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Christiana Care residents do poverty simulation

Sophia Schmidt, Delaware Public Media
Residents wait in line at the model pawn shop during the poverty simulation

First year residents at Christiana Care got a sense of the challenges faced by those living in poverty on Thursday.


For the third year in a row, an interactive poverty simulation was a key part of the residents’ orientation, which began June 18th.

The simulation grouped the residents into families with varying incomes at or near poverty level and asked them to pay for food, housing, utilities, healthcare and incidental costs over four fifteen-minute “weeks.”

Residents had to buy transportation tickets and wait in lines at the bank, supermarket or daycare—in this case, tables manned by volunteers. As the simulation progressed, lines at tables representing a pawn shop and a pay-day lender grew.

The health system’s head of diversity Dana Beckton says the simulation is designed to make residents aware of the challenges low-income patients face.

“The residents are realizing they have to make choices. When they’re living at or close to poverty, it’s not a matter of, I choose not to take my medicine,” she said. “It’s, I got a family of four, if I take this money and pay for medicine, my family’s going to get evicted.”

She says the simulation also helps residents start to learn about some of the social services available to people living in poverty, so in the future they can refer patients to these resources.

Credit Sophia Schmidt, Delaware Public Media
Flipped chairs symbolize eviction for a 'family' of residents who failed to pay rent during the simulation

Jacqueline Ortiz, who works on cultural competency for the health system, says the simulation is effective at getting residents to imagine an experience that’s different from their own—which she says tends to be more economically privileged.

“That first ‘week’ you see people kind of dawdling along, they’re sitting down kind of calculating their income. By the end of the third week you have people running to different services so they can get food and they can get the kids,” she said. “They start getting really stressed out.”

During a debrief following the exercise, residents noted how quickly they fell behind financially when one surprise cost—such as getting robbed or having to pay bail for a family member—came up.

Those running the simulation’s model health clinic noted that very few residents were able to allocate resources to healthcare during the exercise.

Cebert Hines is a social worker who volunteered with the simulation. He says the way healthcare, especially preventative healthcare, fell to the wayside during the exercise reflects the experience of many people living in poverty.

Credit Sophia Schmidt, Delaware Public Media
A 'family' of residents discuss which costs of living they can afford to pay for during the poverty simulation

“Our target group, they’re usually always in crisis mode. They’re usually taking care of their basic survival needs—food, shelter, clothing. Therefore the issue of healthcare and healthcare prevention is at the bottom of their list,” he said. “Unless they’re terminally ill, then it’s shot up to the top.”

Hines says the goal of healthcare providers should be to recognize the other challenges patients are facing and to help patients bring healthcare up higher in their list of priorities.

“Once you meet someone where they have … an immediate interest in, once you can have a discussion around that, then you introduce the pros and the cons. And show how their health is connected to their own wealth,” he said. “You know, taking care of something now will save them money.”

He adds that it can be a problem when patients feel healthcare providers are only interested in treating one part of them.

“If we can not let them feel that it’s about just this one thing, but it’s about their holistic environment, their holistic life, that is a starting point.”


Sophia Schmidt is a Delaware native. She comes to Delaware Public Media from NPR’s Weekend Edition in Washington, DC, where she produced arts, politics, science and culture interviews. She previously wrote about education and environment for The Berkshire Eagle in Pittsfield, MA. She graduated from Williams College, where she studied environmental policy and biology, and covered environmental events and local renewable energy for the college paper.
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