“During the next hour, you’re going to be participating in a simulation of what it might be like to be part of a family with low-income trying to survive month to month.” Assistant Professor (C/T) Deidre Callanan, RDH, DC, MPH, introduced the afternoon’s interactive lesson. “This is not a game or a competition; rather it is a shared learning experience meant to educate and elevate patient care.”
Eighty first-year dental students began to absorb what the next hour would look like. They were randomly assigned identities, based on real people, and placed in family units of four students. Information packets explained their families’ living situations, source(s) of income, bills to be paid, and transportation passes to access community resources around the room.
“You will be living in poverty for one month; a month consisting of four 15-minute weeks and two one-minute weekends,” explained Callanan. “The object of this experience is to sensitize us all to the day-to-day realities of life faced by people with low-income, and to motivate us to become involved in activities which help us to reduce poverty in our country.”
A Surprising Start
Monica Khazaal (DDS ‘26) took on the identity of an 85-year-old male who was retired and without a home. She received a retirement check but didn’t know where to go to cash it. “It was immediately challenging to find the right resources.”
She first tried the bank, where she was told she didn’t have an account so they couldn’t help. That cost one transportation pass, which represented bus fare, or gas money, or time spent walking. She used another pass to visit the “quick cash” center, where they took a percentage out of the check to cash it.
Khazaal was shocked to see how little the retirement check was, and how many expenses go into simply surviving an entire month with that as the only source of income.
Familiar Family Responsibilities
Some students recognized glimpses of their own lives in the simulated situations.
Jaidaa Elbezry (DDS ‘26) was assigned the role of a 10-year-old with a younger brother, a mother working full-time and a father looking for work.
“It was a very full circle moment for me,” Elbezry explained. She had to take on somewhat of a parental role at a young age, also caring for her younger brother.
When her schoolmates in the simulation went on a field trip, Elbezry was one of two children whose family could not afford it. She said, “it’s hard seeing other kids having fun when you’re worried and stressed about responsibilities that you shouldn’t have to take on.”
Adam Schneemann (DDS ‘26) was an older adult taking care of two school-aged grandchildren.
“I have three kids of my own and I’ve been on public assistance before, so I know that when you realize you need it, it’s often too late. Getting ahead of things and reaching out for help early on is valuable, but it’s not the easiest thing to do. I have a lot of respect for anyone in that situation.”
Person-Centered Care
The Poverty Simulation teaches many important lessons, one of which is the idea of person-centered care.
Person-centered care means getting to know the person and working with them to develop a holistic treatment plan. The World Health Organization (WHO) explains it as “care where people, families and communities are respected, informed, engaged, supported, and treated with dignity and compassion.”
In the year following this exercise, students take part in follow-up programming on health communication, literacy and person-centered care.
"We need to have compassion for these communities."
- Monica Khazaal (DDS '26)
Callanan ended the simulation by reflecting as a group on what everyone learned.
Schneemann said, “It highlighted how many hoops you jump through to get help. And even if you do everything right, sometimes things take time when you need help now.”
He continued, “We’re going to see patients in similar situations here at the school and out in the community. I’m grateful for this experience because it’s important to not lose sight of the person in your chair. We’re learning to be empathetic providers and members of the community.”
Callanan’s ultimate hope for this simulation is that dentists educated at the University of Colorado School of Dental Medicine will be benevolent, tolerant and understanding providers.
“You’re going to work on a tooth, and that tooth is part of a person, and that person is part of a family, and that family is part of a community. As dentists, you are part of this bigger picture. Yes, you’re going to fix teeth, but you are also an educator, and a person in your community who can make a difference.”
- Deidre Callanan, RDH, DC, MPH
July 19, 2023