Simulating struggles

Dozens of Cizik School of Nursing at UTHealth Houston students picked up name badges and put on new identities in April to learn what life is like for families living in poverty.

Community health nursing students took on the roles of single parents, seniors experiencing homelessness, a young adult raising her siblings, and other characters based on real people served by social service agencies as part of the Community Action Poverty Simulation (CAPS).

“The simulation is not a game. Millions of people face these challenges every day,” Assistant Professor Riza Mauricio, PhD, RN, told the students.

Among UTHealth Houston faculty and staff helping out with the learning experience was Associate Professor Rebecca Lunstroth, JD, MA, associate director of the McGovern Center for Humanities and Ethics. Lunstroth put together the university’s first poverty simulation for students at McGovern Medical School at UTHealth Houston in 2018. She, Mauricio, and other faculty traveled to Jefferson City, Missouri, to learn about the CAPS program developed by the Missouri Community Action Network and to experience the simulation themselves.

“The goal is to make sure you keep a roof over your head and feed your family. I failed,” Mauricio said of the training session she attended in Missouri.

The objective is to help students understand that purchasing medicine or sticking to a healthy diet are just two of the many priorities patients must juggle when living in poverty. “It’s up to us as nurses to assess the patients and offer the help that they need,” Mauricio said.

Students portraying family groups sat in clusters around the room, each with a packet describing their situation and containing play money and transportation vouchers – less than they would likely need. The challenge was to make it through a month paying all basic expenses and keeping kids in school while dealing with unexpected problems. Workweeks passed in 15-minute segments separated by five-minute weekends.

Meanwhile, volunteers sat behind tables around the perimeter that represented businesses and social service resources – a bank, a homeless shelter, a mortgage company, a school in one corner of the room, and a jail in another. When the bell rang to start a new “week,” many students rushed to the pawnshop or the payday loan table.

By the end of the “month,” only one or two students had visited the clinic, signs indicating evictions or utility shut-offs hung on several chairs, and many families were homeless and hungry.

“I was fortunate to be in a group that could afford to pay the rent and utilities and put food on the table without significant life interruptions, although I almost lost my job because I was tardy,” said RN to BSN student Goreti Okello. “The whole experience was sobering, and it just reinforced the fact that we all need to give each other a little grace and kindness. It is so sad that many Americans are one paycheck, one injury, or one severe sickness away from living on the streets.”

For Pacesetter BSN student Mehgan Orsak, the simulation highlighted the value of connecting with others. “I learned how much kindness and empathy can really make an impact,” she said. “I was running around the room trying to pay bills and buy groceries when I took a moment to talk to a fellow peer. We both discussed everything that was going on within the simulation and the stress we were feeling, and I realized how much better I felt talking to someone rather than trying to focus solely on myself.”

Many aspects of the simulation seemed familiar to Pacesetter student Krystal Rodriguez, who lived through family financial challenges herself.

“I had a very similar upbringing, and I have worked so hard to be where I am today,” Rodriguez said. “It was a privilege to be a part of the simulation, and I am grateful it was offered to the many students of UTHealth Houston. When we start to practice, we will have an idea of how to comfortably approach individuals, how to assess for socioeconomic disparities, and we will have a better holistic understanding of what our patient is facing on a day-to-day basis to truly treat the root of the problem.”

Lunstroth and Mauricio said plans are underway to make the next poverty simulation an interprofessional collaboration among various schools at UTHealth Houston.

(Banner image: Students portraying a family living with poverty discuss how to make ends meet.)