Population Health Clerkship: Final Reflection

Sana Majid
28 October 2016


When I first read about Pernet, I expected a small organization that worked largely with mothers who were struggling with the many difficult parts of motherhood. I expected the clients would be largely impoverished and uneducated, and that many of them would not have the resources to care for a child. Though this is certainly one of the roles of Pernet, there are many more facets to the organization than I could have imagined. They work with currently and previously incarcerated clients, clients living in domestic violence shelters, and children of all ages.
One of the unique things about Pernet is that much of the work is done at the client’s convenience. Employees go to their patients. The office on any given day is largely empty, save for a few individuals with administrative duties. Everyone goes to see their clients in their own homes, so they can see how they are doing, and how their families are doing. This adds both an element of convenience and comfort to the interactions. I think this is particularly important in removing as much of the power dynamic as is possible. Many of these clients feel helpless and frustrated as a result of their circumstances, and removing the power dynamic can help them to see organizations like Pernet as more of a tool to help them achieve their goals.
Pernet works to approach every aspect of the family, which was certainly more than my original expectation. I was taken aback when I first learned of all the different projects they have going on at every day. They work with both mothers and fathers, to help them through their difficulties and connect them with various resources, and also with children, to help them reach their full potential. They work with everyone from new mothers to incarcerated fathers to children with intellectual deficits, and everything in between. 
On my first home visit, I was able to meet a woman who was a survivor of domestic abuse. The most notable thing about that visit was how Courtney, one of the Pernet employees, spoke to her very much like a friend—she wanted to be a resource and a friend, not a figure to be wary or suspicious of. Though the visit was largely business, Courtney checking in regarding this woman’s new job and transition to living alone, the women also shared book recommendations and chatted like old friends. This again showed a conscious effort to eliminate the power dynamic, and to establish Pernet as an assistive resource.
Others programs at Pernet focus solely on the children. These programs span across all age groups. For children under the age of three years old with developmental delays and disabilities, there are Early Intervention playgroups and therapies in place. The program at Pernet is one of only four that serve the Worcester Community, and they serve over one hundred fifty families.  For younger elementary school children from local schools, the daily homework hour provides children with a safe and productive environment to learn and focus on their schoolwork. There are also initiatives and youth groups focused on middle and high school students, to again ensure that students have a safe environment to keep them busy.
Other programs still at Pernet focus on fathers exclusively. One such program is the weekly Father’s Group. The fathers who attended this group all had varying degrees of involvement in their children’s lives, as well as various degrees of involvement with the mothers of their children. This space allowed them not only an outlet to speak about their own frustrations and feelings about struggling with parenthood, but also an opportunity to learn from each other and learn what it meant to be a good parent. The purpose of the group was twofold, as is the case for much of the work at Pernet. What was most striking, however, was the interactions between the facilitators of the group and the fathers. Because the facilitators shared personal stories, and details about their own difficulties with parenting and dealing with separation and divorce, the fathers felt more comfortable, as they were talking to peers.
Another Father’s Group is conducted at the Worcester County Jail and House of Corrections. This group is focused more exclusively on incarcerated fathers, and teaching them how to reestablish relationships with their children when they are released from the jail. I was struck by how engaged these men were, and how open they were to discussing their struggles. Many of them were more than willing to talk about their own shortcomings, something which I have found to be unusual when working with these populations. The Father’s Group at Pernet was even less self-aware than these incarcerated men. These reflections and this thoughtfulness will, hopefully enable them to repair the relationships with their children that may be damaged.
What I have found most striking about Pernet is the effort it makes to become a part of the community which it serves. When Will took us on a tour of the neighborhood, he showed us all the spots for potential growth and opportunity in the community, and he talked to us about his hopes and dreams for the neighborhood. When Emily walked by the park, she called out to the teenagers she knew to encourage them to come in to Youth Group that afternoon. When Sheilah took us to the Computer Lab, we learned about opportunities for adults to learn how to create resumes and apply for jobs, and use the Pernet staff and resources to make that happen. This is not a niche organization—they help families in every way they can think of. It is remarkable how much they are able to do, and I think that this approach to strengthening families by helping every facet of what makes a family successful is particularly effective. 
When you consider what causes this inequality, and where these disadvantages come from, the answer is almost always the same. The vast majority of parents and families in crisis have always been in crisis. Young mothers were born to young mothers, neglectful fathers were raised by neglectful fathers, abusive parents were children of abusive parents. Breaking this cycle, and providing a strong model of appropriate and nurturing familial behavior, is an essential part of the mission at Pernet. It is tragic, still, to see how difficult it is for people to escape the poverty, the abuse, and the neglect. I remember first thinking how obvious some aspects of parenting were, and how clearly inappropriate some words or actions may be in front of children, but those are not always obvious to everyone. Many individuals have never had good parenting modeled to them, so they don’t know how to create a stable and comfortable family environment. Cognizance of that fact alone is important, as providing families with the education that they never received will be crucial to their success. That being said, it is also important to recognize that education by modeling and constant reinforcement at a young age cannot be matched—the results will never be quite as perfect as one would hope. 
It is easy, when you consider that, to find the work to be futile. It is easy to forget about any small and incremental changes that have been made in an individual’s life, because there is still so much that could be changed for the better. Learning to take those small victories is something that I know that I struggle with, and what makes this work so hard. But that lesson to appreciate the small things is not unique to this sort of work—it is ubiquitous to any work, any endeavor. Big change very rarely happens. No matter how frustrating it becomes, I hope that every time I work with these communities, any time I am able to fully contribute my time and my energy, I remember that.
The most significant memories of my time at Pernet are the ones in which Pernet employees removed any barriers between themselves and their clients. After witnessing this time and time again, I can say with certainty that this is how they succeed. This is why they, and any other such organization, are able to see the results that they do. The elimination of the power dynamic helps to relax, comfort, and open up clients. As a physician, I imagine this will translate directly. By treating patients with respect and dignity, by approaching them as human beings who are going through difficult times and not another case with another problem, the health care that doctors provide can be much more complete. I hope that I will personally be able to remember that, particularly when I am frustrated and exasperated with my patients, because I know that is often when they will need that empathy the most.