Aspects of Mentoring
Chronic Disease and Poverty
Today we discussed some key aspects of mentoring and also chatted about chronic disease and poverty. Share your thoughts with everyone below.
Some questions you might want to address:
- What is the cycle of poverty and why can't people escape?
- What impact will poverty have on you as you work with patients?
- What perceptions do people have about the income and lifestyle of physicians?
I think it’s important to understand that poverty is complex and multifaceted, including socio-economic, political, cultural, geographic, and many other variables overlapping each other. Technology and globalization have provided more opportunity than ever to address social injustice issues while also making it more difficult to identify the root causes of certain oppressive forces; for example, decisions made at the top of skyscraper in NYC, or even at the touch of a Smartphone, can have significant ripple effects on people in rural GA, or rural Haiti for that matter. The world has become very interconnected, allowing more communication and insight into the needs of others, yet for many of us, our willingness to be inconvenienced is still very limited. It’s easy to get overwhelmed by the magnitude and weight of poverty, and there’s only so much any one of us can do. A question (or prayer) I’ve been asking recently is simply, “What is mine to do?” I think showing up is a large part of it. Often, those under the burden of poverty feel forgotten; whether it’s a farmer in Haiti who can’t feed his children or a homeless person in Augusta who has had so many people avert their gaze from his/her eyes that now he/she feels worthlessness, showing up can be a significant step. It says the other is worth something, that he/she is important, which is what we all seek. The mystery of it all is that any dichotomy of server/recipient is often tipped upside down in the process.
ReplyDeleteOne of my favorite quotations comes from Frederick Buechner, “When you find something in a human face that calls out to you, not just for help but in some sense for yourself, how far do you go in answering that call, how far can you go, seeing that you have your own life to get on with as much as he has his?” I don’t know the answer to this question, but I think it’s one into which we can live.
I guess I strayed away from those questions, but this is some of what I was thinking about after class today.
I must agree with Peter, in saying that poverty is a highly complex and multi-faceted issue, which explains why poverty continues to persist despite actions taken by government, as well as specific groups and individuals. So many different factors, ranging from socio-economic status to race/ethnicity to geographic location, contribute to the overwhelmingly complex issue of poverty. In addition, there is an aspect to poverty that is fairly dependent upon the individual himself. As we heard in class today, many individuals are forced into poverty as the result of a chronic illness. I can imagine many other scenarios that may force an individual into poverty, which may or may not necessarily speak to other persons living below the poverty line. The intricacies of this issue quickly explain why the number of persons living in poverty continue to increase and why many cure-all solutions have failed.
ReplyDeleteI also struggle with this question, “What is mine to do?” A few years ago, I took an alternative spring break trip to Chicago, in which our initiative was to tackle issues of homelessness and poverty. I went on the trip hoping to find a better understanding of what I could do personally to aid in the solution to this overwhelming problem. While I enjoyed my time in Chicago, I returned even more overwhelmed and disconcerted than when I had left. I still struggle with these same feelings today. By reading Peter’s post, I see that I am not alone. In fact, I think many times people rather remain ignorant to the hard facts of poverty than be swallowed whole in the depths of its complexities.
The effects of the cycle of poverty are something that we, as aspiring physicians, will all face and have to deal with. Poverty plays many roles on physical and emotional health. I believe that the cycle of poverty is so difficult to break because many of the challenges of poverty are insurmountable without outside assistance. This assistance can be a simple as looking up to someone who is doing what you aspire to do. Having this person in your community creates a tangible aspect to your dream so that you believe it is possible. The assistance can also be more direct. Often times jobs require networking and having someone to provide a positive reference is crucial. Direct assistance can also be having someone there to help with family tasks while you are taking steps to further your education.
ReplyDeletePoverty will affect me throughout my career because of the impact that it has on health. Chronic diseases affect those that are improvised more often and affect them more severely. It is very important to understand the challenges that accompany poverty to be able to provide better treatments and create a better patient/physician relationship. Hopefully we as a nation will learn to look on poverty as something that can happen to anyone, and we will learn to offer a helping hand either directly or indirectly.
saw this today
ReplyDeletehttp://www.npr.org/2011/09/15/140428359/making-it-in-the-u-s-more-than-just-hard-work
I believe that poverty will have a profound impact on our work as physicians. We speak often of non-compliant patients who do not follow the guidelines we give them in the office, but may not look deeper to find the root of the problem. Many people who do not take medication or eat healthy food cannot do so because of their financial circumstances. As physicians we should be able to come up with a healthcare plan that will assist such people. We may need to look into prescribing cheaper medications when possible or providing samples, for example. We definitely need to take the time to discuss with patients whether or not the healthcare plan we provide for them is feasible with their lifestyle.
ReplyDeleteGood food should be readily available as well, and the expense of "better" quality food contributes to the cycle of poverty. People who are well off tend to buy better food and are healthier as a result. People who live in poverty cannot buy such good food (organic is one example) and oftentimes have to select the cheapest food which is, unfortunately, oftentimes fast food. Eating fast food consistently may lead to chronic health problems and more financial strain, perpetuating the cycle.
Educational opportunities also contribute to the cycle of poverty. As an SAT teacher, I saw the stark difference that existed among school systems. Suburban schools tended to have more opportunities to succeed than Atlanta Public Schools (APS). Even as SAT teachers we often avoided APS schools because of the high percentage of students who would not show up or were not interested in learning. I believe this stems from the environment in which these students are often raised. Students emulate what they see around them, and when they see the effects of poverty they do not have an example of better conditions and how to work toward them. Furthermore, students who face poverty often have parents who work long hours to make ends meet, or immigrant parents who may not speak English and are unable to navigate the educational system. These parents may not have attended college, or may not have attended college in the United States, and cannot assist their children with the process of applying and finding higher education opportunities. This helps perpetuate the cycle of poverty across several generations.
Yes, it is quite apparent that the cycle of poverty is VERY complex. So many different elements feed into the cycle and contribute to the difficulties of getting out of the cycle. Like Diana mentioned, there is the affordability of healthier food as well as educational opportunities, the need for outside assistance as Lauren indicated, the contributing factor of chronic illnesses as Adatee discussed and the question of how we can contribute to positively affect the cause as Peter talked about. The thing is...the list does not stop here. I'm sure there are further minute details that we have not even realized that contribute to the difficulty. However, I believe that a part of helping to relieve the situation is informing the community. I believe that those who are in poverty and others who are not in poverty all need to be better informed. For those in poverty, many are not aware of different options/ways to alleviate their situation. For example, when I went to Nicaragua on a service learning trip, many of the people did not know how to properly care for their health/well being. Specific to their unfortunate water situation, with the lack of a water filtering system, many families were drinking rain water that they had saved or just drank contaminated water. By educating them, they began to boil their water before drinking or use chlorine tablets. In the US, I'm sure many individuals may not be aware of different opportunities available for underserved communities (ie pipeline programs for different professions, mentoring programs, scholarship opportunities, etc) because the environment around them usually does not lead to looking up or finding out about such opportunities. Additionally, for individuals who may not be able to afford healthcare, they may not know about different occasional community health clinics that are offered for free. As for those who are not in poverty, many individuals are not even fully aware of the physical and emotional distress poverty can cause or the effects of health disparities/inequities. As a result, some individuals may not think about how such aspects could affect various patients or how he/she could contribute to alleviating such problems in the community. Thus, if both ends were better informed, I believe that it could help with the poverty cycle to an extent. But, since the cycle goes beyond the community level, I understand that yes, informing could help only to a certain degree, but I feel that it is a step to be made.
ReplyDeleteI have not read the other comments yet. Therefore, this may be a little off topic. These are the thoughts that have been occupying my mind since Wednesday though, so I thought they were most relevant to share.
ReplyDeleteAs someone who comes from a family that spent many years living below the poverty level, I can say that many people in poverty view physicians as people of wealth. It's almost a negative view of wealth though. As if, by becoming a medical doctor, the physician has taken something that was unfairly given to them. It seems to the people living in poverty, that an individual with a high salary and immense knowledge must have never struggled to obtain his status in society. The "poor" view this person as having opportunities that could never have been pursued by individuals living in poverty. This is general, but this is the view I and my family had. A physician could not possibly know or even begin to understand what it's like to worry about how to feed his children tomorrow. How then, can that same physician even begin to understand how little importance an unaffordable healthcare plan has in these "poor" people's lives?
This topic is a personal topic for me and is in fact, the reason I decided to go into medicine. My mom, dad, two younger siblings and myself all lived below or just above the national poverty limit for the majority of my childhood. My father's heart disease and hypertension lead us to the only encounters I ever had with physicians before college. In these encounters our family always viewed the physician status as unattainable. Often the treatment plans they prescribed where nearly impossible to follow on such a small income. When I think of the future, and my future patients, I think of that automatic assumption that it so easy for many that are living in poverty to make: This person has never experienced the choice of spending money to support her family or spending money for her healthcare. Last week I had the realization that my future patients won't know my background. They won't know that I am practicing medicine because I am compassionate and want to "do good," NOT for the large paycheck. These patients, especially those living in poverty, will most likely think I am so different from them and cannot even begin to understand what maintaining their health costs them.
This fact is true for any physician - regardless of background. We will be faced with many patients from a multitude of backgrounds we do not understand, and even if we do understand their background, the patient will not automatically know it. But isn't it our duty to demonstrate through our actions, language and care that we are compassionate - that we are there to provide a healthcare plan that works for the patient? We should strive to show all patients, regardless of income level, that we view them as equals, as important individuals. While a patient may come with prejudices against our assumed salaries and/or lifestyles, it is our responsibility to demonstrate that this is not why we practice medicine. Is this responsibility an achievable goal or a never ending struggle?
Thank you for your thoughtful, insightful and personal comments. Keep them coming!
ReplyDeleteI’m looking forward to beginning the mentoring process, but when reflecting on my own life I have a hard time picking out a mentor. I guess I never had that one role discernible role model involved in my life. My goal is to give my mentor something that I prize the most, and subsequently receive the least of: criticism. The trick is that in order to deliver effective criticism (meaning advice that will evoke a positive response), trust and appreciation is needed in the relationship.
ReplyDeleteIn the same manner, a similar approach will be needed in treating patients that are different than myself (socioeconomically and culturally). Clear evidence has been presented in class that demonstrates that patient satisfaction is higher when treated by one of a similar race or background. Perhaps I’ll be viewed as privileged or rich as a result of my position as a white physician, suggesting I have little in common with underserved people. But this is only going to have negative effects upon the patient’s treatment. A personal connection is needed in these ‘mismatch’ (for lack of a better term) patient physician relationships. I believe my patients are more likely to take advice and treatment plans whole heartedly if some exchange of trust and understanding has taken place. A delicate balance is important– somewhere between a friend and a superior.
I really like that link you posted Luke. I share so many of the sentiments expressed in that article and on the posts above. It takes more than hard work and pulling your bootstraps to get out of poverty. Many of the circumstances and opportunities already having been established way before you are even born. Until we can say that every child born in this country regardless of race or background has the same shot at life, then the struggle for equality continues.
ReplyDeletePoverty is a difficult cycle to break because its hard to be something you have never seen, experienced, or really understand. Knowledge is power and that is why the right information can go far in helping change things.
All the resources and organisations out to tackle the monster that is poverty do a great job but there is room for improvement. I think they all suffer from the last mile dilemma. How to get the information to the people, how to get the people to utilize this information and the resources effectively etc.
Its a complex issue but i believe we can all play a role by being that source of information. There maybe all sorts of negative views attached to the physician salary and the assumption that we cant relate to the patient and his/her needs, but i think better communication skills and how we choose to interact with the patients creates an opportunity to address this bias. As Atul Gawade says, "Betterment is a perpetual labor".
Hi, guys! Just want to thank everybody for their insight--I'm learning a lot!
ReplyDeleteI remember before we started the discussion on poverty, Ms. Denise talked to us about mentoring, which was a great segue into this "complex" issue. I think that one of the main reasons for the cycle of poverty is that children born under these circumstances might not have mentors or rolemodels in their communities to emulate. They come home from school everyday, and instead of being motivated and inspired, they might become complacent and indifferent as they see their parents and friends doing the same thing day after day. This is just one idea/speculation, but I did observe this while mentoring a little girl who lives in government housing outside of UGA.
The cycle of poverty is SO disheartening because we can talk for days about how bad the problem is, but when it comes to talking about solutions....
Has anyone heard about Promise Neighborhoods? It is a campaign that the president started, mimicking the Harlem Children's Zone (You guys can read about this). The premise is that the government intimately and purposefully invests in the lives, education, and health of a number of children in certain impoverished cities from the time they're babies up until they are in college. The program also provides parenting workshops so that parents are also on board. I learned about this program, which seeks to break the cycle of poverty, from one of my undergraduate professors, who is actually helping with the Promise Neighborhood recently set up in Athens, GA. I think this one tiny step in the right direction.
Like so many people already mentioned, it is so important, especially as future physicians, that we understand that ANYONE can be subject to poverty. Just because someone is poor, it doesn't mean that they are lazy, dirty or stupid. It is not our place to judge, but to comfort and bring hope and compassion.
I really appreciate all the comments you've made on here. You are the future of health care and it is inspiring to read your commitment to providing patient care to all! HEAL is growing and developing into a project bigger and better than what I even dreamed and it is because of each of you. Keep up the good work (and the journal entries).
ReplyDeleteDr. Halbur
It’s hard to feel honest talking about the issue of poverty when it seems so distant to me. I have never endured the difficulties of such a life and often feel like my understanding of those who have is far less than it should be. Of course, I have worked very hard for all of my accomplishments, but I sometimes forget that my starting point was much better than many others. I have always been aware of poverty from volunteering efforts or community involvement, but I can honestly say that I don’t think of the issue on a daily basis. Perhaps some of that reluctance stems from the complexities surrounding the topic. It is often exploited by politicians or makes the daily news headlines, but rarely is it discussed with a sense of true resolve. In fact, many of the same politicians who use poverty as a selling point often promote policies that perpetuate the issue. I would suggest that most Americans are out of touch with the reality of poverty in America and its devastating effects on our citizens.
ReplyDeleteAs physicians, we have many responsibilities for the citizens in our communities. While we cannot individually solve such a large problem as poverty, we can surely make efforts towards small, significant differences. How do we accomplish this? Because we play a significant role in society, we should embrace that influence and use it for best. We should all strive to become knowledgeable about prevalent issues in the community and understand ways of addressing them effectively. We should also be actively involved in our communities in order to gain greater appreciation for our patients’ lifestyles, customs, cultures, etc. We might even have the opportunity to become a role model in the process. Also, communication with our patients can only be enhanced from such experiences and might be a starting point to breaking down the barriers and prejudices that we will undoubtedly face in our future practices. On a larger scale, partnering or developing local organizations, supporting productive political policies, and engaging our colleagues and fellow citizens might provide means of long-term change.
Echoing on what Diana and Ope had said, I truly agree that education is the key to break the cycle of poverty. Education is empowerment. While it's not the only way out, it does provide a powerful tool or foundation for the impoverished to break out of the vicious cycle of poverty. Both my parents are children of WWII that took their families from China to Taiwan, leaving everything behind. Unlike in the States, they didn't have the means nor family support to education. They were forced out of the school system simply because they couldn't afford it. They have worked hard labor all their lives. One thing they instilled in me early on was the importance of education and hard work. I took it to heart knowing that education and hard work are what enable me to break the cycle of poverty. Of course, there were obstacles and challenges along the way. However, not having some of the means and support that others had was never an excuse in my mind. They simply made me want to work harder to get past them.
ReplyDeleteWhat I'm trying to say, is that it's important that we instill in those children's mind the value of education. We also need to make sure that the system does provide necessary assistance to those who work hard to better their education. That is the message I'm passing down to my kids, hoping that they'll take it to heart like I did.