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It turns out that when they call clinics “experiential learning,” they really mean it.
Emily, Buri, and I are enjoying the unique opportunity to participate in setting up a medical-legal clinic. We are seeing things from the very beginning stages and learning about all of the thought and planning that goes into a clinic before you ever meet your first client.
We drafted agreements, started a blog, communicated with healthcare professionals, researched social determinants of health, and delved into the world of poverty through research and in-depth discussion. Our experiences thus far have been both challenging and engaging; they have opened my eyes to a new world and new ways of thinking. I expected that, but I did not expect to learn so much about myself.
This was supposed to be the safe semester. We are not even taking clients. I believe that I subconsciously hoped my work this semester would be just a half a step away from the classroom context I have become so comfortable with. This was not the case. In place of the intellectually stimulating but rarely upsetting work I wanted, this clinical experience has been just that—quite an experience.
I have been forced to confront my own biases and the position from which I act and make decisions. A few short months ago, I was far less aware of these very real issues.
Through readings providing a vivid picture of poverty and homelessness, I was forced to acknowledge and adjust my view of the indigent population.
I was struck by the fact that there is no clear definition or profile for the “poor,” and there is no single party to blame. In the introduction to his book, The Working Poor, David Shipler suggests, but I will say that I believe, that society is largely to blame for poverty. Why don’t we care for our mothers, brothers, cousins, aunts who are in poverty? Yes, the individual is often responsible, but if there are poor, there is probably something wrong with our greater system. It cannot be just an isolated addiction or case of bad luck.
Mr. Shipler also addresses the morality of poverty. This is a concept I had not consciously addressed. He states that, for many, “hard work is not merely practical but also moral; its absence suggests an ethical lapse. A harsh logic dictates a harsh judgment: If a person’s diligent work leads to prosperity, if work is a moral virtue, and if anyone in the society can attain prosperity through work, then the failure to do so is a fall from righteousness.”
Do I subconsciously think this? I’ve never been very motivated by money or given it much thought in my personal life, but I’ve also never lacked it. I think that I may subconsciously give someone more value, or more credibility at least, when I learn that they make a substantial amount of money or drive an expensive car. Being the product of the twenty-first century that I am, I was quite uncomfortable admitting that this necessarily means that I place some moral judgment on those who lack social and economic success. This was directly challenged as I read countless stories of those who found themselves caught in the vicious cycle of poverty. Some lacked the hope to pull themselves out of it, and some were victims of misfortune that upset the delicate balance so many must maintain to stay out of poverty.
As we studied and discussed cultural differences and how to strive for cultural competence, I was forced to wrestle with my ability (or perhaps inability) to recognize that those who come from other cultures or family situations may communicate and think differently than me. Further, I was challenged to learn to look for similarities when they may not be obvious. I anticipate that the greatest challenge may be learning to appropriately balance the two.
As the ‘type A’ outnumbered in a very ‘type B’ family that often thinks it is the exception to every rule, I thought I was accustomed to being challenged and questioned. However, I am thrilled to say that this experience is stretching me in a new way. What a privilege to leave the confines of the classroom for “experiential learning” that is anything but safe.
For one of our classes, our professor had us read an article about Dana Suskind. Dr. Suskind is the co-founder of the pediatric cochlear implant program at the University of Chicago Children’s Hospital, bringing sound into the lives of children born deaf.
I am particularly vulnerable to stories about children, in any form. While the rest of the world runs around making grand gestures, children get hurt and very few of us do anything about it. Those who are in the trenches are driven by love, not for any glamor or glory that may come with it. I cannot think of anything that could be more rewarding than bringing a child’s potential into bloom. And Dana Suskind does that with her implants.
But Dr. Suskind does a whole lot more – she works in the world of holistic health care, where the connection between health and social determinants, the world that we explore in our clinic, is very real. Dr. Suskind’s research led her to the “30 million-word gap” – something that I was unaware of until I read the article. The 30 million-word gap shows that “by the age of 3, children of lower socioeconomic status will have heard about 30 million words less than their more affluent peers” – a gap that impacts everything in those children’s lives, from academic achievement to school preparedness to later success. And as we uncover more information about the social determinants of health, it becomes ever more apparent that life success is intricately connected to our health.
In response, Dr. Suskind has started the 30 Million Words Project, a program that addresses the gap through “parent-directed intervention.” The program “sends research assistants to the homes of at-risk children for 13 weeks and educates their parents about the importance of engaging their children in an ongoing dialogue – and, equally important, offers them the tools to do so.”
I find it remarkable that the connections to long-term health outcomes can be traced to such an absolutely basic idea – to how much a parent talks to his or her baby! And I find it equally remarkable that Dana Suskind has not confined her ethic of serving the most vulnerable among us to just her operating room, but has stepped into a world very different from one that she is used to, and is making a difference in real people’s lives in a way that a scalpel could not.
Sarmistha (Buri) Banerjee
What do Miley Cyrus and holistic medical care have in common? Foam fingers, bears, and twerking aside, both are at the center of a movement. Miley’s movement is more about shock and confusion than substance, but the same cannot be said for the movement to provide more effective healthcare that is sweeping the nation.
Medical-Legal partnerships are not alone in this quest. Across the country, legislators, lawyers, healthcare practitioners, social workers, and advocates for America’s poorest are realizing that there is no single, easily identifiable cause of poor health or poverty and that simple, one-dimensional solutions are ineffective.
“The Hot Spotters,” an article that appeared in The New Yorker on January 24, 2011, highlights several champions of effective healthcare.
Jeff Brenner studied the patterns of patients entering hospitals in Camden, New Jersey and found that, of the 100,000 people using medical facilities in Camden, about 1,000 people accounted for 30% of the city’s medical costs. He developed an innovative approach to healthcare by spending time with some of these high-cost patients to determine the individual causes of their health problems and then solving them by any means necessary. He worked with social workers, visited the patients at home, and even encouraged them to cook for themselves or attend Alcoholics Anonymous and church meetings. His theory is that by focusing on these patients, he can help them and the entire healthcare system.
Rushika Fernandopulle, who runs a clinic for hospital and casino employees with high medical expenses, uses “health coaches” to guide and support patients as they improve and manage their health. These coaches provide the intangible help that is often lacking in conventional medical settings. They connect with patients, gain an understanding of their lives and challenges, and encourage them on a regular basis.
It’s truly an exciting time to be part of the quest for health for our nation’s indigent population.
Check out “The Hot Spotters” at href=”http://www.camdenhealth.org/wp-content/uploads/2011/03/Gawande-Camden-Annals_17.pdf”>http://www.camdenhealth.org/wp-content/uploads/2011/03/Gawande-Camden-Annals_17.pdf
When most people think of homeless individuals they think of two groups: older people and single parents with dependent children. However, with the recession more young people are left jobless and homeless. Young people between the ages of 18 and 24 have the highest unemployment rate of adults. The young adult homeless population has recently grown over 9 percent. Some young adults can easily move back with their families but some do not have that form of family support to fall back on or don’t have families that can financially support them.
With the young adult homeless population growing, homeless shelters need to start carving out a place for this group. For young adults to turn to a homeless shelter it needs to provide services that they require, such as employment, education and counseling programs. The programs that work best to help these young adults to move into a secure adulthood are ones that give them individual attention and the opportunity to develop marketable skills.
This really hit home for me, because my friends and I fit into this age group. As we approach the realm of adulthood it is important to be independent and make things happen for ourselves. Not being able to meet those aspects of adulthood would be emotionally devastating. I think it is important to have shelters and resources to help all homeless individuals. With the young adult population growing we need to be aware of the needs that are unmet and work to meet the unmet needs. Acknowledging that young adults are in need of help in this area is the first step to solving to problem.
Our introduction to the clinic comprised an orientation to Hesed House by Ryan Dowd, Executive Director of Hesed House, and a walk-through of the Resource Center, including the space where the clinic for Aunt Martha’s Health Center and our legal clinic will be housed.
Ryan began the orientation with an introduction to the issue of homelessness, which was eye-opening for me. I was surprised to learn that only 8% of the homeless population is chronically homeless and essentially unemployable. My image of a homeless person is that of an unwashed, poorly-dressed person walking around urban streets, pushing a shopping cart, picking through garbage cans and dumpsters, and mumbling to himself. While I recognize this as a stereotype, I have not equipped myself with any tools to change my perceptions, perhaps because the problem of homelessness does not animate me in the way that other issues move me. I saw homelessness as a problem that exists within our system of institutionalized inequality and the silence surrounding mental illness; I found it baffling that some people “choose” to be homeless; and I could not understand how people with families can be homeless. But I have picked my battles, and homelessness has not been one of them, other than fitting into the general scheme of troubles that plague contemporary human society.
Discovering that my stereotype was wrong was reality-changing. I learned that 50% of the homeless are homeless for two weeks or less and are working or seeking employment, and that 42% are homeless for two weeks to a year and face one major challenge, typically mental illness or substance abuse. I had not known that the vast majority of the homeless population is recently homeless and is attempting to move up and out of homelessness. These are often people with families, confronted by the crisis of homelessness and seeking a return to stability. Hesed House provides that stability and sense of identity for many through its transitional housing, as case managers identify problems and help for those problems. As I listened to Ryan, I was thinking of what I would do if I suddenly found myself homeless with two young boys, and the feelings of fear and anxiety, the stigma, the sense of hopelessness and shame that I had failed my children, that would envelop me. I realized how easy it was for struggling families to slip into homelessness, and how many such people exist in a wealthy country like the United States. What if a young homeless mother with an infant and a toddler did not know about Hesed House? Where would she go? Would her children be taken away from her and lost in the foster system? What if she was poorly educated, did not have much work experience, and could only find a minimum-wage job? Where would she stay? How would she get back on her feet? How would she get her children back?
I was also deeply troubled at learning how many children are homeless, and the lack of an institutional safety net for such situations. I have never seen a homeless child in the United States. In my head, there are no homeless children in this country. All the homeless look like my stereotype. At the same time, I was startled, and relieved, to know that homeless children continue to go to school and that under the law the school district must make the appropriate arrangements to get them to their school. Another stereotype shattered – not only are there homeless children, they still attend school. Coming from India, I am used to seeing children begging on the streets and living with their families under tarpaulins on the sidewalks. These children do not go to school. They are truly the face of the deep, entrenched poverty that overwhelms a country like India. To learn that there are American children who are homeless reminded me of how my background marks my difference from the average American, which I forget sometimes after spending 25 of my 44 years here. And yet, my 25 years in the United States have made me similar to some Americans in some ways, such as how I view certain issues as not my problem and how I sometimes feel that writing a check is doing my part. It was a strange sense of dissonance that I have not experienced in a while, and it took me back to my early years in the United States.
I was impressed at how well Hesed House was organized and humbled to see everyone who was working there, truly connected to service and unafraid of their task. It jarred my sense of comfort to see so many shelter residents in the cafeteria as we walked through it. I felt self-conscious and privileged. I was happy to see the little boy running around shirtless, but I was reminded with somewhat of a shock that he was homeless and had been for some time when Ryan casually said that he had not seen the boy wear a shirt in a month.
I am amazed at Ryan’s absolute dedication, calm, resolve and energy. If I can have a fraction of his spirit as I begin my work of helping those in need, I will consider myself fortunate. He is a leader and an inspiration, in every sense of those words.
I was nervous, but it is a nervous feeling that I have felt before. A feeling of excitement because I am about to embark upon another journey with the purpose to create change. Although I have had a lot of interaction with people in poverty, every new interaction is a learning experience. I was impressed by how vast the Hesed House facilities were; it was the biggest homeless shelter I have seen. It pushed me toward both a feeling of gratitude and sorrow. I felt grateful that facilities like Hesed House exist so that people in poverty have the ability to have a roof over their head and access to food. On the other hand, I felt sorrow because it breaks my heart that poverty has such a strong hold on so many individuals in our society.
It is an uneasy feeling for me that Hesed House is the only shelter in Aurora when there is an overwhelming need in the area. However, I am glad that it can accommodate as many people as it can and that it touches the lives of so many in more ways than just food and shelter. I was impressed by the other ways Hesed House touches the lives of the people they assist. The multitude of social and emotional help Hesed House can give was a very great thing to see. The services they can give introduced me to concepts that we have now talked about in class and read about for class. I am starting to understand how important those services are to people in poverty. I knew before that a lot of people in poverty have issues that need attention beyond shelter and food, but I never saw the resources in action, I am looking forward to the opportunity to see everything come together to create change.
The facilities at Hesed House were much bigger than the homeless shelter I worked at for many years through college. But the style of sleeping was very different. It is amazing that they can provide so many people a cool place to sleep, but I think that if an average American realized how they were sleeping they would hopefully be aroused to make a change. The existence of places like Hesed House is an amazing blessing to the impoverished community; I can only hope to continue to make the live of the people who frequent Hesed House even better with my work. I have always felt that if more people stepped up to touch people in poverties lives that change could be created. I want to start a movement towards helping others.
I was very grateful that I had the opportunity to learn more about poverty while visiting Hesed House. I never had it so simply laid out for me. The fact that poverty is a combination of money and family support makes perfect sense. The static population at Hesed House was not very surprising to me, while volunteering before I saw the same handful of people. Some of them, I was able to talk to regularly and enjoyed the opportunity to get to know them outside of their circumstances. I enjoyed building relationships with the people I came into contact with during my experiences in college. I wanted that to continue beyond college and law school. I am really looking forward to building working relationships with individuals staying at Hesed House. After walking through the shelter I want to help even more than before. It made me even more excited for this semester and next. I want to work with the medical clinic to effect change in the lives of the families who need it. I want to learn more about poverty and hopefully someday use these experiences to strengthen the movement toward change.
I knew that I wanted to help when I signed up for the clinic but I did not understand how I would help. After the visit I started to grasp how I will be helping the people at Hesed House. I am looking forward to gaining the tools and experience needed to assist individuals at Hesed House and others in the future like them. I would like to learn how to help people in poverty so that I can continue to help them once I have my license to practice law. I want this experience to create a stronger desire in me to continue to help others with my law degree. I know that I will help people daily as an attorney, but I want to help people who can’t afford any help and who need it the most. I am looking forward to learning about things that I would not have the opportunity to if I were not apart of this clinic. I think these experiences will be the most important in my law school career.
I left the first meeting of our little group excited, inspired, and pleasantly terrified. A long-time resident and self-proclaimed advocate of Aurora, I am ashamed that this was my first visit to Hesed House. I had read about it, thought about it, and heard its praises sung countless times, but all of my ‘good’ excuses kept me from lending a hand or ever checking it out for myself. I wish I had, because I would have known sooner that Hesed House far exceeds its glowing reputation.
As Mr. Dowd showed us around Hesed House and its Community Resource Center, I became more and more excited to be associated with this shelter. I was impressed by its leaders’ tireless efforts to serve the homeless population by pooling the efforts of multiple organizations, faiths, and disciplines. They do not limit themselves to supplying shelter and food, but helped to establish homeless children’s rights to attend school and set their guests up for success by providing access to job training, counseling, after school programs, and medical care. Hesed House even has designated staff that systematically endeavors to prevent homelessness.
I was especially interested in Mr. Dowd’s discussion of the causes and types of homelessness. He mentioned that, although Aurora is predominantly Hispanic, the Hispanic population makes up a very small portion of the homeless in Aurora. Their cultural values dictate that families take care of each other and often live together, resulting in only a marginal amount becoming homeless. Buri added that Indian culture is similar and that her in-laws regularly stay at her home for six months at a time when they visit from India. These comments started me thinking about the cultural and social causes of poverty and wondering whether the ‘breakdown of the American family’ that everyone is always talking about isn’t as much to blame for the rising number of homeless as the recession. Although there are surely countless cases that are unavoidable and unaffected by family situations, I wonder what the effect on poverty and homelessness would be if families and neighbors took care of each other instead of being content with the awkward conversations at Christmas, the begrudging wave at the mailbox, and the occasional phone calls. Sometimes I wonder if we get so wrapped up in ‘doing good’ through volunteering, community involvement, work, and education that we forget to be responsible family and community members. We look at the overwhelming problem, that over 600,000 Americans experience homelessness, and forget that we have the ability to prevent homelessness and its common causes in our circles of influence.
It is also easy to become overwhelmed by the shear complexity of the problem of homelessness, as the causes are about as numerous and diverse as the homeless population. However, we again forget to look at those around us. This is not a problem that can be solved without collaboration and exploiting countless skill sets, passions, and ideas—it will require a community and the use of all of its resources.
The word ‘community’ may be an overused cliché, but it is my favorite cliché, and I am a proud over-user. The concept, or rather the ideal, of community pervades almost every aspect of my life. It is the reason I chose a small undergraduate institution, the reason I chose NIU, the reason I talked my family into opening a coffee shop, and the reason I commute from Aurora. The remarkable thing about Hesed House, and perhaps one of the reasons for its success in combatting homelessness, is that it engages the community. It works alongside the YMCA, PADS, churches, the interfaith food pantry, the local community college, and countless other entities to meet needs its own administration could not. Perhaps the break down of the most intimate community—the family—is related to the breakdown of the larger community and is partially to blame for large-scale problems with homelessness, crime, and addiction. Perhaps the community needs to be restored and utilized in order to address these large problems. Or perhaps this is only the idealistic musing of a naïve law student. I guess I’ll have to throw myself into this to know for sure. I cannot wait to get started and to find out how the legal field fits into this project.
I mentioned at the beginning of this reflection that I left feeling pleasantly terrified. It’s not a miserable terror; it’s a sort of thrilling terror; it’s the kind of fear you get right before you do something new—something you have looked forward to but might fail miserable at. It’s the feeling I have gotten before I have done anything remotely worthwhile in my short life. Perhaps the prolific tweeter, Erada, was right when she said: “if it’s both terrifying and amazing then you should definitely pursue it.”
 Snapshot of Homelessness, National Alliance to End Homelessness, http://www.endhomelessness.org/pages/snapshot_of_homelessness (2013).