Community Action Poverty Simulation challenges students to rethink poverty’s impact on health

By Jonathan Garris, Office of Communications

Poverty Simulation 1

Balancing budgets, meeting goals, and taking care of relatives are a few of the challenges students face, moving from table to table and institution to institution as part of the Community Action Poverty Simulation.

While some may believe poverty is a stand-alone issue, the complexities and challenges of poverty and its effects on health can’t be ignored. A 2013 survey by The Associated Press found four out of five adults in the United States struggle with joblessness, near poverty, or reliance on welfare for at least parts of their lives. Now, a new program at McGovern Medical School aims to show medical students the realities of poverty through a simulation.

The Community Action Poverty Simulation is the brain child of the Missouri Community Action Network, a state association of Missouri’s 19 Community Action Agencies and supporters that provides direct services to low-income Missourians.

Rebecca Lunstroth, associate director for the McGovern Center for Humanities & Ethics and assistant professor in Family Medicine, brought the program to McGovern Medical School as a way to combat stereotypes medical students may have of those who don’t follow treatment regiments due to challenges outside of a doctor’s office.

“I understand it – they undergo years of training in order to give the best medical advice and treatment, only to have it seemingly dismissed,” Lunstroth said. “But it also became clear to me that, regardless of one’s personal behaviors, no one truly wants to be sick, so there was a disconnect.”

That disconnect stems from an unfamiliarity of the personal circumstances of some patients, particularly those living in poverty.

Medical students keep close track of their finances throughout the simulation, experiencing a first-hand look at what their future patients may be confronting outside of the doctor’s office.

To help students better understand how the medical community can better serve patients living in poverty, Lunstroth opted to bring The Community Action Poverty Simulation to campus. The simulation has participants take on the roles of members of up to 17 families, who face a variety of challenges. At the beginning of the simulation, each participant is assigned as part of a family and is given a card explaining its circumstances and must provide basic necessities like food and shelter by accessing community resources during the course of four 15-minute “weeks.” The resource providers are played by UTHealth faculty, staff and students, and the families move from table to table throughout the simulation. At the end, participants discuss their experience.

Medical student Andrew Bain said he had no real knowledge of the event, and the experience he had was wildly different from his expectations. During the simulation, he took the role of a 16-year-old pregnant girl focused on one day obtaining a college education.

“However, I spent the ‘four weeks’ cutting class to help pay bills, attempting to care for two younger brothers while both parents were trying to make ends meet,” Bain said. “Even if I wasn’t too believable in my acting performance, the ideas of chaos, stress, and worry felt very real.   Only in the last ‘week’ did I remember that as a pregnant girl I should visit the community health clinic.”

Bain said the program did an excellent job of creating a high-stress environment that took students completely out of their element, and he recommended the simulation to other students, saying they should approach it with an open mind.

“Our classmates gained real insight into the conditions faced by those in poverty and the extremely difficult decisions they have to make,” Bain said. “As future health professionals, I think we took one more step toward understanding the issues our impoverished patients will face and the almost insurmountable circumstances they face, which often leaves caring for their health on the back-burner.”

Students discuss their options as “families,” working together to achieve their goals while struggling with the realities of poverty.

For medical students like Kyra Frost, the program took on a different kind of significance. She was accepted into McGovern Medical School through the Joint Admission Medical Program and knows first-hand the realities of coming into medical school below the poverty line and dealing with the misconceptions that come with living in impoverished conditions. She praised the program for doing a good job simulating “what it feels like to be stuck or caged by one’s own life circumstances and socioeconomic factors.”

“The lack of both resources and time caused many students to act uncharacteristically and to make decisions that they would never have made given ample proper resources,” Frost said. “Some examples included- stealing from others to get enough money to survive bills, keeping children home from college to watch over siblings while mom is at work, deciding to pay mortgage over their child’s $300 medication, begging.”

She said the program reminds students to ask non-compliant patient questions rather than judge, and to always remember the patient has an entire life beyond their treatment. Lunstroth said she aims to include the simulation as part of the formal curriculum at McGovern Medical School, and Frost agrees it would be in the best interests of all fellow medical students.

It isn’t just finances students have to worry about – securing transportation, employment, and childcare are all part of the simulation.

“Having personal experience living impoverished, I am honored to be part of a school that brings in doctors and professors such as [Lunstroth] who aim to make a real difference at how we treat and perceive our patients and to take their time to offer us the opportunity to become a better doctor to our patients,” Frost said.