Written by Lauren Murphy, SIU School of Medicine
If you were given an opportunity to switch identities with another person for an hour of your life, whom would you choose? You probably wouldn’t choose  a young man with a criminal record, a minimum wage job as a cafeteria worker and a daughter and girlfriend to support. You also probably wouldn’t choose to be someone trying to earn a college degree while caring for three younger siblings because your dad is in prison and your mom left.
But last Friday, that’s exactly who School of Medicine Internal Medicine physicians and staff chose to be.
In a poverty simulation designed to reflect real families’ situations and develop physician and staff’s understanding of the challenges associated with poverty, fifteen minutes represent a week. As internal medicine physicians, faculty members, nurses and support staff arrived, they were given a new identity, along with a name badge, photo ID and a packet of information describing their new lives. Chairs set in circles represented families’ homes. Tables lining the perimeter of the room represented community resources, childcare centers and businesses.
As the simulation began with the chirp of a whistle, participants were unsure where to head first. If
employed, they had three minutes to reach the employment table, where they waited until their work day ended. Single parents were also tasked with getting children to the school or childcare center before heading to work. Workers at the supermarket, bank, utilities office and pawn shop were often rude and unhelpful, as can often be the case in real life.
Unemployed participants formed lines at the community support tables. Though lines were often frustratingly slow and confusing as participants were unsure what each table could provide them, the mood was light and jovial. When the first fifteen minutes of the simulation ended, however, many families realize they’d missed work, had little remaining money and had a limited number of transportation passes left. A slight but noticeable urgency appeared among participants. What began as a tentative walk to the bank or Community Action Program in week one became an all-out sprint in week two.
Luxuries like stereos, jewelry, televisions and cameras were quickly taken to the pawn shop where increasingly desperate patrons were offered far below market value for their prized belongings. One woman sold her grandmother’s wedding ring to make ends meet.  The occasional miscounting of money also occurred as families tally their remaining cash and transportation passes. Though participants are told they must pay all bills, bills labeled “miscellaneous” or “clothing” quickly fell by the wayside. Babies, represented by baby dolls, are all but forgotten.
Many families found comfort in the Community Action Program, but once the resources – which include transportation passes, childcare vouchers and assistance with food, clothing and utilities – were gone, they were really gone. By the end of week three, many families returned to their “homes” to find they’d been evicted after failing to pay their rent or mortgage. Others’ electricity was turned off. Bewildered families searched the perimeter of the room for the nearest homeless shelter. Some families returned to find their children have been put in juvenile detention after they failed to take them to school or childcare.
Many of the participants were left to the good graces of those around them. Others made their own luck; families turned to thieving and purposely misleading merchants to save a bit of money.
As the simulation ends, participants are noticeably uncomfortable. During a period of reflection following the simulation, physicians, nurses and support staff share several takeaways:

• The lack of assistance offered in finding the right resources was troubling. As employees of a health care organization, they feel they need to be aware of community resources so that they can be the assistance their patients are seeking.
• Poverty is an endless cycle. Families stressed the inability to save money to get ahead while living paycheck to paycheck.
• Poverty affects the entire community. The simulation was a reminder to participants that some patients struggle to find transportation. The next time a patient arrives an hour late for an appointment, be patient and realize it may have taken three different busses to travel four miles.
• Some patients may be reluctant to share their circumstances with health care professionals; therefore, it’s up to nurses and doctors to recognize the signs and offer assistance when needed.
• If you don’t know the answer, find someone who does. Springfielders are urged to call 211, a service offered by United Way that will help families receive the assistance they need.

The poverty simulation was an eye-opening 60 minutes, but for more than 15% of Sangamon County residents living at or below the poverty line, the frustration, hunger and desperation are inescapable. Pawning off a loved-one’s wedding ring isn’t as easy as handing a piece of paper with a picture of a wedding ring on it to a pawn shop. Being talked down to by the people who are supposed to help you is an unfortunate but daily occurrence faced by impoverished families. Infants aren’t dolls that can be ignored; they’re loving, crying, hungry, growing children in need of diapers, formula and attention.
While most of us wouldn’t willingly trade lives with those less fortunate, SIU physicians took the challenge and are now armed with greater empathy and a greater respect for patients whose physical and mental wellbeing has been affected by the burden of poverty.
“I’ve had patients tell me that their electricity had been cut off,” one physician said. “I listened, but until today, I didn’t know what services were available. Now I know how tough it is.”
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