Complexities of Care: Breakout Princeton trip examines inequalities in cancer care

Tuesday, Nov 6, 2018
by Benjamin Gelman '22, Pace Center student correspondent

Karen Schmitt began her talk by discussing what became a foundational idea of my fall break: “Cancer care inequalities start way back in inequalities in health care.”

Ms. Schmitt is the director of the Manhattan Cancer Services Program at New York Presbyterian. Speaking to our group -- 12 Princeton University students on a Breakout Princeton trip in New York City -- she discussed how her organization aims to make cancer care as accessible and affordable as possible to those in the Manhattan area who are lower on the socioeconomic ladder. 

Breakout Princeton trips are part of the Pace Center for Civic Engagement and organized and executed by student leaders. Small groups of students, 10 in my case, are then accepted into the program free of charge and attend the trip over five days of fall or spring break. This fall, five Breakout Princeton trips examined everything from the return of wolves in the Rocky mountains to using performing arts to empower youth in Trenton, NJ. 

Senior Ruby Guo and junior Alice Vinogradsky led our trip on “Inequalities in Access: Cancer Screening, Prevention, and Treatment ” and put together a great experience that shed light on critical and alarming medical inequalities while also offering us some great opportunities to contribute to another community in meaningful ways. 

Breakout Princeton

“The Inequalities in Access: Cancer Screening, Prevention, and Treatment​” Breakout Princeton trip team meet with representatives at the Columbia University Irving Cancer Research Center.

Along the way, my fellow trip members and I were able to travel all over New York City, seeing plenty of sights with some new friends. When asked how she and Ruby came up with the topic, Alice explained: “We both knew that we had genuine interest in learning more about something that was so important not only in today’s social and political climate, but also in the process of molding the physicians, policy-makers, and healthcare field of tomorrow,” she said. “You take driven people who care about community, education, and service, and you give them the tools and support to build something from the ground up— things like our trip, like our peers’ trips, like Breakout Princeton happen.”  

Much of the trip was spent in discussions with community partners who are concerned with how patients are granted access to cancer care and what barriers there may be to them acquiring it. These can come in many forms, as we learned, such as social, emotional, cultural, economic, and environmental concerns that coalesce to create vastly different experiences for different patients. 

Milagros de Hoz, a representative of We Act, an environmental justice group based in northern Manhattan, explained to us how economic inequality can exacerbate exposure to carcinogens in people’s homes. She also elaborated on how the United States public education system can do a better job of educating students about environmental justice.

In addition to these factors, we also learned from Jacqueline Xouris, clinical director of the New York State Cancer Services Program of Queens, about cultural and language barriers to care. “Our first conversation with patients is always barrier assessment” she said, and these barriers can include not speaking English, which can make it more difficult to engage with the healthcare system, as well as having cultural or religious norms that may make patients hesitant to agree to screenings or treatment. 

Jacqueline and her team, with whom we had a full panel discussion, focus on “cultural competence” in order to engage with their local communities in ways that facilitate care while operating within patient’s abilities and comfort zones. They also offer free cancer care to those in financial need through New York’s emergency Medicaid program.

To complement these more policy and education based events, we also connected with multiple community partners for service activities. Highlights included painting pots and planting succulent plants with patients staying at the American Cancer Society Hope Lodge, which offers free lodging for those who travel to New York for care. We were also able to volunteer at God’s Love We Deliver, an organization that provides meals for the sick and hungry in the New York area, through both working in the kitchen and assisting in food delivery. 

Breakout Princeton

Working with God’s Love We Deliver trip participants prepared ingredients for cooking, packaged food, and delivered frozen meals to people’s doorsteps.

These were truly rewarding experiences that offered a more personal element to the themes of inequality and need in the New York area, which also allowed us to assist in more practical ways. One of our leaders Ruby explained our trip’s approach to service in terms of “vertical” vs. “horizontal”  service. While vertical service can be characterized as approaching a needy population from your position of privilege and with a certain sense of superiority, horizontal service is “recognizing that you’re on the same level as those you are serving and learning from them.”

As we studied and witnessed all of these diverse issues in person, we were also fortunate enough to have time to explore New York, visiting places like Times Square, Soho, and the World Trade Center. It was another amazing aspect of the trip to be able to learn about the city through the lens of cancer inequality while also gaining a sense of it as a whole.

Overall, this fall Breakout Princeton trip was a fascinating, troubling, and worthwhile dive into the complexities of medical and social stratifications in New York City and the American healthcare system in general. It offered a unique combination of education centered programs and firsthand volunteering that enabled everyone in my group to gain an understanding of how disparities in care occur and what can be done to remedy them. 

Fellow participant Sarah Lee, a first-year student, noted how the trip altered how she viewed a variety of issues. “I arrived with a preconceived notion of cancer, regarding genes as the only factor,” she said. “However, my narrow perspective was quickly expanded through meeting patients, cancer treatment directors, patient navigators, and realizing we as a society can always do more in breaking socioeconomic and racial barriers in any capacity we are able.”

Read more about all five Breakout Princeton fall trips on the Breakout Princeton Blog