Reflecting: Shawnee, Richmond, Justice.

This summer, I completed my internship experience at Shawnee Christian Healthcare Center in Louisville, Kentucky. The organization’s mission is to transform the local community by empowering and healing its residents through holistic and accessible healthcare. Contextually and historically, the neighborhood the clinic serves presents a unique array of socioeconomic, demographic, behavioral, public health, and medical challenges. The Shawnee neighborhood is a predominantly African American neighborhood where a large portion of individuals live below the poverty line. The neighborhood is a food desert without sufficient access to healthy food options. A majority of the individuals smoke cigarettes habitually. Violence and crime rates are extremely high. Mental illness, particularly cases of depression, anxiety, and PTSD, run rampant within the community. Thus, the clinic’s commitment to providing “holistic” healthcare requires the providers at the clinic not only to treat and diagnose physical medical problems. To properly and holistically care for a patient, they must examine and treat the behavioral, mental, and physical aspects of an individual’s health. As an intern, I gained a tremendous amount of practical knowledge and skills about patient triage, administering tests, and clinical operation. However, even more so, being immersed in this unique clinical atmosphere complemented my leadership studies as a Jepson student and transformed my understanding of what it means to offer holistic, just, and accessible healthcare to members of an underserved community. 

In my Personal Plan Paper, I referenced hoping to find an internship that would allow me to cultivate my passion for the science of medicine, while simultaneously exploring social justice within the healthcare field. In addition, I mentioned how being a member of the multidisciplinary Jepson Science Leadership Scholars program has fueled my passion for addressing current scientific needs and questions of health equity in the modern sector. After serving this summer, the context of my internship proved to be the perfect environment to explore the intersection between social justice, healthcare, and the medical field. Each day, the clinic aims to overcome the barriers to healthcare based upon socioeconomic status, race, geographic location, etc. The Shawnee neighborhood has traditionally been identified a medically underserved population. Meaning, there is a lack of access to primary healthcare services. While I was drawn to and agreed with the organization’s overarching vision before actually working at the clinic, I did not have an understanding of how this mission to facilitate health coverage would be carried out in practice. As a result, from my decision to serve with the type of organization that I described in my personal plan paper, I gained practical knowledge about federally qualified healthcare centers and the role they can play in combating disparities in health care coverage. Shawnee Healthcare is a Federally Qualified Healthcare Center, which are community-based health care providers that aim to provide primary care services in underserved areas. FQHC’s are generally outpatient centers that qualify for reimbursements through Medicaid and Medicare. Furthermore, FQHC offer comprehensive services. Meaning, either at Shawnee or via connection with associated facilities we were able to offer our patients: preventative health services, mental health services, substance abuse services, dental services, transportation services, etc. Thus, Shawnee was able to meet not only the physical needs of individuals, but also the behavioral, financial, mental, etc. needs of its patients. Moreover, as a FQHC, Shawnee operated on a sliding fee scale. Meaning, in a largely underinsured and low income neighborhood, patients are actually able to afford the services they require. Through serving at Shawnee, I was able to learn about the overall operation, organization, and services FQHC are able to offer. In this way, I was able to participate in the work being done by an organization to actively tackle and combat systemic injustice. In doing so, by serving with a FQHC, I was able to see firsthand how organizations like FQHC emerge as viable solutions that hold tremendous promise for improving healthcare accessibility and coverage. 

In my both my Site Description and Personal Contribution Paper and my Learning Contract, I outlined several key skills I hoped to obtain through my time in my internship. First, I mentioned how the majority of physician assistant programs require prospective students to possess a certain number of healthcare and patient contact hours. Secondly, I mentioned hoping to develop skills taking directions from authority and utilizing constructive criticism. Thirdly, I mentioned how I wanted to gain experience working in an interdisciplinary healthcare team as the healthcare field is highly collaborative field comprised of many different healthcare professionals. Finally, I mentioned how I hoped to obtain confidence interacting with a diverse array of patients in a low-income health clinic.

Throughout my internship, I developed an understanding of both my present limitations, given my limited knowledge and experience overall, and my capabilities, given the skills and training I do possess, within the medical field. As an undergrad student, I was fairly limited in terms of my capabilities. Thus, much of my patient experience involved simply feeding information to providers so that they could then give patients the care they needed. With time, I grew to appreciate the fact that though my actions were more indirect, they were still necessary in the patient care process. Moreover, as my internship progressed, I developed more hands on skills and confidence in patient interaction than I ever anticipated. By performing tests, taking vitals, and taking vitals in an orderly and efficient way, I developed essential clinical skills for myself, while ensuring providers were able to spend as much time as possible face-to-face with patients and get them the care they truly need. Specifically, I learned and practiced a multitude of skills including: performing patient check-in, triage, blood pressure, heart rate readings, oxygen levels, urine analysis, A1C procedure (blood sample for diabetes), hemoglobin testing, prescription verification, and more. After receiving instruction, I was given the freedom to practice these skills largely independently. After doing so, I would simply give the patient information or test results to the primary care providers. The freedom and autonomy I was given within the clinic allowed me to interact with patients one-on-one quite frequently. Though I do not yet have enough knowledge to interpret lab results or discuss treatment procedures with patients, I was able to conclude my experience with more confidence with interacting with, caring for, and developing relationships with patients as I performed these basic tasks and skills than I expected I would or could in such a short time. Moreover, my position in the clinic gave me a unique appreciation for interdisciplinary health teams. In order to properly and holistically care for a patient, the clinic was committed to examining the behavioral, mental,and physical aspects of an individual’s health. Organizationally, this required the behavioral health, clinical, and administrative teams to work in extremely close proximity to each other. As an intern, I constantly reported results to physicians, delivered paperwork to the front office, assisted the nurses, and spoke with the behavioral health specialists. Thus, working in the clinic, I worked as a small member within a larger team in an environment that challenged me to practice collaborate with and learn from other healthcare professionals. Thus, I was able to meet my learning goals through a lot of hands on work, while simultaneously gaining an appreciation for how much specialized knowledge and training I still require before becoming a medical professional. 

My Leadership Studies education laid the foundation for my interest in, exploration of, and immersion in my work within the healthcare field this summer. For me personally, my Jepson courses have inspired me to see leadership as a means to drive intentional change within society. In this way, my leadership courses shaped the way that I approached both Shawnee as an organization and my work within it as a force for positive change within the healthcare system. At the conclusion of this summer, as I have had time to reflect on my experience as a whole, I have gone back to read and look at work I completed within my Justice class and reflected on it. Though I have always been interested in healthcare, Dr. Kocher was the first to really push me to ask specific questions like “Why are there such stark disparities in health outcomes along racial, environmental, and socioeconomic lines?” and “Why is the United States the only developed country to deny that universal health coverage is a fundamental human right?” 

In this class, we were encouraged to write about a justice issue of our choice and instructed to use Sandel’s book, Justice, to enhance our arguments. For my paper, I explored why the United States remains  the sole developed country to refuse to respond affirmatively to the question of whether healthcare is a human right. Ultimately, in the paper, I came to the conclusion that health care should be considered a fundamental right, not a purchasable commodity. Moreover, I argued that the present organization of the healthcare system discriminates according to socioeconomic status and warrants reform. I argued that the present organization of our system perpetuates the false narrative that individuals deserve only as much as they can afford. I gathered data on the social determinants of health and found the widening health gap according to race and wealth astounding. The hands-on work I completed this summer within my internship experience was a direct extension and embodiment of the academic research I conducted for this paper. For example, in my paper, I wrote about how affluent, predominantly Caucasian communities have demonstrated greater longevity than poor, predominantly African Americans communities for centuries. On average, the average life expectancies in richer communities are often 15-20 years longer than in poorer communities.

Within the city of Louisville, the life expectancy for individuals living in the Shawnee neighborhood where I served is approximately 10 years less on average than more affluent neighborhoods across town. Countless parallels from my leadership classes, and my Justice class in particular, came alive within the walls of the clinic where I served this summer. Situations I read about in books, discussed in my classes, and gathered data on became patients sitting directly in front of me. Patients who struggled with high blood pressure, chronic pain, or mental health came to the clinic in search of quality, compassionate, and holistic healing. Thus, my Jepson education allowed me to appreciate the intentional change the clinic is striving towards and to recognize just how necessary that change is in our society as a whole. Thus, it became a privilege for me to work alongside this organization in striving to simply give people the care they need and deserve. My Jepson classes made me aware of the way our present organization of the healthcare system perpetuates injustice within our society. My internship this summer reinforced and enhanced these convictions. Simultaneously, through working at my internship site, I learned that though the implementation of accessible healthcare is in some ways logistically challenging, it is both ethically necessary and possible. Ultimately, my internship this summer built upon notions of justice I obtained from my leadership classes and informed my understanding of public health disparities and the challenges that come with striving to eradicate those disparities through patient care.

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