at Waycross in Morgantown, IN. What fascinated me about JVC was its focus on intentionality regarding aspects of community, spirituality, living, and society. The focus is on a mindfulness regarding all forms of decision-making. Sometimes we are so accustomed to our position in society that we simply overlook the clutter and complexity that we voluntarily choose for ourselves. At the end of the day, does certain forms of technology and habits allow us to engage in the greater community as partners or simply isolate us in our own self-centered comforts? Indeed, life has allowed us to invest in certain peer groups based upon political or socioeconomic leanings. There is nothing wrong with that. The problem stems though from the fact that we so easily associate people as others. To what point does this comfort disengage us from a greater dialogue?

One of the phrases that struck me was a Jesuit saying: "The world is my house, the journey my home." To this extent, I reflect on how my journey in life has been about learning from people of different backgrounds. I have been lucky to learn through my grade school's outreach programs that people in poverty experience the same suffering and joys as any person albeit in different forms. I have been lucky to learn from Honduran farmers, Chicago inmates, and New York immigrants the brokenness of local healthcare and legal systems. I have been lucky to learn intellectual endeavors in art, literature, philosophy, anthropology, and chemistry from a Western collegiate education. What I'm trying to say, is that my life has been enriched by my encounters with people from different peer groups. This is something that we as a society should be mindful of when we engage technology and our personal choices.

What ultimately amazed me at orientation was the sheer passion and excitement that people had for intentionality. We all shared fears and anxieties about being thrown into uneasy situations, but we look forward to the challenge. Yes, we had fun socializing through dancing and singing and exercising, but we all came with the commonality to intentionally engage the world. We are meant to engage the world realizing how we have propagated broken systems, but also realizing that the world is beautiful. We are privileged in our ability to sacrifice a year and it is our responsibility to fully invest in such an engagement. Our service is transient and temporal; we can't do much good. But we can be part of greater engagement in dialogue. In the end, I believe the program is about loving the world in a holistic manner and that is the eye-opening reality of service.

The next post will be about my first week in Detroit and the vibrancy that has failed to capture our attention.

To Donate

Working as a Jesuit Volunteer allows the organizations we serve to direct their finances to the communities and people they work for. My service does not cost Mercy Primary Care a single dimeFor Mercy Primary Care this means being able to focus more of their resources towards serving 1,458 active patients. . All my finances are covered by the Jesuit Volunteer Corps through their network of donors. It has been estimated that a single JV can save domestic agencies like Mercy Primary Care approximately $20,000 annually. As such, I ask you to donate at Send Me to Serve.

To Serve

 I have studied the past four years at Loyola with an open-mind towards Ethics and Social Justice. To learn more about the ideas that I fell in love, I have chosen to spend One Year to Serve through the Jesuit Volunteer Corps.

This year will be spent serving as an Enrollment Coordinator at Mercy Primary Care in Detroit, MI. I believe that this experience will enrich my life and my goal of becoming a socially conscious physician.

This blog is a means for all my sponsors to keep tabs on the work I'm doing through their generous donations. I believe that asking for donations implies a responsibility to do everything in my power to do good with such donations.

Ultimately, this blog will be a recounting of my experiences and the stories I encounter throughout the year. I hope you join me in this learning and service endeavor. My hope is that my stories will provide insight into a healthcare system that is broken and the marginalized uninsured and under-insured.

If you wish to be involved feel free to donate at Send Me to Serve or simply keep me in your thoughts and prayers.