When the System Fails...

At work I get the privilege to work within the health care system, learning about how it functions on the personal, local and national level, while also getting to see where the system fails. When this system fails, I am grateful there are people like the ones involved in our organization who take on the personal responsibility of caring for those who may fall through the cracks. Last week I experienced a perfect example of this.

As I explained in my last blog entry, our clinic has a state contract to administer the two part physical required for all refugees upon entrance into Nashville. Resettlement agencies in Nashville bring their clients to our clinic before and after their physicals as well, and because we wanted to provide continuity of care for these refugees, we have begun accepting the state insurance given to refugees. All refugees being resettled in the state of Tennessee are covered for 8 months by HCC medical insurance, except for children and pregnant women who are granted TennCare upon application. This confusing system means that in addition to serving the uninsured, we serve all refugees for entrance physicals, refugees on HCC insurance and those who later become uninsured once they are dropped off HCC coverage after 8 months. It is confusing to say the least.

Last week a young Burmese couple who were expecting their first child were sent to Siloam by their caseworker. They had arrived in Nashville just a few days before, but originally had been settled in Houston, TX. Since they had arrived in Texas, they were granted the state run insurance there but upon arriving in Tennessee, the husband would receive HCC coverage while the wife would not since as a pregnant woman, she was eligible for TennCare. The catch is that to apply for TennCare, the woman needed a proof of pregnancy. However since we are not a walk in clinic (we only see established patients, and because of her Tenncare eligibility, she would never be one of our patients) according to the system, we would send her somewhere else. I spent over an hour with this sweet young couple. I got in touch with their caseworker to clarify the situation. I called other clinics (by this I mean sat on hold for extended periods of time and navigated endless automated menus) to see if they would take this couple as a work in and how much they would have to pay out of pocket for a pregnancy test. I talked with my supervisors to see if there was any way we could just see them at our clinic. In the end we preferred to find a way to see them at our clinic instead of sending them all over Nashville to get a signature verifying something that one could obviously see by looking at her belly.

Our clinic has a heart for the refugee population in Nashville and although we are working within our complicated, oftentimes broken health insurance system, it is our heart that guides us. When that refugee couple left the clinic that day they made a special effort to stop and thank me for my help. Having that moment to look back on reassures me that while I am trying to work to understand and hopefully someday improve health insurance policy or refugee intake systems, it is the call from God to care for one another that is inspiring these efforts in my life.

Playing Quarterback for a Day

Something I did not know until moving here is that Nashville is a large haven for refugee resettlement by the government. The clinic where I work, Siloam Family Health Center, has a contract with the state of Tennessee to administer the two-part physical required for all refugees entering the country. So theoretically, all refugees that come to resettle in Nashville come through our doors at Siloam within the first few months of their arrival in the United States. Their diverse countries of origins, unique stories and amazing spirit make it an incredible experience to witness and be a part of.

We see anywhere from 30 to 70 refugees on a Monday which makes it a hectic day that needs a lot of organization. There are color- coded nametags that help navigate families between different stations including vitals, histories, immunizations, labs and even behavioral health consults. As they travel through this gauntlet of health services, someone needs to keep track of their medical charts, know where each family goes next, if they need a translator at that station, make sure all stations are completed, and that a urine sample is deposited before they walk out our doors. This job, which has been affectionately nick-named the “quaterback postion” (complete with a dry erase board and sticky notes to “run the plays’), belongs to Kim, one of our staff nurses. I normally serve as her second-in-command, but last week Kim was not there and I had to take over the coordinating duties.

Now the doctors, nurses and volunteers do an incredible job on their own, but it seems that if I can be in charge of knowing where everyone is and where they are going next, they can do their job easier, more effectively and with less stress. I think this position is a good use of my talents; but what makes it the most rewarding is the moments I get to spend with the refugees. It’s the shared smile as I help put on their name tag or the laughter that they try to hide as language barriers cause me to physically act out how they are to give a urine sample.

There was one Monday when all the other families had left, but one Burmese family was taking a long time to finish. They had a large family, and several members with extensive medical problems. Their 11-month-old baby was crying and distracting the family from getting their medical histories done, so I was asked to take him into another room until they were finished. That hour holding that baby was the slowest, easiest and most fulfilling part of my day. It was amazing.

All mornings at our clinics, but especially Mondays with our refugees, are truly an indescribable, awesome thing to see. The work that is done and the love that pours out of Siloam is inspirational and I feel blessed to be a part of it all.

Blogophobia

This year I will be venturing into the formerly unexplored world of blogging to bring you, the reader, insight into my year of service as a Young Adult Volunteer in Nashville, TN.

The Program: For the next 11 months I will be serving as a Young Adult Volunteer with the Presbyterian Church (USA) in Nashville, TN. The Young Adult Volunteer program, under the Missions branch of the PC(USA), is designed to give young people the opportunity serve God and their communities, live in intentional Christian community with one another, and focus on spiritual formation and vocational discernment. For more information visit the program website at http://www.pcusa.org/yav .

The Location: I have relocated to the fantastic city of Nashville, TN. There are 7 other incredible young women in the program with me and I am living with two others in a small house affectionately nicknamed the "toolshed" for its smallish size and dark green exterior paint job. I am also forming a new church home at Hillsboro Presbyterian Church where I will be worshiping and getting involved throughout the year.

The Job: My service placement for the year is at Siloam Family Health Center which is a non-profit organization dedicated to providing high quality, whole-person, health care to the uninsured of Middle Tennessee. I will be working in many areas at Siloam including patient support, refugee assistance, patient education and community outreach. I am very excited about the opportunity this work will give me to gain insight and experience with refugee programs, poverty and ill health.

The Reason: Throughout my education (earning a Bachelor's degree at Clemson University in Economics and Health Sciences), volunteer experiences, and faith development I have become increasing passionate about social justice issues. I am confident God is calling me to work with impoverished populations, possibly addressing the barriers they face to recieving health care, but am unsure how to pursue this call. This year I am hoping to explore and grow in my faith and learn more about how God wishes to use me while serving God's people.

I am so grateful for all of your support and invite you to keep in touch during this year of service which will surely bring me a lifetime of change. I hope that you will enjoy reading about my experiences, and what I am doing can resonate in your life in some way.