Poverty simulation challenges residents to overcome real problems in social inequality

June 26, 2024

As part of their orientation, about 100 new residents had to make tough decisions — decisions that some of their patients face every day: When money is tight, how do you choose between paying for groceries and your medications? Do you receive a fixed wage for leaving work early or do you pay a fine for being late to pick up childcare? How do you handle medical appointments if you can’t see or walk properly, or if you’re pregnant but don’t have health insurance?

“I really hope this helps residents realize that our families are in dire need and when they come to the hospital, all they really need is someone to take care of them,” said Hazel Morales (seated, left), a health equity specialist with Delaware First Health who volunteered in the simulation.

Through an immersive simulation hosted by the Office of Health Equity, residents were able to put themselves in the shoes of those who have been in these and other heartbreaking real-life situations, such as evictions and theft.

click here to learn more about ChristianaCare’s nationally renowned residency programs.

The exercise simulated life challenges such as transportation, stable housing and food insecurity over a month, with each week broken down into 15-minute increments. Residents were brought together as ‘families’ to try to combat the exorbitant fees charged by payday lenders, job losses due to excessive absenteeism and unsympathetic workers in social services.

Jaki Ortiz, vice president for Health Equity & Cultural Competence at ChristianaCare, reminded participants that eviction means “you’re standing on the sidewalk with your apartment right in front of you and you have all your stuff in there. What little food you have is in there, and your kids are on your doorstep. What are you doing?”

Volunteers from ChristianaCare and other local organizations played assigned roles in the simulated community, including bank, child care, grocery store, and social services workers. Their roles reflected the obstacles people in poverty face when trying to get help: bureaucracy, lack of funding, and institutional barriers to help.

In a race against time, most residents did not have time to claim their social benefits. During a debriefing, they expressed frustration about not being able to pay their bills, missing work or being evicted. One resident found it difficult: “In the third week we were robbed.”

By grappling with the same types of health barriers that exacerbate the financial problems and family dynamics their patients face, residents learn what it’s like to survive from week to week as a family living at or near the poverty line.

“It’s a miracle that your patients can come in and see you. When you are with them, make the most of every moment,” said Tabassum Salam, MD, MBA, Chief Learning Officer of ChristianaCare, who participated as a caregiver. “Don’t judge people who are late and yes, they may need five to ten things at once.”

Residents assigned to families with diabetes were unable to reach the clinic. Another family received a message that their utilities had to be turned off. The experiences reflected the social drivers of health: the conditions and environments that influence health risks and outcomes, functioning, and quality of life.

A resident feels what it is like to wait to be picked up late from childcare.

“The simulation really helps physicians understand why patients are coming into the office the right way,” said Michelle Ax, MS, CHES, program manager of Food and Social Care Initiatives for ChristianaCare. “It’s easy to think, ‘Oh, they’re not following the rules,’ without understanding that an appointment or medication could be the last thing on their minds.”