Post written by Dr. Iris Liu, Abbotsford-Mission Family Practice Residency Program Faculty Lead for Behavioural Medicine & Scholarship

Hi Everyone!

So June 13, 2019 was our welfare challenge for our residents.  The inspiration for this challenge came from my patients, who do indeed work hard to trying to manage their chronic illness, disability and social circumstances.  Social economic status has a major impact on health.  (Read here for a quick summary: https://www.apa.org/pi/ses/resources/publications/work-stress-health)

There is a mental and physical stress component to being on a tight budget.  So knowing this – I wanted to give my residents a taste of what it is like to be on welfare.  I will confess that as a physician, I get frustrated by the level of paperwork that piles on my desk for disability forms, tax forms, food forms etc.   However, I try to remind myself that my laziness to put my signature on a piece of paper, may mean that my patient might go without.  Hence the following challenge:

Welfare Food Challenge
How much money do you think your patient has on welfare for food?
1)     You have $20 to buy groceries for yourself
2)     It is to last for 1 week
3)     Please put your cell phone on airplane mode
4)     DO NOT use the calculator function of the phone
5)     You have 45 minutes to get the groceries and meet me at the house of James Coffee shop

The actual website from https://welfarefoodchallenge.org/ actually states $19.  (I decided on $20 for my sanity as an administrator.)

You may wonder about the instructions 3 – 5 – they aren’t on the website!  They are there because I wanted my residents to get a taste of what it is like.

Item # 3: My patients have confided to me that they often feel isolated  and that there is no one whom they can turn to for help.  I was hoping that by being on airplane mode – my residents will experience what it is like to be socially isolated.  After all, how often do I face a problem, and text a friend for help?  I also wanted them to NOT have internet access.  After all these are smart people and they will start looking up the deals at Superstore. What I wanted them to experience was the mental and physical exhaustion of having to look for the items which are on sale and fits their budget while being completely isolated.

Item #4 – no calculators.  Again I wanted them to feel the mental exhaustion of having to account for every penny in your head.  Because that’s what happens when you are on welfare. I also wanted to let them experience what it feels like to go up to the counter – go over the budget, and then feel the humiliation of asking the check-out person – “Sorry, I don’t want that item.”

Item #5 – this item was inspired from talking to my friends at Social Work.   I will confess that often times as a physician I get frustrated “Why is this patient late – they don’t have a job! What could possibly be holding them up!!!”  Well – over the years I have learnt that I really need to learn to walk in my patient’s shoes.  It isn’t easy to get around – buses run late or are inconsistent.  Childcare can be impossible to find.  And groceries are HEAVY.  I wanted them to feel how annoying / tiring it is to lug your groceries up a hill.

After the challenge, I then asked me residents to journal on the following and we had a chat about the challenge over some gelato.

Welfare Food Challenge – Journal time
Possible prompts for writing

– How did you feel overall?
– How was your stress level?
– What if you had a cold that day and was told by your GP to just take some Tylenol? (Do you know the cost of Tylenol?)
– How would you feel if you have been struggling with your weight and your GP tells you to “eat health”?
– What if you needed other stuff that week – e.g. toothpaste, toothbrush, toilet paper?
– What if it was your child’s birthday and you wanted to get her something?

I’m hoping that this Welfare Challenge will inspire us to be more patient and understanding.  This is just a small taste of what it is like.  Certainly for me, it has put my spending habits into scrutiny when I think about what I spend on food and entertainment.

As one of my mentors have said to me “Your patient lives with the chronic illness every day. You deal with it for ten minutes. So guess who is the expert in the room?”

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