Walk in My Shoes

“Do I take care of my own worsening condition, or the poor health of my 8 year-old son?” “Do I risk losing one of my three jobs to spend the day getting a referral for my annual check up, filling out a health insurance application for my daughter and picking up my son’s asthma medication from the pharmacy?” These are just two examples of the difficult decisions that must be made by many uninsured, indigent or homeless individuals. As healthcare professionals both in practice and in training, it is essential that we understand the struggles and barriers which patients of these populations encounter.

On May 23, 2007, the BUSM Outreach Van Project (OVP) partnered with the Massachusetts healthcare advocacy group Community Catalyst to host Walk In My Shoes. This event was a simulation of some of the real healthcare issues faced by those with limited access to medical facilities and services. There was a particular focus on immigrant and homeless populations, as these are the most common encounters for OVP on any given night in East Boston. Each participant was assigned a role as either a healthcare administrator, government official, or an individual of a specific race seeking medical services. Individuals were also provided with a detailed description of health problems for themselves and their family members, insurance and financial information (or lack thereof), and obstacles (such as a language barrier, lack of transportation and existence of a disability) to obtaining the services they required.

With nearly 70 people in attendance, the room bustled as everyone became thoroughly involved in their role. One participant waited at the adult clinic for what seemed an interminable amount of time, just so a weary interpreter could show up to tell her she would need to fill out forms at the government offices to obtain insurance before she could be seen. That same participant appeared frustrated and helpless as she waited across town at the government offices yet again for an interpreter. On the other side of the table, a receptionist at the ER intake was becoming increasingly agitated by the number of patients arriving, as this rapidly increased the amount of time spent by each person in the waiting room and the amount of paperwork to be completed.

These experiences culminated in an insightful post-simulation discussion. Participants who had acted as administrators or patients expressed their uneasiness and frustration with the system. Administrators were surprised at how detached they could be and how quickly they could lose their temper when dealing with certain individuals. One administrator noted that during the simulation, she knew nothing of the patients’ complicated histories and so found it easy to turn them away or send them somewhere else in order to meet her goal of seeing as many people as possible in the shortest time. Upon hearing the patients’ stories in discussion however, she was struck by their struggles, and regretted how she had treated them. Some patients also noted aggravation in attempting to obtain free advertised mammograms from local clinics. Despite the posted notice, some of the providers claimed they were unaware that such an offer existed. Participants came to the conclusion that healthcare promotions should be more widely advertised and more easily accessible. Participants raised other thought-provoking issues during discussion, which will no doubt stay with them throughout their service to the medical community.

The event, funded in part by Harvard Pilgrim Healthcare, the Boston Evening Clinic Foundation, Tufts Health Plan Partnership and the Student Committee on Medical Student Affairs, was a complete success. The simulation increased awareness of healthcare issues, particularly those relevant to OVP’s main population, and allowed participants to experience first hand what difficulties are encountered by this growing population. The evening also served to highlight the important role that OVP has played for the past ten years, in bringing medical services to the East Boston community, and referring them to clinics, detox centers, and hospitals where their greater needs can be met.