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Shahrin Khan

Zachary Brewster

SOC 2000

26 April 2018

Service Learning

HUDA Clinic 03/13/18 8:15-2:15 (6 hours)

As I plan on pursuing medicine, I thought it would be adequate to choose the sociological

aspects of health in Detroit as the foundation for my service learning project this semester. Thus,

I volunteered my time at HUDA (Health Unit on Davison Avenue) Clinic, a free clinic located

here in Detroit. Walking into the clinic, I noticed how many younger people were volunteering

alongside me, and were taking on the roles that are required in such a facility. I realized that the

demographic of college students my age almost monopolized volunteering, and this is due to

role sets​. As a student, there are several instances where we are expected to go out and

volunteer. Especially for prospective medical students, it is necessary to show that you spend

your time doing something useful for society, without pay. It makes me wonder if people would

still dedicate their free time towards doing things like this if this role set (or ​prescriptive norms)

did not exist. Additionally, I wonder of the sustainability of such organizations in the case that

the structure of medical school changes. ​Functionalism ​states that every institution and structure

serves a function in society, and as long as it continues to serve that function it will persist. If

medical schools change their requirements to not value this type of work, I question whether

these institutions will survive.

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One of the biggest sociological concepts that reflected my first day at the clinic were the

ideas surrounding ​socialization​. Prior to my first day, I had to get several things ready, which

makes clear ​anticipatory socialization​. This included buying ciel blue scrubs, getting a TB test,

and going through a volunteer orientation, since I was getting prepared for a position that I

would attain in the near future. Wearing that particular color of scrubs demonstrated ​symbolic

interactionism​, because it showed how we use colors as a way to illustrate different positions in

this culture. By wearing the ciel blue colored scrubs, I showed anyone who came to visit the

clinic that I was a volunteer; not the pharmacist or the doctor, nor was I working front desk. All

of these positions are given a different color of scrubs/ uniform to denote their positions within

the clinic. Instead, I held the position of medical volunteer. Learning how to be competent as a

medical volunteer who is the first to see the patient prior to the actual provider requires

developmental socialization, ​since I received on the job training for a position which I had

obtained at that present moment. The role of this kind of medical volunteer is to “triage” the

patient, as they termed it. It is the preface to the actual treatment that they receive at the clinic. I

learned how to take manual blood pressure, how to take different vitals (e.g. blood glucose level,

weight, and temperature), as well as how to use their electronic health record program, “Athena.”

Next to the computer where we inputted all of this information about the patients was a “Cheat

Sheet” that helped volunteers as they were working on “Athena.” This meant that there was a

continuous influx of volunteers who were new or did not work on a regular basis.

Another aspect of socialization that I can apply to my first day at HUDA Clinic is

Mead’s Theory of Self that delves into role taking​. ​This is because prior to allowing myself to

ride the bike without the training wheels and taking the role of volunteer by myself, I shadowed a
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fellow volunteer who worked there for a while and watched how they triaged the patient and did

some of the steps in front of them, mimicking their actions. This reflects the ​Imitation and Play

Stages​, in which I take on the role of a specific other and get to acquire/become familiar with the

language that is integral to this role. I saw not only the logistics of triaging the patient, but also

how the volunteer communicated to the patient in a friendly manner, which I mimicked in my

own interactions with patients. Prior to these self development stages, I only felt the need to talk

to the patient in reference to the reason why they were there. This was because although I work

front-desk at a clinic in my community, I rarely get the involved patient interaction that I

received here. After watching this particular volunteer however, I started to feel the need to

engage in small talk with the patient as well, since I saw how it makes the environment lighter.

This situation parallels the ​Sapir-Whorf hypothesis​, which stipulates the notion that language

shapes our realities and cultures. The way that I express myself at the clinic can greatly shape the

reality of the experience the patient has. I learned that a bright demeanor accompanied with

words of positivity can make the patient’s experience as one that is more enjoyable.

I found myself trying to learn as much as possible because this is where I wanted to see

myself in the future. I notice that for myself, I tend to slack when I feel like what I am required

to do is not imperative to my future. However, I placed my full attention in learning how to work

with the programming and dealing with patients because it is what I plan to do as my career. This

parallels to the ​two different kinds of strippers we learned about in class: goal-oriented and

career-oriented. ​I feel much more invested in the kinds of things I am learning in this facility

due to the very fact that I see this as a stepping stone to achieve what I want to accomplish in the

future. When I asked another volunteer when we were able to eat in the six hours as I started to
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feel peckish, he responded with the idea that volunteers typically do not give themselves a lunch

break because it gets very busy. The clinic wants to serve as many patients as they can, and that

we have dedicate our time to these patients who cannot seem to find help elsewhere. I

completely empathized with what he was saying because of my ​career-oriented outlook ​in this

discourse. Though I had the goal of completing my service hours for this particular course, the

clinic provided me with a chance to gain hands on experience in the field of medicine, thus my

outlook is career-orientated.

In the process of triaging the patient and asking them why they are here, the mnemonic

OPQRST is used. This acronym allows the volunteer to get enough information on the purpose

of the patient’s visit before the doctor/provider sees them. The example of knee pain can be used

to explain this device. The ​onset ​of the knee pain is when they fell down the stairs, which began

the pain. The ​provocation/progression ​of the pain is that the patient notices that in the evening

after a long day, there is more pain. They can then describe the ​quality ​of it as dull, shooting,

throbbing, etc. Following this is ​radiation​, where the patient describes if the pain radiates to

another part of their body - such as their calves. The ​severity​ of the pain is then discussed on a

scale of one to ten. Its ​time ​is then provided, to give the provider a sense of how long this issue

has been going on. Although it is difficult to remember the entire thing, I can recognize the

importance that the acronym serves.

When I learned about this technique, it reminded me of the ​Sapir-Whorf hypothesis

again. When the patient describes how they are feeling in this way, it allows the provider to

perceive and cognitively understand what is happening to this patient in their own reality, and

can then be followed by an adequate treatment plan. Simply saying knee pain will not allow the
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doctor a complete sense of the patient’s plight. This linguistic veil/connection is what the

medical field is founded upon, and displays how crucial communication is. In a Public Health

class I took last semester, we discussed the importance of cultural competency and translators in

facilities like this because of how essential language is in the patient being able to seek help. If

they cannot adequately convey what is wrong with them, or rather if our facilities do not have the

resources to understand them, the relationship between the patient and treatment becomes looser,

and can be severed. This is why ​multiculturalism ​is especially important for a place like this

which serves a variety of people. Valuing these cultures means that this kind of service provides

the means necessary to help groups of people in a way that is appropriate for that particular

demographic. This differs from the simple value of diversity, as diversity is a society that has

multiple cultural identities. However, multiculturalism is accepting these varying cultures and

treating people from all cultures with the same level of respect and importance.

The actual structure of the facility also paralleled to some sociological aspects that we

learned in class. There were no walls/doors to separate the rooms where we triaged different

patients. Instead, there were only curtains that we closed to allow some privacy, but clearly you

can still hear the discussion from outside the confines of the curtains. Despite this, it is clear that

these curtains serve as a symbol for the ​value of privacy​, as it follows some particular guidelines

for social living. As such, it also represents ​symbolic interactionism. ​Even though you can hear

outside of these curtains, it serves as a way for our society to understand that there should exist

symbols that maintain a level of privacy. Our interactions should then reflect these symbols. The

norms ​of closing the curtain when a patient is occupying a room ​upholds the value of privacy,

which is further upheld by the laws that dictate healthcare, such as HIPAA.
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HUDA Clinic 03/15/18 8:15-2:15 (6 hours)

On this second day, I started to notice more about the demographic of people who would

come to the clinic. Since this clinic is in the city, it has a patient population primarily of people

of color: immigrants and African-Americans. This is not representative of the national statistics

however, as ​⅔ of the poor population are white​. It is not surprising that we see different groups

of people, since it is an inner-city clinic where the demographic is represented in the patient

population. However, I was bewildered at the fact that even though ​⅓ of poor people are

children​, this clinic does not provide healthcare to kids - only adults. This shows that there is a

gap in the services that are provided and the population that needs them. The reason for not

allowing children to be seen at the clinic is primarily because of s​ociety’s value of liability and

responsibility. ​Children are protected in our society, and there are many u​nfounded fears ​that

are associated with children. To avoid such complications, the clinic only provides its services to

adults.

On this particular day, the most surprising individual who I saw at the clinic was my

mom's friend. This is because in her own home, she doesn't present herself to be somebody who

is in need of assistance compared to my own family; so I was taken aback when I called the next

patient's name and I saw her sitting in the waiting room. Free clinics are thought to be places that

are dedicated to people who are impoverished, and the media presents this group of people as

exclusively those who overtly present themselves as lacking resources through their clothes, their

body language, etc. However, many of the patients looked like they came from my own

community and typical Average Joe's. This relates to the notion that the ​people in poverty are
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faceless, which we learned in class. Instead, they are illustrated as numbers and statistics,

and so it can prove to be difficult to have an image of what the poor actually looks like. This

gray area where we do not know who around us are actually “poor” lines up to the two ways that

sociologists do not use to define social class: ​the reputational method and subjective method​.

In the case of my mother’s friend, her husband owns a successful small business and I am always

taken aback by the kind of wealth she presents in her home. However, this reputational method

failed me since I assumed that she was of a class that could afford insurance. The subjective

method also claims many people as middle class, so that is what I associated her with. The only

way I can really define her socioeconomic status is through the objective method, which requires

information (such as income) that she has the ​agency ​to keep private.

HUDA Clinic 03/20/18 8:15-2:15 (6 hours)

One interaction that I had on my second day at the clinic highlights the importance of

privacy again, and concerns the discussion of a patient's medical information. When the provider

is ready to see the patient, the volunteer is required to present to the provider on the information

they acquired while triaging. This is to allow the doctor to gain some initial knowledge and

familiarize themselves with the patient’s condition, and potentially think of treatment plans

before they enter the room and meet them. As I was triaging a patient, the clinic coordinator

approached my room to say that the provider was ready to hear my presentation on a patient that

I had triaged earlier. Because I was already seeing another patient in that moment, I was going to

tell the clinic coordinator the reason why the previous patient had come to the clinic, so I can go

back to the person at hand. She stopped me and took me to the other room so that we can discuss
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it further without allowing the patient in the room to hear about another patient’s information.

Even though the initial patient came in for a very simple reason (refills), I realized from this

interaction (as well as the curtains), that HIPAA (the Health Insurance Portability and

Accountability Act) is strictly followed, no matter the reason. This then falls under the topic of

norms​, which are rules and expectations that guide the behavior of individuals. Sitting like this

highlights the​ individualist reductionist perspective​ because it shows how much attention is

placed on the individual, and that their ​agency ​to their privacy must be protected. In this case, I

was about to violate a ​proscriptive norm, ​which tells us what not to do. Although, this

particular action can be considered a ​folkway​ since there were no serious repercussions as I was

a new volunteer who was getting accustomed to ​culture ​of this environment. A ​sanction ​exists

however, as I could sense a level of annoyance from the clinic coordinator, and this made me

become more aware of this enforcement of the norm of privacy.

On this day, ​Cooley and the Looking-Glass​ self manifested. The physician's assistant

who was present on that particular day was someone who another volunteer said liked to “grill”

new volunteers - i.e. me. I noticed that his personality was theatrical, and he came off as

intimidating. When it came time for me to present, I was a bit nervous and thought of all the

potential ways he would scrutinize the things that I was saying. The first patient I presented had

knee pain. Before I could continue, he interrupted me to ask if he should guess which knee I was

talking about, since I did not specify which one. This would make anyone embarrassed if caught

off guard. Luckily, in my ​developmental socialization​, I learned from the other volunteer that

this is something that I should not be phased by. I was prepared for this culture where new

volunteers have to become recognize that this is a learning environment, as most of them are
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medical students or prospective medical students. Although I am someone who gets flustered

very easily in a situation like this, I appreciated the volunteer’s advice because I understand the

importance of making a good impression and how that affects how I perceive myself, which is

why I wanted to keep my cool.

After presenting a little bit more, the physician's assistant asked me if I knew why we

asked the “P” in OPQRST (progression); why did we ask if the knee pain happens more at night

or more in the evening? I responded as best as I could, but maybe had not been as clear as I

wanted to be. I answered with the fact that if the patient had complained of knee pain at night or

in the evening it may have been the result of walking on your legs all day, and you know the root

of the issue. However, this answer was not adequate enough for him, and so he repeated it -

leading to my response of, “I don't know.” Because of ​Cooley and the Looking Glass,

numerous individuals find it difficult to admit that they do not know something when posed a

question. This is because one becomes afraid of being perceived as ignorant, which becomes a

way for you to start seeing yourself in that manner as well. Instead, to my surprise, he says that

admitting that I didn’t know was a good answer. He goes on to explain that if you know the pain

happens more in the morning but upon moving the joints it feels better, arthritis becomes the

prime suspect. By admitting to my own ignorance, I was able to gain a new piece of knowledge

that will stick with me in the future.

HUDA Clinic 03/22/18 8:15-2:15 (6 hours)

On this day, I triaged a patient who was from my cultural background. She was a new

patient, meaning that I had to go through more steps in Athena than I would for a returning
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patient. This included an assessment of the patient's mental health through the PHQ-9

assessment, which would ask various things regarding the patient's emotions/issues within their

daily live. This included how interested they are in doing different activities, if they ever feel like

a failure or suicidal, or if they have poor appetite - to name a few. I know that in my own culture,

discussions surrounding mental health (especially for the generation above me) are almost

invisible; it is considered shameful or even silly to talk about these kinds of things. This mimics

the ​Thomas Theorem​, ​where perceiving the problem as real makes it have real

consequences.​ But in this case, belittling this issue makes it so that the consequences do not

make themselves clear to you. I learned these ideas from my ​primary agents of socialization:

my family, ​who showcase what my culture is to me. So prior to asking her these questions, I felt

that asking her these questions would be futile, and I subsequently felt a bit embarrassed since I

knew that mental issues are borderline taboo. To my surprise however, the woman answered

truthfully and recognized that she did feel depressed at times and had trouble falling asleep as

she may lay awake anxious.

This reminded me of​ Emile Durkheim’s Suicide Study in 1869, where he observed

how social integration (and regulation) played a role in increasing suicide. ​As a Bangladeshi

housewife, it can prove to be difficult to integrate yourself within society if you do not have a job

or go to school, or even be a part of the religious community present within mosques. Instead,

much of your time is spent at home cooking and cleaning and you may occasionally visit your

friends. I know several women who do feel lonely at home when their husbands are at work or

their children are at school. Thus, it is evident that lack of social integration contributes heavily

to mental health problems, and have the potential of becoming something fatal - as seen in
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Durkheim’s study​. Among the four types of suicide, ​egoistic ​presents similar symptoms that

this women was feeling: meaninglessness, hopelessness, emptiness, and isolation. However, the

demographic that is more susceptible to this are men - but it is clear that anyone who does not

find themselves involved with other people lean towards these feelings.

When I talked to another volunteer, (who was also from my cultural background), about

how it surprised me that the patient acknowledged her own mental issues, the volunteer admitted

that her own mother faces the same problems. Thus, ​the Thomas theorem​ makes it clear that

presenting mental health problems as real to our community will allow for healthier mental states

to become a priority. This could then champion ​the functionalist approach that depicts how

form follows function and structure follows need. ​If the mental wellbeing of Bangladeshi

wives becomes a need, there will be the implementation of different solutions, such as

community-wide classes for these women that are accessible and culturally competent, and

would allow them to integrate more.

HUDA Clinic 04/05/18 8:15-2:15 (6 hours)

On my last day volunteering at the clinic for the semester, I had an interaction with a

particular patient that forced me to think about how interactions define our objective reality. On

this day, a young female patient came in with a very concerning complaint. It began with the

chief coordinator of the clinic warning me about her, repeatedly mentioning that she could be

difficult and that her triage would take a long period of time. While triaging her, I am responsible

of asking her for any chronic issues that plague her. Her answer outlines the mental health issues

that she faces day to day, including depression and severe anxiety, that have led to her being
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diagnosed with Post-Traumatic Stress Disorder. Her response to the question shows that

although ​language shapes our reality, a reciprocal relationship can still be observed​. The

language that I expected her to use was that related to chronic physical illness, but given her

reality of dealing with mental health issues, her choice of words were related to her objective

reality. She was very animated in her responses and began to ramble for some time. I can

recognize that our​ society places value in time​, as periodically a volunteer or coordinator would

peer into the room to observe the progress being made on this patient.

What was especially alarming in regards to this patient was when I asked her what her

chief complaint was for the day. She said that she feels that she had a heart attack a week prior,

as she had experienced chest pain and fainted. Given this information, I spoke with the provider

and explained the situation, to which I was met with distraught. An otherwise healthy woman in

her late twenties should not be affected by a heart attack. The provider then tells the woman that

it is possible that she had a heart attack, but it is more likely a fainting spell caused by the mental

issues that was currently facing. She complained of her head and chest constantly hurting, and so

the nurse practitioner recommended that she must immediately go to the emergency room. This

is due to the fact that our clinic did not have the adequate resources to treat her for these very

pressing issues. She turns to the patient’s boyfriend and states that her health is much more

important than any financial barrier, which I saw as something much easier said than done. The

nurse practitioner was startled by the idea that during and after the incident, she did not go seek

immediate medical attention. The patient stated that it was because she was just hoping and

holding onto the idea that nothing too serious was happening to her. This is a demonstration of a

couple aspects of the ​essence of the poor American experience: doing without and stress​. In
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“​doing without​,” the patient placed her financial needs over the needs for her health and thought

she could do without the help. This is primarily due to how costly it is to seek said help. This is

why she came to a free clinic, and had high hopes for finding a solution(s) to her various issues.

Stress ​is glaringly shown in this case, and it parallels to the ​heat/eat ​dilemma.

Upon hearing this, the woman becomes very visibly emotionally taxed. She starts

sobbing, and this is followed by anger and cursing at the provider. To this, the provider and the

surrounding staff were quite shocked. This is because the woman had violated a ​more ​of society,

as she used derogatory language to address the person in charge of her care. American society

places a large value on respecting those who are aiding us. “Do not bite the hand that feeds you”

is a saying in our society, and because the woman broke the more that upheld this specific value.

A more differs from a folkway, as a folkway does not have any large consequences.

The consequence of the woman acting the way that she did was that she was no longer

taken seriously, and she was asked to leave the clinic. To this, the patient demanded that all of

her information is deleted off of our system, Athena. She stipulated that she came here to be

helped, and that she was not receiving the help that she was hoping for. Thus, it was important to

her for us to delete her information. This was impossible since you cannot delete a patient’s

information that was already inputted, especially for a patient that was already seen by the

provider. This was against the law since she signed a consent form, and it was also impossible to

do so on this software. This related to our discussion of the “​culture of fear” ​in class, as the

patient seemed to have an ​unfounded fear​ of technology. I suppose that she saw us as people in

positions of power, and since technology is a ​material part of our culture​ that is meant for

sharing information, she became paranoid. She would not leave the clinic and was very
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adamant/emotional about her information being deleted from the system because she did not

know “what we were going to do with it.”

Eventually after she left, all of the volunteers were left in shock and tried to navigate

through what exactly had occurred. I felt like I was trying to recover the most from that situation

because I was a primary character in it, but at the same time I felt like the environment was not

appropriate for me to talk badly about the patient, because that would be considered gossiping.

Although it is something that I do often times, I really felt that it would be inappropriate for me

to talk about that while volunteering because I was attempting to maintain the culture. However,

an intern who was working did not hesitate to talk about the scene that had just occurred and

continued to move her index finger in a spiraling motion indicating a ​symbol in our language

that implied that the patient was crazy. ​George Herbert Mead talked of the way people assign

meaning to each other’s words and actions (symbols), ​ and so I understood the derogatory

way in which this intern viewed the patient. It is clear that there is a level of hierarchy in her

mind, and she sees those who are unstable mentally as inferior. Although I would not consider it

a complete ​culture shock​, I still felt a level of anxiety as to how much I can discuss with people

I am working with about patients before it is considered inappropriate.

From my initial volunteering experiences at HUDA Clinic, I felt that it was very relevant

to the content that we learned in Sociology. I got to work with and for people from my own

community, and realized how much “doing without” several people that I know do. This is

because people do not broadcast their socioeconomic plights. My own friends may have issues

with seeking healthcare, or getting adequate and nutritious food on the table. This experience
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allowed me to de-glorify the medical field. What I mean by this is that many people become

doctors because they want to “help people.” What they fail to realize is that there are so many

limitations for people, especially in a capitalist nation like America that does not provide

healthcare for all. People with emergency insurance (or no insurance at all) have to put their

health at an expense due to their financial situation. Clinics have to refuse people because they

do not have the proper insurance, or in a clinic like this, be refused because there are too many

people. HUDA Clinic does provide specialized care (such as dentistry, physical therapy, etc.),

but it is often filled up and the patients have to be referred elsewhere (which is typically not

free).

Overall, this service learning project allowed me to become familiar with the culture

surrounding healthcare, and a glimpse into what problems it faces.