Note: This story originally appeared in the Chatham University Spring 2015 Recorder alumni magazine.
Good news: you have only a bank account. Bad news: there’s $200, and you don’t get paid until next week. Good news: you have a bus pass, so you can get to work. Bad news: you also have to take your child to day care, which is not on the way, and requires an additional bus pass, which you do not have. Good news: this is not real.
Well, not for you. Not right now. You’re in class. Welcome to the Community Action Poverty Simulation, a role-playing initiative that Chatham’s Master of Physician Assistant Studies program has begun using with its students.
“We had been seeing that when our students went out on clinical rotations, they often interacted with people with different backgrounds,” said Gabrielle Strong, remote site development manager and simulation facilitator. “There was sometimes a lack of understanding of how to deal with those situations, so we decided to bring poverty awareness under the umbrella of cultural competence.”
When Strong runs the simulation, as she has done four times at Chatham, between forty and sixty participants are randomly assigned the identity of a person living with poverty – family members, young or elderly persons, many of whom may live in a household headed by grandparents or a single parental figure. Each family unit starts with a sheet detailing their circumstances – descriptions of family members and health, behavioral, or major life issues, a breakdown of bills they owe, their housing situation, income, etc. And you have some resources to start with. “Some families start up with a few bus tickets, or some cash, or a bank account. Others do not,” says Strong. “You might have a job, a TV, a young child, someone who can watch that child so she or he doesn’t need to be in day care. Or, again, maybe not.”
Also in the room are volunteers who represent services in the community – bank, supermarket, pawnshop, school, employer, day care, utilities and mortgage offices, social security office, and social services agency. When possible, Strong likes to involve people from the Pittsburgh area who have had firsthand experience working in a social services office, such as the Greater Pittsburgh Food Bank. “They can play their roles from a more authentic standpoint and speak to students afterward about what they saw and how they think it reflected reality,” she says. “One volunteer had experience working in rental properties, and her take was ’You paid your rent, but you never got a receipt. Therefore it didn’t happen.’ These are the realities that unfortunately happen to people,” says Strong. “You have to think of all the ways you have to protect yourself. It’s very eye-opening.”
The challenge is to use what you have at hand – your resources and the community services in the room – to meet your basic needs, for four 15-minute periods, each of which represents one week. As in life, there are rules. Children must not be left alone. If you’re not at work on time, you may be fired. You must feed your family – the supermarket clerk knows how much it costs to feed your family, and will cite you if you don’t spend that amount. There’s a jail, and a juvenile delinquent center. And as in life, things happen: You might be robbed. You might be illegally evicted. You might have a sudden windfall.
Through it all, you must continue to meet the basic needs of you and your family, week after week. “It’s really high energy and exhausting,” Strong says. “Students don’t always know where to get the information they need. But sometimes poverty happens very suddenly, and you have to figure out very quickly what to do. And people in the community may or may not be helpful.”
“Poverty is complex,” she continues. “Some things that we see as simple choices may or may not be actual choices. What we find is that as students are put under more and more stress, it gets harder and harder to meet their basic needs, and they would forget about things. Children would be left at daycare. They’d forget to feed their families.”
After the simulation, Strong has students write a reflection about what they were feeling, how it affected them, and what it made them think as a healthcare provider.
“The poverty simulation taught me a lot about the anxieties that poverty can cause as well as situations poverty can cause. I realized that even in a room of future healthcare providers, once money was enough of an issue we made decisions based on it and not on health,” says one.
“As a future healthcare provider, I need to be aware of the resources in my communities for my patients that may need a helping hand. If I don’t ask what they need help with I won’t know how their life/finances may be affecting their health,” says another.
Strong views the poverty simulation as an important educational tool, and has most recently run the simulation for an inter-professional group of nursing students (including a cohort of nurses from China), counseling psychology students, and faculty. “Students who are going into medicine may find themselves working with people whose situations are complicated. My goal is to expose students to these ideas, to some facts around it, and to be able to see a little bit from an emotional standpoint, which you do when you take on the identity of an individual.”
The Community Action Poverty Simulation was created by the Missouri Association for Community Action.