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Journal of Social Work in End-Of-Life & Palliative Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wswe20

Contributing Cause of Death: Poverty Jennifer Davis-Berman

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Department of Sociology, Anthropology and Social Work , University of Dayton , Dayton , Ohio , USA Published online: 02 Dec 2013.

To cite this article: Jennifer Davis-Berman (2013) Contributing Cause of Death: Poverty, Journal of Social Work in End-Of-Life & Palliative Care, 9:4, 244-246, DOI: 10.1080/15524256.2013.846890 To link to this article: http://dx.doi.org/10.1080/15524256.2013.846890

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Journal of Social Work in End-of-Life & Palliative Care, 9:244–246, 2013 Copyright © Taylor & Francis Group, LLC ISSN: 1552-4256 print/1552-4264 online DOI: 10.1080/15524256.2013.846890

REFLECTIONS

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Contributing Cause of Death: Poverty JENNIFER DAVIS-BERMAN Department of Sociology, Anthropology and Social Work, University of Dayton, Dayton, Ohio, USA

It began with my fascination for social work research, and I guess when the story is over, it will end with research as well. I am a social work professor who is involved with teaching, research, and service. Conducting in-depth interviews with older women at an overnight homeless shelter helped me understand the chaotic nature of living in the shelter. I listened to these women as they told their stories about stress, anxiety, and yearning for some quiet, some relief, not only from their circumstances, but from those around them. These were brave women; old before their time, fragile, some even frail. Were they at the end of their lives? Perhaps some were. The more time I spent in the shelter, the more stories I heard about death by disease, overdose, and accident. Next I showed up as a social worker with a yoga mat. After teaming up with a wonderful and generous yoga teacher, we began to offer weekly yoga classes for the single women at the shelter. Our main intent was to provide a safe space, a time where people could relax, be calm, and reflect a bit on their lives and their futures. Was teaching relaxation and stress reduction social work practice? I like to think so. What I was not prepared for was the physical debilitation of some of the people with which I worked and came to care deeply about. Our yoga class often included people in wheelchairs who had very limited mobility. Others sat in regular chairs, unable to sit on the floor. Yes, there were able bodied participants, but even they seemed old and feeble before their time. You may be asking what this has to do with social work end-of-life issues. Not much in a traditional sense. However, in our yoga program, we have been exposed to people near the end of their lives. We have had a participant with end-stage pulmonary disease in class, toting her oxygen Address correspondence to Jennifer Davis-Berman, Ph.D., University of Dayton, Department of Sociology, Anthropology and Social Work, 300 College Park Avenue, Dayton, OH 45469, USA. E-mail: [email protected] 244

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tank with her. Can you imagine struggling with breath while living in a shelter? The weather is hot and humid here and the air inside the shelter seems stagnant. Also, despite the best efforts of the staff, the place is not clean. How could it be? Fresh air? Forget it. Another of our yoga participants had end-stage renal disease as a result of years of struggling with uncontrolled diabetes. Some days, her legs would be so swollen she could not participate. Other times, she was so tired; she almost appeared to be semi-conscious. We encouraged her to come into yoga anyway to relax, and to sleep if she needed to. When all the medications failed, it came time to do dialysis … three times a week for the rest of her life. How was she to get to these appointments? How was she to cope with the physical and emotional stress of this intensive treatment? The last time I saw her, she told me that another woman in the shelter was taking her to treatment, waiting all day with her, and then driving her back to the shelter. She is not in the shelter now. Yoga class goes on without her. We are not told where people are or what has happened to them. Rumors abound. Our community has a few beds for respite for people in poverty. These beds allow people a few days away from feeling homeless after surgery, or in the case of serious illness. A few beds are not enough. How does a social worker deal with end-of-life issues in a homeless shelter? It has been shocking to see how many sick and disabled people are here, with so few options for help. Being a social worker with a yoga mat, I am outside the structure of the formal shelter system, so my ability to help is limited. I begin to get close and care about people, and then they are gone. I try to stay in the moment, listen, and give unconditional support and kindness. But, I feel helpless in doing anything about what is going on around me. The other day, I saw a woman sitting outside the shelter in a wheelchair with what looked like a surgical boot lying next to her. Was she at the end of her life? Probably not. But, she had just had major foot surgery and was discharged to the shelter. She is one of the lucky ones, I guess, because she is not in a life-threatening situation like others are. My next research project is coming together. I need to understand this system. As the political season heats up and talk of cutting social welfare programs abounds, does anyone really know or fully understand what it is like to be sick and die in poverty? Why are there so many women here with hospital bands on their wrists? How can hospitals ethically discharge patients after surgery to a homeless shelter? Why don’t we have more facilities for palliative care for the poor? Can’t we as a society do better? Most people don’t think of homeless shelters when they think about social work services at the end of life. We think about hospitals and hospices, working with families and taking care of ourselves as we work through these difficult issues. Rarely is there talk about having to navigate the terrain

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of poverty, watching people struggle not only with illness but with a system that has literally turned its back on society’s most vulnerable members. It hurts to have this yoga program, to be an outsider with little power or influence. It hurts to see the impact that poverty has on obtaining decent medical care. And it really hurts to see people at the end of their lives in a homeless shelter. At first I was shocked, then saddened, and now my anger is rising. I will learn to navigate this system, hoping that someone will read my work or listen to my ideas, and that social work research can really lead to changes in practice. Sometimes social work practice insights occur in strange places and spaces. I learned today that the woman on dialysis was found dead yesterday in her apartment. She was able to get placed in a low-income senior building, so at least she didn’t die at the shelter. Still in her 50s, she did not have the support and assistance to do thrice weekly dialysis. Contributing cause of death: poverty. I once again return to my passion for research. What I can do is to ask questions and learn about this system to expose its weaknesses. Social work research has power. You have not heard the last from me, but it’s shelter yoga day and I must get going.

Contributing cause of death: poverty.

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