Poverty simulation sheds light on underserved patients


A male student assumes the role of an indigent elderly man attempting to make it financially through the month by seeking assistance from a community action agency staff member.

In late February, student pharmacists from The University of Texas (UT) at Austin Pharmacy School got a glimpse into what it feels like to live day-to-day in poverty. They were part of an interprofessional education simulation, organized by student pharmacists through a grant from Target. 

“I think it’s integral for student pharmacists and other health care students to understand how poverty affects access to health care and how priorities change when people are confronted with poverty,” said Natalia Malesa, a second-year student pharmacist who helped plan the event.

Along with students and faculty from nursing, social work, communication, public health, and dentistry, student pharmacists gained insights into what some of their future patients might face, as well as ways they might be able to help them. 

“We learn in school about different medication compliance issues, like patients splitting their pills, and we just put them under the umbrella of non-compliant,” said Malesa. Through the poverty simulation, Malesa said students were able to grasp that without money, patients don’t make it their first priority to find a way to get to a clinic to pick up their medications. Feeding their children would likely take precedent over adhering to their medications. 

Expectations changed

During the 2-hour simulation, students were organized into family units and assigned different scenarios where they were challenged by a specific set of circumstances. Lining the room were faculty and community volunteers who staffed organizations representing charities, clinics, employment centers, banks, and more. Each family unit had to collaborate and figure out how to feed their families, pay bills, and generally get by for a 1-month period, which was broken into four 1-week units that lasted 15 minutes for the sake of the simulation. In order to include different perspectives on how poverty affects access to services, each family consisted of students from 
different disciplines. 

“Trying to do this for one hour was so stressful, I can’t imagine living it day-to-day,” said Sarah Rumbellow, a second-year student pharmacist participant. “It will help change my expectations of my patients living that way and the lack of information they might have about resources available.”

Rumbellow was particularly struck by the gap in knowledge—even her own—on which particular organizations can help patients. For instance, she said that during the simulation, Christian Charities was simply advertised with a sign. She had no idea that they provided daycare services and more. 

“Telling patients about these 
resources and being aware of them is an extra service I could provide,” she said. If a patient couldn’t afford their medication, Rumbellow said she would want to tell them specifically where they could go to get help. “It’s valuable to get in their shoes and it can help me know how to troubleshoot things better: Would it be OK if they cut their tablets in half? Are there dietary things that are lower-cost? Telling them to exercise once a day might be crazy when they are trying to put food on table.”


The event was also eye-opening in another way. Students outside of pharmacy were surprised to hear that pharmacy was hosting the event. Malesa said she heard many people ask, “What does pharmacy have to do with poverty?” She responded that community and ambulatory care pharmacists are on the front lines caring for patients living with these issues. Pharmacists are also more accessible to these patients than most health care providers. 

“It was a big reflection on people’s lack of understanding of pharmacy services and the need for us to be visible as a profession,” said Malesa. 

Veronica Young, PharmD, MPH, 
Director of Interprofessional Education 
at UT–Austin, said because pharmacists are so accessible, they can play one of the biggest roles in helping underserved patients learn and navigate available services. 

“I see this as another venue for a dialogue in the community—how do we as students and faculty improve the lives of the underserved?” Young said. 

Young is keen on continuing these kinds of simulations in the future and is currently working with the university to bring the event to students at least once a year. 

Loren Bonner, MA, is a Reporter for Twlug Periodicals in Washington, DC.