On September 29, the Office for Professional Education sponsored a simulation exercise for HSPH students called "Walk in My Shoes(tm)" in the Kresge cafeteria. The event was designed as an in-depth participatory learning experience that focused on the experiences of low-income families and the barriers they face accessing health services. The participants' mission was to obtain health care needed by themselves or their families as they visited stations in the cafeteria that simulated the offices of Medicaid, health plans, and private physicians, as well as a local health clinic, pharmacy, and emergency room.
A freelance writer, Eileen McCluskey, participated in the simulation for HPH NOW. Here are her thoughts:
I have been given the role of a 42-year-old African-American man living in dire straits. Homeless and HIV-positive, nearly penniless, I suffer from a recurring substance abuse problem. I am unemployed and have no health insurance, and today I will try to obtain health care.
As the simulation begins, I wander into a community health center. A doctor explains that he cannot examine me because I have no health insurance. He sends me to a hospital emergency room across town.
I take the "bus"-simulated by walking twice around the cafeteria's periphery. After I wait in line at Outskirts Hospital, an administrator hands me a free-care application, which presents me with questions that I answer as "not applicable," since I have no address, no job, and no family.
The ER administrator announces that I qualify for free care. "But there is a $35 co-pay," she explains.
"I only have $4," I reply, immediately regretting that I spoke truthfully, since she asks for it all. After an examination, I am given a prescription and a suggestion to seek a specialist. The hospital does not dispense medication, and they don't have the required physician on staff. I will have to try a private practice.
Lyne Soucy and Leonard Yuen played a Vietnamese couple seeking care.
"Walk in My Shoes" is a service of Community Catalyst, a national nonprofit working to build consumer and community participation in securing quality, affordable care for all. Participants in the HSPH workshop were assigned roles relevant to ethnicity, language, gender, health problems, citizenship status, employment, and health insurance status. During the workshop's first hour, participants sought the care they needed. Then, a one-hour debriefing session followed the simulation, giving participants time to discuss their experiences and reflect on how health care policies affect the poor and marginalized.
Roberta Gianfortoni, assistant dean for professional education, explained to participants, many of whom were students: "We hope to bring into focus some of the issues you might consider in pursuing your studies here at HSPH and your world beyond. This workshop gives you a chance to reflect on the reasons you came to study here, and to consider which skills you may want to develop."
I interviewed student Leonard Yuen after the workshop. He and fellow student Lyne Soucy played a Vietnamese couple who understood little English. "This was an invaluable exercise that helped Lyne and I gain insight into the isolation and helplessness of patients, and exposed the steep learning curve and bureaucracy of American health care."
Another participant, Sonak Pastakia, noted, "I have researched many understudied barriers to care in indigent HIV-infected patients, and I plan on continuing to work on resolving these obstacles. I thoroughly enjoyed 'Walk in My Shoes' and would recommend that every provider in the health care system experience this simulation to empower them to better serve their patients. The next time I feel frustrated with a patient who is missing appointments or forgetting to refill medications, I will use this simulation to understand their situation rather than blindly judging them for their poor decisions."
Student Brian Swann plans to apply his workshop experience "to think twice about what someone may have gone through to arrive at a particular point. All training institutions need to create this type of exposure to enable another level of sensitivity and understanding."
During the debriefing session, Deborah Katz, policy analyst and community organizer with Community Catalyst, pointed out that the country's patchwork health care system will only be improved "by the efforts of people-prominently, those in the health professions-who advocate for change."
In the workshop, four simulated weeks passed for me as I tried to obtain the care I needed. In the end, I failed to secure the care. At the same time, I discovered a keen compassion for anyone seeking health care with few resources.
—EM
Copyright, 2007, President and Fellows of Harvard College
