Friday, October 28, 2011
October Update
One of the best aspects of my fellowship is that my supervisor is so supportive of my professional progress – I’ve been taking time to meet with other professionals in both the nonprofit world and the business world, taking classes to develop new skillsets and attending conferences. People often have the impression that learning stops once you graduate, but in my experience, that hasn’t been true at all. Learning in the professional world, however, is much more open-ended, and you have to be skilled at asking the right questions. I feel like I’ve come so far since beginning this fellowship, but there’s still so much further to go! I’m looking forward to the opportunities and challenges that the rest of my fellowship year is sure to bring.
I hope you’re all having a lovely fall!
Thursday, October 27, 2011
Foster Care Emergency Removal
"Can you meet KC at penn station at 8:45am? The plan would be to head to LI, move the child to FR. Lmk thanks!!"
It was a little after 10 PM last Thursday when I received the text above in an e-mail from my supervisor.
My supervisor provided no other information surrounding the case. (I knew this was a true emergency because my supervisor usually does not e-mail me work assignments late in the night!)
All I knew was that I had to help KC (the Foster Care Social Worker supervisor at my agency, NAC) remove a foster child from her current foster home and place her in a new one. I also knew that this emergency removal was tied to the foster child's medical needs. That night I went to bed trying to put two and two together.
What were this foster child's medical needs and why was the current foster home unable to meet them? The LIRR train cut through the crisp fall morning air as KC and I sat wrapped in our scarves and fall coats. "So did your supervisor tell you what's going on yet?" I looked at KC blankly and shook my head. "I bet you must have felt like you were on a covert operation, like you were a CIA agent!"
We both laughed and the train zoomed onwards into the morning. During the train ride, I learned that the medical staff and supervisors in Foster Care had studied this case closely and decided that moving this foster child was the best choice for her health.
When KC and I arrived, Shayla (name changed for confidentiality) sat at the bottom of her foster home's stairs with her head down next to her foster mom. Surrounded by trash bags full of clothes, I had a feeling she knew quite well why we were there. When Shayla burst into tears before KC or I said a word, my suspicion was confirmed. Shayla knew. And I also knew that this was just the beginning of a tough day.
My interest in learning about Shayla's medical needs faded upon seeing Shayla so sad. Foster Mom comforted Shayla, assuring her that this was not their last time together. In the meanwhile, I moved Shayla's trash bags into the agency van, eyes cast downward, moved by Shayla's sadness.
The van ride to Shayla's temporary foster home placement was long, cold, sad, and bumpy. Shayla, a 16-year-old immigrant, came to the United States on a medical visa to treat what doctors initially diagnosed as Cystic Fibrosis (CF). Over time, doctors ruled out Cystic Fibrosis. Shayla instead has Non-TB Mycobacterium and Bronchiecstasis.
These two conditions make oxygen uptake into Shayla's blood much harder than for a person whose lungs are functioning normally. Shayla has to breathe more often to get the same amount of oxygen that somone with healthy lungs gets in one breathe.
(Interesting fact, especially for pre-meds out there: If a person with healthy lungs breathes 20 breathes per minute on average, Shayla breathes about 32 breathes per minute. If a person with healthy lungs breathed at Shayla's rate, he or she would be classified as hyperventilating.)
Now the question still remains, why was Shayla removed from her foster home on an emergency basis? Earlier in the week, Shayla went to the ER for severe respiratory distress. The ER doctors were not sure what triggered the distress but thought something in the home (e.g. air freshener, lit candles) could have been the cause.
The NAC medical team met together after learning about Shayla's ER visit. At the NAC medical staff meeting, the doctor, nurses, and some foster care staff decided that Shayla would be better off in a new foster home that was more sensitive to Shayla's medical needs.
Shayla smiled and laughed upon seeing her replacement foster mom because she had previously met with her and gotten to know her in another context unknown to me. I helped Shayla move her clothes into her new room and helped her throw out old school work papers, or artwork she didn't like.
Out of a trashbag, Shayla pulled out two half folded images of bunnies she colored. She gave one to me and one with googly eyes to KC. I felt a sense of joy that I had been able to make Shayla's emergency transition slightly more bearable. I helped her move her things and let her vent to me during the van ride!
Ever since that day, Shayla's bunny hangs on my office wall. Despite how dramatic and sad the experience initially appeared to be, Shayla was upbeat in her new foster home. Her optimism was illuminating. And whenever I look at the picture of Shayla's bunny, I will remember Shayla's optimism during her difficult times.
A Fall of Firsts
It’s officially fall.
If the changing tree colours weren’t enough to tip off everybody here in Chicago, the highs of about 10 degrees C this week should do it (50 F for all you Yankees). And as I started to pull out all of my sweaters to deal with the new chill, it finally hit me – I’m really not at school this year. I know, I know, for most people that realization would have come back in September, but I guess it took the important changes that come with the fall season – the weather, the acceptability of eating pumpkin pie, and the start of the hockey season, of course – to really enforce the fact that I’m starting my post-college life. It’s the first fall I’ve worked full-time, the first fall in 4 years that I haven’t had a mid-term menacingly creeping up on me, and the first fall in about 15 years that I haven’t been training for hockey season. Needless to say, a lot of changes at once.
That being said, those changes have already brought about some great experiences. I’m on my third month of work at the Better Boys Foundation, an out-of-school program that works with youth in the North Lawndale area of Chicago. We provide typical after-school services such as mentoring and tutoring, but are also home to an awesome and unique apprenticeship program for the older participants. To avoid an epically long and detailed post I think I’ll leave the full explanation of the program for next time, but suffice to say the kids are happy and actually eager to work in their apprenticeship field. It’s nice to see. My official job title is ‘Volunteer Coordinator’, but in the last month or so I’ve been segueing into the development side of things to work in Agency Marketing and Communications. There’s been somewhat of a learning curve that has come with the transition, but it’s good to have a few challenges thrown my way from time to time. The most frustrating part so far has been mastering the waiting game, since a lot of my tasks seem to depend on outside processing. In particular, the processing times for our volunteer’s background checks have been less than reliable (aka extremely long), and it's left most of my volunteer recruitment efforts at a standstill. I guess that would be a lesson in itself – I’m here for a whole year, and I need to resist the urge to get instant results and satisfaction. The impact I want to make may take a while.
Outside of work, the city itself has been great. Really. I love it. Now that I feel more settled with work and my apartment I’m trying to take more time to explore, to find my favourite places before it gets too snowy, and to work on remembering how to find and make new friends (yes, after college you have to go out and make friends, they don’t magically live next to you anymore. Very tragic). Will I eventually hang out with more than just my roommate? Will I find my token “spot” in a coffee shop or bar that I frequent like all cool movie and tv character seem to do? Will I be able to survive not just the fall but a whole year of firsts?
I guess I'll let you know!
Tuesday, October 25, 2011
Fall in NYC
Fall in New York City is spectacular. Seriously. It is a different sort of autumnal experience. It is not the sort of experience where you can go on deep-forest nature walks in dew-soaked grass, colored leaves around you, and a scarf around your neck. No, this sensation is crisper and, yet, harder to describe.
This is the time and the place where you can go to a farmer's market on a Sunday morning and pick from a dozen apple varieties with people from all over the city and the world. And then walk 200 feet over to the Museum of Natural History and learn about the history of the solar system.
This is the time and the place where you can spend an evening at the MET and learn about almost every facet of world culture over the past 800 years. And then you can walk 500 feet over to Central park, scarf around your neck that you just bought from a street cart for $5, and observe all of the colored mini sailboats in Conservatory Park--knowing that this may be the very last weekend for some time that these boats will set sail.
And this is the same city where you can stand at Morningside Drive and 115th street, look East, and drink in the huge expanse of varied Harlem architecture. Surrounding you are the colored and falling leaves from Morningside Park and the beautiful Columbia University campus.
Seriously, if you can look past trash at your feet and smog in the sky, the picture becomes complete: Fall in New York City is spectacular.
A Foundation Center NY blog post
For my October blog, I thought I'd share with you guys a recent blog I wrote for the Foundation Center's New York blog.
Here is the link to the FCNY blog if you're interested in checking it out.
And the links to my last two blog posts: Blog 1 (about a survey on nonprofit orgs and Facebook usage) and Blog 2 (about the Millennium Villages Project for Blog Action Day 2011).
Here you go!
Learning All That You Can – Recommendations from a Recent College Grad
All through college, I kept this little pearl of wisdom in my back pocket. With every class I took, every book I read, and every research opportunity I embarked on, I reminded myself that there was always something more to learn, always another perspective or different angle.
Why did I feel the need to remind myself of this? Because I graduated from a prestigious high school, ready to attend Princeton University, thinking how smart I was and how much I knew. And all it took was 10 minutes in the first class I ever sat in at Princeton before that was completely shattered! My fellowship at the Foundation Center has also been an education in expanding perspective beyond what I think I know.
Sure, I had experience in the nonprofit sector before the Foundation Center. I tutored at a charter school; I did some community organizing; I worked at a foundation…In short, I thought I knew about the nonprofit sector. And just like my first class at Princeton, that rosy image too was shattered on day 1 of my job, July 25, 2011. There were so many acronyms, organization names, people's names, new terms, and so on floating around the office, and I had no idea what they were talking about.
But here I was at the Foundation Center, with access to great free and fee-based training about the foundation and nonprofit sectors – and I didn't even need to step outside the building to attend! And believe me, since my extremely confusing day 1, I have signed up for a myriad of courses.
Taking the in-house classes rivals any other training for people starting out in the nonprofit sector and for those transitioning from the for-profit sector. You can't beat the opportunity to be taught the ins-and-outs of a field – your field – by an experienced professional. This is especially true for new nonprofit professionals, who, like me, find themselves trying to absorb as much information as possible to get oriented to the demands of a new career.
The Foundation Center's newly launched seminar, Starting a Career in Nonprofit Fundraising, will be held on Friday, November 4, 9:00 am to 4:00 pm. With this seminar and with guidance from veteran development professionals, you will learn what it takes to build a fulfilling and successful career in nonprofit fundraising, understand the roles and responsibilities of fundraisers, and get insight into the various opportunities and career paths available in the field. Our instructors will share their career experiences and insights with you, making for a great learning experience! Plus, attendees get bonuses, like templates of career planning worksheets, a $50 gift certificate toward another full-day grantseeker training course, and a complimentary one-week subscription to the Foundation Directory Online Professional, the comprehensive database of U.S. foundations and their recent grants.
Register today, before the course fills. And if you're interested in viewing our full calendar of courses and special events, click here.
Natasha Benacerraf
Nonprofit Services Fellow
Foundation Center-New York
Highlights from SF and the Breast Care Center
Hello everyone!
I apologize that this blog post is extremely overdue. I have been living a full life in San Francisco and to date haven’t taken as much time as I should to reflect and write about my experience. As I (hopefully) settle into a more steady pace of grown-up living, I will make this blog-writing a routine part of my coming months as a fellow.
I moved to San Francisco’s Inner Sunset neighborhood on July 3 and began work at UCSF’s Breast Care Center (BCC) on July 5. In the past three months, I’ve learned about the work of the BCC at a rapid pace, immersed myself in a couple of different projects, and met some incredible clinicians and staff. The BCC is full of visionary and integrative initiatives and is a wonderful learning environment. Below are a few words about the experiences that have been highlights for me here so far.
Decision Services
I devote about 20% of my time working for a program at UCSF called Decision Services. In this role, I work most closely with patients and this service has become my favorite part of the internship. Through Decision Services, we help patients to come up with a list of questions that will help them to choose between complex treatment options with multiple risks and benefits. We then give the list to the patient’s doctor and accompany her to the appointment. After the appointment, the patient receives our typed summary and a CD recording of the appointment, with the hope that these resources will allow her to make thoughtful treatment decisions based on what matters most to her. Through working for this program, I have learned about the diverse factors that are important to women who are choosing, for example, between a lumpectomy and a mastectomy or between different types of reconstructive surgery. Accompanying patients to their appointments also offers a perspective on a wide range of different styles of doctor-patient interactions. I’ve witnessed unusual appointments (such as one where a patient was accompanied by 12 of her family members) and very difficult appointments (for patients struggling with various other diseases or breast cancer that has progressed to metastatic disease).
Athena Project
The Athena Breast Health Network is a project pioneered by the BCC’s director, Laura Esserman. It intends to be a “Framingham 2.0” of breast cancer, alluding to the seminal Framingham Heart Study that established many of the correlations between lifestyle and heart disease. Furthermore, the project is trying to spearhead a culture shift to break down some of the barriers that separate clinical care and research in breast cancer. Ultimately, the Athena network will include 150,000 participants across 5 UC medical centers. Now, I’m working a great deal on some of the nitty-gritty details surrounding a questionnaire that accompanies participation in the network, but I cherished the opportunity to learn about the big picture vision at a conference a couple weeks ago in San Diego.
Tumor Board
Tumor Board is the weekly meeting that convenes all the BCC doctors and staff to discuss difficult cases to diagnose or treat. I find it fascinating to learn through observing the clinicians’ different personalities and clinical approaches at play in interpreting ambiguous cases (often, it seems that the two are linked).
Outside of work, I hang out a lot with my fantastic class of eleven “pre-medical interns.” We are currently making preparations to compete in the annual Halloween costume contest at UCSF – apparently, we have an esteemed reputation to defend. On the less festive end of things, I spend a lot of time these days studying for the MCAT :-/.
In my free time, I try to keep up my violin playing. I’ve joined an orchestra called Symphony Parnassus, which is rehearsing for a November concert. Once a week, during my lunch breaks at the Medical Center, I am starting to play my violin through a music program at the Hospital. Last week I played a song for a man who was on his way being wheeled into the OR. I also love playing chamber music and joined a friend from Princeton ’09 yesterday for a chamber music sight-reading party. Finally, I have been trying to keep up my Spanish-speaking skills through this “Conversation Exchange” program, where I talk with a conversation partner from Costa Rica each week. She is also in the health care field, so our Spanish and English conversations have been really fun.
I hope everyone is having a great fellowship and enjoying autumn!
Monday, October 24, 2011
FORUM TIME
While Carol deserves much more than that brief tribute, I have to move on to the Forum itself, which took place over three jam-packed days of keynote speakers, educational workshops and sessions, and school site visits. Carol and I flew into San Francisco on Tuesday afternoon so that we could be ready to work hard to prepare the conference bags for every attendee and set up the Exhibit Hall the next day. This "set-up" day was the most exhausting for me, but Thursday, Friday, and Saturday went by a lot more quickly as we worked to put into action everything that we have been planning since Carol and I arrived at CEP and that the other fellows planned before us.
Like Carol, the most rewarding part of the Forum for me was finally meeting all of the individuals I had been communicating with via email and telephone for months and seeing for myself the caliber of people who dedicate their lives to a cause such as character education. It was really wonderful to be able to connect with the exhibitors, educators, and scholars who were there. Everyone was thrilled to be participating, and in one of the discussion-based sessions that I was able to attend on the last day (the topic was how character education can help close the achievement gap), I heard many comments from participants who were so happy to have attended such a worthwhile conference and who hoped their schools could send more representatives next year. I was very proud to have played a role in pulling off the Forum, and I'm looking forward to using what I learned to help make next year's Forum an even bigger success! Planning Day 1 starts tomorrow!
Can't believe it is almost winter
I've been at my job about five months--and I honestly have no idea how the time went by so quickly. Although I do sometimes get a bit bored at my job, I still love what I do, the people I work with and feel pretty lucky to be working a field that is so directly relevant to what I want to do in my future career. I try to find other useful/productive things to do with my free time at work but it is difficult--often I am waiting for court cases to be called, and thus am forced to stand around, or simply can't think of much more that I could do in my office. It has, however, given me PLENTY of time to work on my law school apps . I do worry a lot about whether or not I am doing the best I can at my job--in particular, I stress over how I represent the Choices program in court since I am the only representative in the court house (thus, I often feel it is up to me to present our program in the best light possible). Simultaneously, however, I feel like no matter what I do--how much I try to get lawyers to parole their kids to Choices--ultimately the judge is going to do whatever the judge wants to do.
Hopefully this provides anyone who is interested a bit of insight into my job--and I suppose my mind. Have a great weekend!
-Steph
Still Settling In
During those hazy weeks I also spent a lot of money. The 'setting up' costs of living in a city are pretty high and difficult to anticipate. I was aided by a generous grant from the Bank of Mommy. If I could do it again, I would've rented a van or truck, got furniture from Salvation Army and gotten a moving service to help get stuff up the stairs to my apartment. It's still cheaper than buying new, low quality furniture.
The other thing I noticed upon my arrival is the stark socio-economic and racial divisions in Chicago. It's kind of like being on campus: There are lots of different groups in close proximity, but the groups rarely intermingle, and when they do its often awkward.
It's pretty tough to find meaningful engagement across difference in Chicago. The first few weeks here I spent a lot of time trying to see which neighborhoods I felt most comfortable in, and I was shocked to realize just how hostile entire parts of town can be to black and brown peoples.
As someone who presents as 'Black' I've felt most comfortable in the West and South Side - where I work doing prisoner re-entry stuff. Otherwise, I'm often the only person of color in the restaurant/conference/bar/party/lounge.
I've been pretty conditioned to entertaining stupid and offensive questions from well-meaning white people (the worst kind). Luckily, my workplace is primarily filled with women of color and its nice to not have to debate the existence of racism. There are a lot more comfortable, safe and productive conversations around racialized oppression. That's perhaps the biggest and most satisfying difference from going to Princeton; I don't have to defend my life experiences to the same people who are actively oppressing me, my friends and family.
The National Forum on Character Education, aka my very first business trip!
My favorite part of the Forum was definitely meeting the conference participants (largely educators) with whom I have been emailing and speaking for the past few months. Putting faces to names was really fun, and everyone was so nice! Since I had been in charge of giving out scholarships to schools with tighter budgets, it was particularly rewarding to see how grateful the scholarship recipients were to be able to attend the Forum.
Now that the Forum has come and gone, however, I'm feeling a little lost. I imagine I'm feeling like a parent whose child just left for college, or, as I told my coworkers on Saturday afternoon once we were officially done with everything, it feels like the day after Christmas--so much excitement and hard work, and now it's over! I know I'll still have plenty to do at work, so now I just need to get excited for what's coming next.
Hmm...
Sunday, October 23, 2011
Accelerated Misdemeanor Program (AMP)
One of the most exciting parts of my job thus far has been getting to handle cases for the Accelerated Misdemeanor Program (AMP). AMP is a citywide diversion program, based on a Brooklyn Community Court model, which was established to handle the less-serious misdemeanor cases clogging up the Philadelphia criminal justice system.
The cases diverted into the program are usually limited to drug possession, retail theft, prostitution, or solicitation of prostitution. The Charging Unit identifies ideal candidates for the program (non-violent offenders) and offers them a period of community service instead of prosecution. On-site social workers provide program participants with a number of critical services, including information about drug rehabilitation programs, housing, and employment opportunities. In order to successfully complete the program, the defendant must pay $199.50 in court fees along with any restitution they may owe the victim. They also must complete between 12-18 hours of community service. Following successful completion of these requirements, prosecution is withdrawn and the defendant can have the record of the arrest expunged.
My work with AMP includes going to court 1-2 days a week, where I work closely with the public defender in monitoring the status of each case. Our caseload for each day varies from 20-50 cases. My main duties in court are to withdraw prosecution on successful participants, or revoke AMP for defendants who have shown unsuccessful progress or because they violated the conditions of AMP.
AMP has been successful thus far in removing low-level misdemeanor offenses from the trial process. This has saved city resources by reducing costly aspects of the criminal justice system, including subpoenas, trial court dates, police testimony, and public legal defense – all without compromising public safety. According to the budget hearing statement given by District Attorney Seth Williams to City Council in April, AMP is ensuring “swift and certain punishment and offender accountability to the victims and to the community.” Our office estimates that in the first four months of this year, 700 individuals were diverted through AMP, placing the program on target to divert over 2,400 individuals by the end of the year.
Saturday, October 22, 2011
A Few Insights
In late September, I had the privilege of attending a lecture by Carmen Beauchamp Ciparick, Senior Associate Judge of the New York Court of Appeals. Aside from being in awe of the fact that a New York Court of Appeals judge was less than ten feet away from me and that Cyrus Vance, Manhattan District Attorney was twenty feet away (I guess you could say that I was a little star struck) it was fascinating to get an insight into the decision making process at the highest judicial level in the state of New York.
Attending the lecture highlights an important aspect that is essential for enjoying my fellowship opportunity, and that is taking advantage of every opportunity whether or not it is PP55 related. Last week, for example, a representative from Harvard Law School came to talk specifically to prospective students at the Manhattan District Attorney's Office. While I am still a little hesitant to say that I am applying to HLS, mostly because of the intimidating factor of the prestigiousness associated with HLS, it was helpful listening to the representative and thinking about what characteristics to look for in a law school and how to write a strong application.
That week was exceptionally exciting since we also had to actually evacuate for a fire alarm (normally we are told to simply disregard that ear-splitting siren...as if that were even possible), and then had a blackout in the office that sent everyone home early.
October has not been nearly as eventful, but I have come to the conclusion that due to the amount of paperwork that our bureau goes through every day, some pro-environmentalists might have a serious issue with our paperwork management system. More importantly, I now know why government is not as quick to respond as private enterprises. Hopefully I will have more to report in November. As for now, I am simply looking forward to the upcoming holiday season.
Thursday, October 20, 2011
Chicago ideas?
I will be visiting Chicago next month and am looking for some "must see" spots. So, I'm reaching out to my network of Chicago "locals" to get some ideas! I would love to see the Art Institute, but other than that, my itinerary is flexible.
What shouldn't I miss on my trip to the windy city?
Friday, October 14, 2011
After Work
Thursday, October 13, 2011
I Am Really Into Reading
Note my sweet Princeton Tigers keychain on my lanyard. |
Wednesday, October 12, 2011
Something to Make You Smile
Cold weather got you down? Here's a video that I hope will put a smile on your face. I know it worked for me!
P.S. 76 1st Grade Students Sing
Thanks to former PP55 fellow Dominique Salerno '10 for posting this on Education Through Music's facebook page. I just love how ALL of these ETM partner school students are rapt with excitement.
Now, how many Princeton precepts do you remember 100% student participation? I didn't think so. ;)
Monday, October 10, 2011
More great work, and a move
It’s been a busy past few weeks, and things continue to be very exciting at the office. The work that I do has been quite varied, which has built up my knowledge base about a number of different fields, like school turnaround, community engagement, and college access, among others. It’s been great to visit a number of schools in the past month and see the fantastic work that’s happening at so many of them. And since CityBridge values school visits, I’m looking forward to seeing more and more going forward. I’ve gotten to participate in many interesting meetings lately, including one recently with the DC Schools Chancellor and Deputy Mayor for Education.
On the personal front, I just moved into an apartment in Gallery Place last weekend. After much unpacking and Ikea furniture-assembly, I’m finally getting to explore the area. There’s a lot going on in the area, and it’s in a very central location. It’s hard to beat being a few blocks from the National Mall!
Happy October!
Transitions
Sunday, October 9, 2011
The Interrupters
The Interrupters is a movie all the fellows should go see, but especially my Chicago compatriots, and I'm not just saying that because 1/4 of the movie takes place in one of the neighborhoods the Carole Robertson Center (where I work) serves, or because my drive to work features in not one, not two, but three scenes.
Some of us work in very volatile neighborhoods, and the danger factor is not something we blog about often. For the most part, this is because we are not directly affected. We're not held at gunpoint or threatened. Nonetheless, one of the parts of my job that has been the most educational in the past two weeks is the daily walkover. We offer a service to students who attend nearby schools: staff members will go and meet kids when school lets out and accompany them back to the Center. I recently replaced a coworker whose schedule got switched around on one of these walkovers, and so every day two staff members and I make the fifteen minute walk to a nearby charter school to greet the kids.
The first week of walkover was a breeze. The second week, there were three separate incidents that had the police swarming the neighborhood and had us going to our supervisor and strongly recommending that we spring for a bus. Parents offered to pass the hat. One mother decided that she was going to take off work and drive her kids to the Center every day.
Watching The Interrupters, I couldn't get the faces of the kids I work with out of my head. It was one of those viewing experiences that left me shaken and sure that someone needs to do something. I'm doing all I can at this point in my life. I'm not huge and imposing and I don't know the neighborhood inside out and I am not an organization with endless funds. Still, I'm not going to let CeaseFire out of my sights just yet.
Friday, October 7, 2011
Hello from Norwalk, CT
In about an hour and a half my 15th week at the health center will be coming to an end. In that time I have become fairly comfortable in my role here, along with the other P55 fellow, Julia. So far our work has been mostly administrative: We have worked on various quality improvement projects and have chipped in to help compile data for various government public health departments on the health center's clinical performance in a number of areas. We have also worked to contact and communicate with patients about their ongoing healthcare needs, helping them to schedule appointments with specialists and find their way through the complex, disorganized, and often frustrating healthcare landscape they face. At the end of the month, we will play a small clinical role for the first time by acting as quasi-medical assistants in a pilot of the use of knowledge supplementing software for managing diabetic patients.
What patient contact I have had so far has been fairly astonishing. Many of the health center's patients are socioeconomically disadvantaged, and I've found that while some of these patients are quite knowledgeable of their conditions and involved in their own care, others are sometimes almost entirely ignorant of the diseases that afflict them and their implications. This is not to say that these patients are always irresponsible. Some of them are very tenacious in finding out where it is the doctors want them to go and what it is they want them to do without really conceptually understanding why they are doing all these things. Nevertheless, the lack of basic medical knowledge that I have seen has in some cases rivaled or even surpassed that which I saw in rural West Africa, which I never would have imagined before.
The other notable aspect of my interaction with patients so far has been the prodigious difficulty I have seen some of them face in simply accessing any kind of specialty care. Patients with Medicaid or no insurance are able to access high-quality primary care at the health center because the health center qualifies for adequate compensation from Medicaid (somewhere around 120 dollars per visit), and because the health center offers a sliding fee scale for the uninsured such that they pay out of pocket for care only as much as they are able to according to some financial formula. However, virtually no independent specialists are compensated reasonably by Medicaid (their compensation per visit can be as low as 15 dollars, which simply doesn't begin to cover all the costs of a visit), and thus almost all do not accept Medicaid patients. Meanwhile, sliding fee scale patients are left to face high specialist visit costs by themselves, and are almost always unable to afford these visits to private providers.
The only option for Medicaid and uninsured patients is then to go to "specialty clinics" run by area hospitals where specialists donate their time and skills for little or no compensation. However, demand for these appointments is far greater than capacity, and the waiting list for an appointment can range from 3 months to more than half a year, depending on the specialty. Some effort is made to accommodate patients with emergency referrals first, but most of these patients must suffer long waits to be seen, and even then it is uncertain they will be able to afford the remedies they may need to solve their problems.
This is not the time or place to discuss healthcare reform, and, to be fair, the health center's Medicare patients (for people over 65) are able to receive very generous care from any specialist, but the inequality in access and care for those who do not qualify for Medicare is nothing short of a national disgrace. This fellowship has put us in the middle of issues that I had previously only read about distantly, and it has certainly been a more worldly sort of education that we have been receiving here so far than most of what we've had in the past.
Personally, I have spent a lot of time travelling on the weekends this summer and early autumn, and am now beginning to settle down for the next few months to study for the MCAT. Norwalk is a lovely town, almost like Princeton on the beach in some parts, but it can't compete with the magnificence of nearby New York City as a weekend hangout. I have been able to find a group to play pickup soccer with in Stamford, a few miles down the road, but other than these weekly excursions and my MCAT studying I have no scheduled extra-office activities for now. Once that MCAT is done that will certainly change.
Anyway, hope to be able to contribute more regularly to this blog from here on out.