Far from the US-Mexico border — ground zero for one of the most polarizing issues in America today — University of Bridgeport students are addressing the region’s growing public health emergency.
Border health centers are struggling to address a humanitarian crisis shaped by years of political conflict. Every day, immigrants arrive in dire need of medical care. Aside from the possibility of arriving with injuries, many immigrants come to America with pre-existing health conditions. In rural communities — especially those scattered along the border — illnesses such as diabetes, asthma, and heart disease are notably prevalent. Moreover, the quality of care that many Mexican immigrants received prior to their arrival is not up to the United States standards, further worsening their health issues. Consequently, there is an urgent need for high-caliber healthcare providers who are capable of addressing these issues.
Tucked away in the northeast corner of the country, these problems might seem decidedly far from life in the Nutmeg State. But public health issues are never as isolated as one might think. Aside from the Connecticut-based families who’ve been affected by the crisis at the border, similar healthcare disparities plague communities closer to home. A region is considered medically underserved when social and financial disadvantages affect peoples’ access to sufficient healthcare. In fact, parts of Bridgeport are considered medically underserved, with HRSA-designated clinics existing throughout the city.
Identifying Healthcare Deficits
In 2022, the Physician Assistant (PA) program launched a new clinical requirement — the Special Populations rotation. Also known as a Selective Rotation, this five-week clinical experience sends students to medically underserved areas. Aside from providing life-changing services to those who need them most, this program exposes PA students to social inequities in healthcare.
The breadth of the Special Populations program is far-reaching. Students can choose to work in locations such as a municipal hospital on the California-Mexico border, the West Haven VA Medical Center, addiction treatment centers, LGBTQIA+ health centers, Bronx-based clinics, and other HRSA-designated locations. Though the program is still in its infancy, clinical director Michelle Lea, PA-C, has already seen its impact on how PA students approach medicine.
“Certain things go into providing quality care that just can’t be emulated in a classroom,” Lea explains. “The goal of Special Rotations is to introduce students to underserved and marginalized populations — helping them learn to identify and overcome the social determinants that affect people’s access to care .”
From Bridgeport to the Border
For some of us, healthcare can be easily taken for granted. But for many, factors like social class, race, and geography can create significant barriers to access. Individuals facing these barriers find that the road to high-quality care is strewn with red tape and insurmountable obstacles. When UB students journey to the California-Mexico border, they are exposed to these very issues and tasked with addressing them head-on.
In Mexico, healthcare can be expensive and inaccessible. The insurance system is difficult to navigate, and high-quality care is often only available to the wealthiest people. Consequently, many individuals are forced to receive treatment from unqualified physicians whose practices are not appropriately regulated.
Aside from leaving patients in urgent need of care, these situations present a unique challenge for UB’s PA students. Though these disparities are frustrating to face, exposure to inequity plays a vital role in teaching future PAs how to provide inclusive and culturally sensitive healthcare. “By acknowledging and addressing special challenges and inequities,” Lea elaborates, “students learn to bridge the gap and provide better services.”
Building Bridges with the Bronx
UB students needn’t necessarily travel to the US-Mexico border to see the results of healthcare inequity. During their Special Populations rotation, students can work as closely to campus as Bridgeport itself. “Students are being sent to HRSA-designated areas and facilities with personnel shortages,” Lea details. “Bridgeport is considered underserved for both primary and mental healthcare.”
Another rotation available much closer to home is the Bronx rotation. Much like those living along the border, Bronx residents suffer from higher rates of asthma, diabetes, heart disease, obesity, HIV/AIDs, and infant mortality. Poverty plays a significant role in affecting residents’ access to healthcare. South Bronx is often cited as the poorest urban congressional district in the United States, with studies showing that the poverty rate rests at a staggering 30%. This means that one in three families struggle to meet fundamental needs, including access to food and medical care. Given the Bronx’s high population of Black and Latinx citizens, people of color have been disproportionately affected by this issue.
Over the past three years, program faculty and students have been reaching out to underserved or underrepresented areas to increase knowledge about the PA profession through a program called Bridge to Bridgeport. Michelle Lea and her colleagues expanded the Bridge to Bridgeport program to increase student engagement with communities that are part of the special populations initiative. A voluntary mentorship program, Bridge to Bridgeport has UB students work with adolescents from two health science high schools in the Bronx.
Bridge to Bridgeport ultimately aims to encourage teens to pursue a career in healthcare. However, Lea and the volunteers have often found that their scope is much smaller. “Many of the high school students we work with lack an understanding of higher education. Sometimes, it’s simply about explaining their options,” Lea elaborates. “They may have an interest in pursuing a higher education, but they lack the knowledge and resources to explore their options.”
Aside from encouraging high schoolers to pursue their education, Bridge to Bridgeport has indeed served its purpose in putting a name and face to the patient demographic. “Students build a connection to those within the communities through mentorship,” Lea says. “The experience is very eye-opening for students.”
Addressing Accessibility
The Physician Assistant Institute places immense value on the experiential learning that Special Rotations provide. “Although many of our students come from diverse backgrounds, they haven’t necessarily been exposed to the challenges they see during Selective Rotations,” Lea explains. “The rotations increase student healthcare literacy and teach them how to foster inclusivity as they provide healthcare.”
For PA students, a big part of this learning experience involves a summative project, in which they create an educational product tailored to their patient demographic. “They can create a video, pamphlet, brochure, or another product that speaks to the population they’re working with,” Lea describes. “It should be creative and eye-catching, while also incorporating what they’ve learned about addressing inequity.”
In illustrating this project’s importance, Michelle Lea reflects on the experiences of a PA student who completed their Special Rotation working with incarcerated patients. “This particular student found that the inmates were unaware of the medical screening options that were available to them,” Lea recalls. “The student produced a flier that spoke to the community’s healthcare literacy deficit.” Moreover, this student designed their pamphlet with equity in mind. Considering that 70% of incarcerated individuals can’t read above the 4th-grade level, this student made sure the flier was written in appropriate and accessible language.
The Special Rotation summative project also includes an essay wherein students meaningfully reflect on their experiential learning. Their essays must address the barriers and inequities faced by their patient population and explain how their product helps bridge the gap in healthcare accessibility.
Learning to Listen
When asked why the Selective Rotations are so valuable to the PA program, Michelle Lea considers the special role that PAs play within the landscape of healthcare. “PAs provide listening and empathy,” Lea says. “It’s not about passing tests or meeting numbers. It’s about what your patients say and feel. Our students learn to address patient needs by listening to and assessing the entire problem. Recognizing social barriers is an important part of doing that.”
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