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HEALTH Helps Needy Get Aid

By Ariel R. Frank

Health care policies and welfare reform may not directly affect most Harvard students, but some undergraduates have still found a way to make these issues part of their daily lives.

For many area residents, pursuing health care and federal assistance can prove daunting as regulatory bureaucracy necessitates the filing of a myriad of forms.

Project HEALTH (Helping Empower, Advocate and Lead Through Health) is a new service program administered through the Institute of Politics. Using a multi-disciplinary approach to health care, undergraduates advocate for patients at Boston City Hospital.

The program has three parts: service, mentorship and reflection. Undergraduates are paired with mentors, who are physicians, attorneys or social workers at the hospital.

Under the guidance of their mentors, the students research a health care-related problem. That can entail interviewing clients who are referred to lawyers or conducting surveys of patients' parents in the pediatrics waiting room.

The next step in the service portion of Project HEALTH is to implement a program in the hospital or to represent an individual patient's case.

Projects

Projects on which other volunteers have worked over the past year have included the creation of an asthma-education curriculum in inner-city schools where poor housing conditions aggravate asthma, and a "Human Faces" project, through which undergraduates record in print and film the stories of the hospital's clients.

The volunteers also attend weekly reflection sessions, at which they share the experiences they've had at the hospital or listen to speakers on a variety of health care issues such as the impact of the November elections on children.

Founder Rebecca D. Onie '98-'97 says she got the idea for Project HEALTH last year after reading a multi-disciplinary approach to health care in The Boston Globe.

The article profiled Dr. Barry Zuckerman, who instituted such an approach in the pediatrics department of Boston City Hospital (BCH), which he chairs.

Onie called Zuckerman with the idea of beginning a similar program at Harvard, and he wanted to tackle it immediately. She spent last fall meeting with physicians, lawyers and social-workers at the hospital to develop the framework for Project HEALTH.

Last spring, the first 10 undergraduates participated on a trial basis. This year, the organization has doubled its number of volunteers, mentors and programs.

Profile of a Volunteer

Sitting across from an elderly sage in a rural community in India last year, Sumedha Lamba '98-'99 became convinced that medicine was her calling.

During a year away from Harvard, Lamba, having just finished her first year, visited the seer in her birthplace who had counseled her mother 20 years earlier.

The woman held Lamba's hands, peered into her eyes and told her she had sparks emanating from her palms. She said the flashes of light and heat represented the power to heal by touching.

Lamba had just completed an intense six-month internship in a city hospital in Florida. During that time, she had hoped to find out why she wanted to be a doctor.

Many of her relatives are physicians, and she was concerned that their legacy was drawing her blindly to the profession.

She often worked 80-hour weeks at the hospital, assisting doctors and nurses in the emergency and operating rooms and sometimes performing tasks like changing beds.

Lamba says the experience convinced her that medicine is "the noblest profession," and after listening to the seer, she knew even more assuredly that it was the right path for her.

Although she admits she was skeptical of the seer's prophecy, Lamba says it made her recognize that medicine has a spiritual side that is equally as important as its scientific side.

"I was coming from a biomedical perspective. I viewed things as objective reality," she says.

This year, Lamba says she is concerned that other people will think her story--about a seer, sparks and a calling--is kooky.

But she adds that she takes it very seriously. Since the sage told her she has the power to heal, she has been unwavering in her pursuit of a career as a physician.

"If someone has been given the power to empathize...it should compel them to choose medicine or another healing profession," she says. "[The seer] made [medicine] more of an obligation [for me]. Nothing else would be as fulfilling or as beneficial to society for me to do."

Following Her Calling

This year, almost immediately after Lamba returned to Harvard as a sophomore and a social anthropology concentrator, she applied to volunteer in Project HEALTH and was one of 11 undergraduates selected.

She completed the project's voter registration drive at Boston City Hospital in October and is currently conducting initial interviews of patients who have been referred to the advocacy program.

Lamba says that in Project HEALTH she tries to heal patients by ameliorating every aspect of their lives.

Lamba, a new American citizen, says that in India sickness is seen as both a spiritual and a biological phenomenon, and spiritual counselors like the one she visited are viewed as more mainstream than they are in Western society.

"A doctor's responsibility is to look at the entire picture of a person's life, not just a set of systems," she says. "Disease is not just biological. If a doctor does not see that, then he is treating half of the patient."

A Client's Story

After conducting initial interviews Onie set to work on behalf of client Ruth M. Crosby.

Over the summer, on a grant from a Harvard Club, Onie stayed in Boston and advocated for Crosby, researching welfare regulations, obtaining evidence, drafting letters and preparing to speak on Crosby's behalf at a welfare office hearing.

Crosby, who is paralyzed, receives $350 per month in federal aid to raise her teenage son. Combined with her $600 monthly support from Social Security and disability, her income places her just above the poverty line.

To this single, unemployed mother the government assistance means she can afford to travel 100 miles every few weeks to visit her son in a residential treatment center for emotionally disturbed youths.

In June, when the 13-year-old moved into the Baird Center in Plymouth, the state welfare office told Crosby she was no longer eligible for Aid for Families with Dependent Children (AFDC) because she did not have a dependent child living at home.

Crosby, 35, had already been separated from her son for the past six years. She was undergoing physical rehabilitation for a bullet wound to her head inflicted by her abusive second husband seven years ago.

After Crosby was shot her son lived in various foster homes in New York, where the family resided when the attack occurred.

When the hospital in New York transferred Crosby to a facility in Boston that was better equipped to care for her, she tried to find a nearby foster placement for her son.

She rented a one-bedroom apartment in a dangerous part of Dorchester, but her son was suffering emotionally after years of being physically and psychologically abused by Crosby's second husband and then shuffled between foster homes.

Crosby's son spent time in three temporary psychiatric placements and endured a year of tantrums in a Boston public school before a social-worker placed him in the Baird Center.

This fall, Crosby was able to rent a clean, safe, handicapped-accessible, two-bedroom apartment in South Dorchester, where her son can visit her every weekend. He sleeps in his own room, on a bed he built out of salvaged wood.

The federal aid Crosby receives provides just enough for her to put a home together and to rent a car to travel to Plymouth, according to Richard M. Schultz, a friend whom Crosby met in a support group for manic depressives.

Without the AFDC payment, Crosby says, she would not be able to see her son or participate in his care--taxis are too expensive and trains and buses are often not wheelchair-accessible. Buses with broken wheelchair lifts have stranded her in the street many times, she says.

According to Joshua D. Greenberg, director of the Family Advocacy Program at Boston Medical Center and a Project HEALTH mentor, not only is Crosby's intervention in her son's care crucial to his improvement, but she is still eligible for AFDC because she maintains control of decisions regarding her son's treatment and education.

Greenberg and Onie took up the task of proving that last summer to the Massachusetts Department of Transitional Assistance.

Hundreds of pages of complicated welfare regulations often confuse both applicants for aid and workers in state welfare offices. Often families are denied benefits for which they are actually eligible.

Sorting through Bureaucracy

Between 64 and 79 percent of Medicaid application denials for pregnant women, infants and children were due to applicants' inabilities to fulfill procedural requirements, reported a 1994 Massachusetts children's health study.

According to Onie, an increasing number of cases in which people were terminated from welfare because regulations were misinterpreted or overlooked have recently been referred to Massachusetts Legal Services, which provides free legal aid to income-eligible clients.

Legal Services attorneys this year requested that intake workers at welfare offices receive specific instructions on how to deal with clients like Crosby.

Greenberg says the problem lies in the federal government's method of fraud prevention.

"What [the federal government] says is [a state] will get in trouble if [it] gives welfare benefits to a family who doesn't deserve them. [The state's incentives] are to deny everyone rather than to help people who deserve them," he says.

Model Programs

Although the report by the Massachusetts Law Reform Institute, entitled "Missed Opportunities," addresses health care issues specifically, it describes two programs which may serve as models for ways in which bureaucracy can be minimized for aid applicants.

The Department of Public Health oversees a program in which case managers help families identify resources available to them and then advocate for them when necessary. This service is crucial because each family's case is different and applications are dealt with on a personal level.

In the other model, an applicant's eligibility for two mutually exclusive programs is evaluated at one point of entry.

When a pregnant woman applies for Healthy Start--a prenatal care program--the staff determines whether she is likely to be eligible for Medicaid. If she is, they begin her Medicaid application process immediately. If she is not eligible for Medicaid, a Healthy Start application is processed instead.

According to Greenberg, Crosby's problem resulted from the lack of such streamlined evaluations. When she came to him in July, she had been terminated from AFDC and was receiving "aid, pending hearing."

"She was confronted with a very complicated system and an unfriendly bureaucracy that wasn't going out of its way to help her," Greenberg says.

The Need for Advocates

Crosby says she would have lost her AFDC permanently if Greenberg and Onie had not intervened.

According to Onie, the welfare office had overlooked the stipulation that, as long as a parent maintains "care and control" of a child, they can continue to receive AFDC.

Onie used car rental receipts and a letter from her son's caseworker at the Baird Center which testified that Crosby had been involved in key medical and educational decisions regarding her son to prove to the welfare office that Crosby did indeed maintain "care and control."

Four days before Onie was to present the case at a hearing of the welfare board, the supervisor of the welfare office told her in a telephone conversation that Crosby would be reinstated for AFDC.

Holiday Wishes

Although things have improved, the road remain arduous for Crosby and her son.

According to Schultz, Crosby's apartment is still not completely handicapped-accessible. Until she gets in-home help from an occupational therapist, she cannot reach food stored in the cabinets, so she usually eats microwave meals.

Schultz delivers food to her on his bicycle, but needs to find a system for the winter.

Crosby recently acquired a power wheelchair and a handicapped-accessible toilet, stove and sink.

Their federal aid now secure, Crosby and is working to create a normal home life when her son comes home for weekends.

They will be together this Thanksgiving, and Crosby has told her friend Schultz to spend time with his family--she won't be needing his assistance this year. She's taking her son to the church in their old neighborhood, where his friends live, and they'll have dinner cooked by the minister and his wife. Santa will be there with gifts.

Crosby wishes for a computer with a CD Rom, so that she can begin working at home toward her GED. According to Schultz, adult basic education programs are difficult for her to attend because they are often not wheelchair-accessible and she has a learning disability in addition to her head injury.

Crosby says her son has told her that he wishes for a car when he turns 16, so that he can drive her everywhere she needs to go.

Last weekend, Crosby says, she woke to the scent of French toast and pancakes her son had made for both of them.

"It was great," she says twice, her voice trailing off. "It was great."CrimsonMary L. NaberMURIEL JEAN-JACQUES '99 confers with founder REBECCA D. ONIE '98-'97

Projects

Projects on which other volunteers have worked over the past year have included the creation of an asthma-education curriculum in inner-city schools where poor housing conditions aggravate asthma, and a "Human Faces" project, through which undergraduates record in print and film the stories of the hospital's clients.

The volunteers also attend weekly reflection sessions, at which they share the experiences they've had at the hospital or listen to speakers on a variety of health care issues such as the impact of the November elections on children.

Founder Rebecca D. Onie '98-'97 says she got the idea for Project HEALTH last year after reading a multi-disciplinary approach to health care in The Boston Globe.

The article profiled Dr. Barry Zuckerman, who instituted such an approach in the pediatrics department of Boston City Hospital (BCH), which he chairs.

Onie called Zuckerman with the idea of beginning a similar program at Harvard, and he wanted to tackle it immediately. She spent last fall meeting with physicians, lawyers and social-workers at the hospital to develop the framework for Project HEALTH.

Last spring, the first 10 undergraduates participated on a trial basis. This year, the organization has doubled its number of volunteers, mentors and programs.

Profile of a Volunteer

Sitting across from an elderly sage in a rural community in India last year, Sumedha Lamba '98-'99 became convinced that medicine was her calling.

During a year away from Harvard, Lamba, having just finished her first year, visited the seer in her birthplace who had counseled her mother 20 years earlier.

The woman held Lamba's hands, peered into her eyes and told her she had sparks emanating from her palms. She said the flashes of light and heat represented the power to heal by touching.

Lamba had just completed an intense six-month internship in a city hospital in Florida. During that time, she had hoped to find out why she wanted to be a doctor.

Many of her relatives are physicians, and she was concerned that their legacy was drawing her blindly to the profession.

She often worked 80-hour weeks at the hospital, assisting doctors and nurses in the emergency and operating rooms and sometimes performing tasks like changing beds.

Lamba says the experience convinced her that medicine is "the noblest profession," and after listening to the seer, she knew even more assuredly that it was the right path for her.

Although she admits she was skeptical of the seer's prophecy, Lamba says it made her recognize that medicine has a spiritual side that is equally as important as its scientific side.

"I was coming from a biomedical perspective. I viewed things as objective reality," she says.

This year, Lamba says she is concerned that other people will think her story--about a seer, sparks and a calling--is kooky.

But she adds that she takes it very seriously. Since the sage told her she has the power to heal, she has been unwavering in her pursuit of a career as a physician.

"If someone has been given the power to empathize...it should compel them to choose medicine or another healing profession," she says. "[The seer] made [medicine] more of an obligation [for me]. Nothing else would be as fulfilling or as beneficial to society for me to do."

Following Her Calling

This year, almost immediately after Lamba returned to Harvard as a sophomore and a social anthropology concentrator, she applied to volunteer in Project HEALTH and was one of 11 undergraduates selected.

She completed the project's voter registration drive at Boston City Hospital in October and is currently conducting initial interviews of patients who have been referred to the advocacy program.

Lamba says that in Project HEALTH she tries to heal patients by ameliorating every aspect of their lives.

Lamba, a new American citizen, says that in India sickness is seen as both a spiritual and a biological phenomenon, and spiritual counselors like the one she visited are viewed as more mainstream than they are in Western society.

"A doctor's responsibility is to look at the entire picture of a person's life, not just a set of systems," she says. "Disease is not just biological. If a doctor does not see that, then he is treating half of the patient."

A Client's Story

After conducting initial interviews Onie set to work on behalf of client Ruth M. Crosby.

Over the summer, on a grant from a Harvard Club, Onie stayed in Boston and advocated for Crosby, researching welfare regulations, obtaining evidence, drafting letters and preparing to speak on Crosby's behalf at a welfare office hearing.

Crosby, who is paralyzed, receives $350 per month in federal aid to raise her teenage son. Combined with her $600 monthly support from Social Security and disability, her income places her just above the poverty line.

To this single, unemployed mother the government assistance means she can afford to travel 100 miles every few weeks to visit her son in a residential treatment center for emotionally disturbed youths.

In June, when the 13-year-old moved into the Baird Center in Plymouth, the state welfare office told Crosby she was no longer eligible for Aid for Families with Dependent Children (AFDC) because she did not have a dependent child living at home.

Crosby, 35, had already been separated from her son for the past six years. She was undergoing physical rehabilitation for a bullet wound to her head inflicted by her abusive second husband seven years ago.

After Crosby was shot her son lived in various foster homes in New York, where the family resided when the attack occurred.

When the hospital in New York transferred Crosby to a facility in Boston that was better equipped to care for her, she tried to find a nearby foster placement for her son.

She rented a one-bedroom apartment in a dangerous part of Dorchester, but her son was suffering emotionally after years of being physically and psychologically abused by Crosby's second husband and then shuffled between foster homes.

Crosby's son spent time in three temporary psychiatric placements and endured a year of tantrums in a Boston public school before a social-worker placed him in the Baird Center.

This fall, Crosby was able to rent a clean, safe, handicapped-accessible, two-bedroom apartment in South Dorchester, where her son can visit her every weekend. He sleeps in his own room, on a bed he built out of salvaged wood.

The federal aid Crosby receives provides just enough for her to put a home together and to rent a car to travel to Plymouth, according to Richard M. Schultz, a friend whom Crosby met in a support group for manic depressives.

Without the AFDC payment, Crosby says, she would not be able to see her son or participate in his care--taxis are too expensive and trains and buses are often not wheelchair-accessible. Buses with broken wheelchair lifts have stranded her in the street many times, she says.

According to Joshua D. Greenberg, director of the Family Advocacy Program at Boston Medical Center and a Project HEALTH mentor, not only is Crosby's intervention in her son's care crucial to his improvement, but she is still eligible for AFDC because she maintains control of decisions regarding her son's treatment and education.

Greenberg and Onie took up the task of proving that last summer to the Massachusetts Department of Transitional Assistance.

Hundreds of pages of complicated welfare regulations often confuse both applicants for aid and workers in state welfare offices. Often families are denied benefits for which they are actually eligible.

Sorting through Bureaucracy

Between 64 and 79 percent of Medicaid application denials for pregnant women, infants and children were due to applicants' inabilities to fulfill procedural requirements, reported a 1994 Massachusetts children's health study.

According to Onie, an increasing number of cases in which people were terminated from welfare because regulations were misinterpreted or overlooked have recently been referred to Massachusetts Legal Services, which provides free legal aid to income-eligible clients.

Legal Services attorneys this year requested that intake workers at welfare offices receive specific instructions on how to deal with clients like Crosby.

Greenberg says the problem lies in the federal government's method of fraud prevention.

"What [the federal government] says is [a state] will get in trouble if [it] gives welfare benefits to a family who doesn't deserve them. [The state's incentives] are to deny everyone rather than to help people who deserve them," he says.

Model Programs

Although the report by the Massachusetts Law Reform Institute, entitled "Missed Opportunities," addresses health care issues specifically, it describes two programs which may serve as models for ways in which bureaucracy can be minimized for aid applicants.

The Department of Public Health oversees a program in which case managers help families identify resources available to them and then advocate for them when necessary. This service is crucial because each family's case is different and applications are dealt with on a personal level.

In the other model, an applicant's eligibility for two mutually exclusive programs is evaluated at one point of entry.

When a pregnant woman applies for Healthy Start--a prenatal care program--the staff determines whether she is likely to be eligible for Medicaid. If she is, they begin her Medicaid application process immediately. If she is not eligible for Medicaid, a Healthy Start application is processed instead.

According to Greenberg, Crosby's problem resulted from the lack of such streamlined evaluations. When she came to him in July, she had been terminated from AFDC and was receiving "aid, pending hearing."

"She was confronted with a very complicated system and an unfriendly bureaucracy that wasn't going out of its way to help her," Greenberg says.

The Need for Advocates

Crosby says she would have lost her AFDC permanently if Greenberg and Onie had not intervened.

According to Onie, the welfare office had overlooked the stipulation that, as long as a parent maintains "care and control" of a child, they can continue to receive AFDC.

Onie used car rental receipts and a letter from her son's caseworker at the Baird Center which testified that Crosby had been involved in key medical and educational decisions regarding her son to prove to the welfare office that Crosby did indeed maintain "care and control."

Four days before Onie was to present the case at a hearing of the welfare board, the supervisor of the welfare office told her in a telephone conversation that Crosby would be reinstated for AFDC.

Holiday Wishes

Although things have improved, the road remain arduous for Crosby and her son.

According to Schultz, Crosby's apartment is still not completely handicapped-accessible. Until she gets in-home help from an occupational therapist, she cannot reach food stored in the cabinets, so she usually eats microwave meals.

Schultz delivers food to her on his bicycle, but needs to find a system for the winter.

Crosby recently acquired a power wheelchair and a handicapped-accessible toilet, stove and sink.

Their federal aid now secure, Crosby and is working to create a normal home life when her son comes home for weekends.

They will be together this Thanksgiving, and Crosby has told her friend Schultz to spend time with his family--she won't be needing his assistance this year. She's taking her son to the church in their old neighborhood, where his friends live, and they'll have dinner cooked by the minister and his wife. Santa will be there with gifts.

Crosby wishes for a computer with a CD Rom, so that she can begin working at home toward her GED. According to Schultz, adult basic education programs are difficult for her to attend because they are often not wheelchair-accessible and she has a learning disability in addition to her head injury.

Crosby says her son has told her that he wishes for a car when he turns 16, so that he can drive her everywhere she needs to go.

Last weekend, Crosby says, she woke to the scent of French toast and pancakes her son had made for both of them.

"It was great," she says twice, her voice trailing off. "It was great."CrimsonMary L. NaberMURIEL JEAN-JACQUES '99 confers with founder REBECCA D. ONIE '98-'97

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