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Poverty Simulation: This is Not a Game

Meet Zola Zuppot, 50 year-old cashier raising grandkids

Kevin Hachey MD, Medicine-Pediatrics resident, role-plays Zola, who is married to a disabled diabetic and is raising a 9 year-old girl and a 7 year-old boy with ADHD whose mother is in jail for drug abuse.

Zola, with only a high school diploma and limited English, makes $9.50/hour, and pays 2 mortgages, a car loan, and medical expenses (grandchildren have no health insurance).

This is one of 26 family scenarios in  The Community Action Poverty Simulation

For most people, it may be hard to understand why a mother of a child just diagnosed with diabetes wouldn’t make sure he got his insulin every day. It may be just as hard to imagine being homeless, living in a motel, and not having access to a refrigerator in which to store the insulin.

Narrowing that gap in understanding is the goal of a poverty simulation exercise for interns starting their residency training at Baystate Medical Center.

Understanding the Challenges of Poverty

Poverty is a powerful predictor of disease and death. The poorest 1% of people in the U.S. die a decade or more earlier than the richest 1%, according to an April 2016 article in Journal of the American Medical Association.

And poverty is an issue in the community served by Baystate Medical Center—the poverty rate and reliance on government support programs like Supplemental Nutrition Assistance Program (SNAP) is higher than the Massachusetts average.

One of the goals of the simulation was to give residents a better understanding of the complexity and interconnection of the social and economic issues affecting their patients' health, according to Dr. Molly Senn-McNally, Director, Pediatric Continuity Clinic, who was instrumental in bringing the Community Action Poverty Simulation to Baystate.

A Big Eye-opener for Residents

Each resident was assigned a role in a family that is struggling financially—perhaps recently deserted by a breadwinner, or disabled and living on Social Security. They must figure out how to survive on an extremely limited income, deciding how to allocate their resources to pay for housing, buy food, get to work, keep their kids in school, pay utilities, and deal with unexpected challenges.

Built in to the simulation are constraints common to those living near the poverty line, such as, being without a car, having no phone, or needing to cash a check without having a bank account.

“You are barely keeping your head above the water and you have to kind of play loose with the rules or break the rules," explained resident Taylor Koerner MD. "We were supposed to have everybody home sick for a week but we sent people to work anyway.” 

“As the month went on, expenses really started to get away from us and things got more and more overwhelming,” another resident, Anthony Nicolas MD, said. “I think the biggest lesson to take away from this is, so many unexpected challenges start popping up.”

“It was a big eye opener for all of us,” concluded Dr. Nicolas.