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By Leah Asmelash
Since 1970, third-year dental students at UNC Chapel Hill have spent eight weeks in the summer going out into communities around the state and treating patients, many from low-income families, as part of the Dentistry in Service to Communities program.
Forty-five years into this practice, the School of Dentistry’s Lewis Lampiris realized something was wrong.
“I would hear things like, ‘These people are bad that come to these clinics.’ ‘These parents – they don’t take care of their kids.’ ‘They don’t feed them well.’ ‘They bring the whole family to the visit,’” said Lampiris, who is the current director of the DISC program. “There are probable reasons for that stuff to happen that had nothing to do with being a bad person.”
Those comments got Lampiris thinking about how he could help his students understand these patients’ lives so they could be more empathetic. He wanted to help them understand the context of their patients’ lives.
The solution came to him from a simulation exercise that had been done with nursing students at UNC and lead by facilitators from the United Way of the Triangle.
In the exercise, students are divided into small groups who function as families facing poverty. They receive a packet containing information on what their role in the family is, what expenses the family must cover, who has to go to work, who has to go to school, bills such as rent, if they have a baby that needs care, etc. Some families are single-parent units, others might be taking care of an older relative, but all are real scenarios.
Each group of students then receive fake money to pay bills and spend on groceries, gas, car maintenance and unexpected expenses that can send a low-income head of household looking for a payday lender.
The ‘families’ experience four 15-minute “weeks,” where they have to fend for themselves and deal with all the issues that low-income families have to deal with. Some of the scenarios include: a son getting his girlfriend pregnant, a daughter with failing grades, or a husband who cleans out the joint checking account, leaving a mom without a way to pay bills.
Taking it seriously
In 2015, Lampiris decided to bring this exercise to his dental students.
He set up the simulation for his third-year dental students. After the first run-through, he said he knew it needed to be tweaked, but thought it went well. When he surveyed students afterward, one anonymous comment stuck out.
“You cannot simulate what it feels like to be hungry!” the comment read. “I grew up in poverty. Although I’m sure there was good intentions behind this, it was hurtful for me to see this as an “example” for wealthy classmates to feel like they now better know poverty.”
“It was like they hit me over the head with a 2 by 4,” Lampiris said. “I was like, ‘Whoa, I got more work to do.’”
Lampiris also perceived some students didn’t take the simulation seriously. So he took it up a notch, bought the kit that the United Way used and went to a training with three other dental faculty to the Missouri Community Action Network which developed the simulation.
Then, he was ready to try again.
Lampiris changed how he introduced the simulation to the students. Now, he makes the purpose specific by telling the students why they are doing the simulation: to help them understand what life is like for many of the families they will see over the summer.
“This is not a game. You need to take it seriously,” Lampiris tells the students. “I want you to be aware that there are some members, some of your classmates here, who have experienced poverty. This is where they came from. For them, this is real. I want you to respect that fact.”
He adds that the simulation can never replicate what real people living in poverty experience, and he repeats it over and over.
Kelsey Knight Cody is a rising fourth-year student at UNC’s dental school and participated this spring. She said she was apprehensive going into the simulation.
“I had pretty low expectations that you could actually simulate poverty because I grew up kind of poor,’” she said. “I was like, ‘There’s no way a simulation in the middle of the Atrium of the dental school can account for all the decisions and emotions that you face growing up.’”
To her surprise, she said the simulation left a lasting impression going into her rotations and gave her a better idea of the decisions low-income families face.
“It was another perspective,” she said. “They may just not have time, or the clinic hours wouldn’t work out, or they couldn’t take off from their job because that would mean they couldn’t feed their family that week or they didn’t have transportation.”
When Lampiris first conducted the simulation in 2015, most students said they got something from the exercise, but about a quarter said they found it either not very valuable or not valuable at all.
After some tweaks the following year the number who didn’t find it valuable shrank to 13 percent. This year, it was 2 percent.
Although Lampiris knows the program makes a difference the day of the simulation, he’s still evaluating the lasting impact.
“I have anecdotal information,” he said, explaining students have to write a reflective essay at the end of their experience. “Several times I read that ‘it reminded me of the poverty simulation… the role I played.’”
Lampiris thinks the simulation is something all health care students should experience, not just dental students.
“As the healthcare system in our country becomes more expensive, more difficult … there will be more and more people that cannot access care because the costs associated with it,” he said. “Everybody who is taking care of folks needs to understand.”