Hirsh Sandesara - SOL intern

The Big Picture

Hirsh Sandesara’s initial expectations about working with the Albuquerque Healthcare for the Homeless (AHCH) clinic, and the population it serves, changed before he even entered the building. As he walked to the clinic on his first day, two clean-cut women wearing sweatshirts and jeans mistook Sandesara for a patient going to the clinic.

Sandesara was there to work as a medical assistant as part of his summer internship for Service Opportunities in Leadership (SOL), a yearlong leadership development program that is part of Duke’s Hart Leadership Program. The two women were there as clients.

It was Sandesara’s first introduction to how deceptive appearances can be. Sandesara admits that his primary impression of the homeless came from media images: “dirty unbuttoned shirt, sackcloth pants, barefoot, clutching a bottle in a brown paper bag,” he says. “But the first person in line that day looked like she was pulled from a department store catalog in her peasant blouse and well-cut khakis. Throughout the week, I saw people in the clinic lobby who ranged from the media stereotype to a businessman on casual Friday.”

Several weeks later, Sandesara, a sophomore double majoring in chemistry and public policy, found himself discussing protein synthesis with a homeless man and former Oklahoma State chemist whose expertise had been protein synthesis.

“He seemed perfectly normal,” Sandesara recalled. “And he was. Throughout my internship it was brought home to me how perfectly average, how Everyman our clients were. And by extension, how any normal, regular Joe could become homeless in days.”

While there is a segment of the homeless population that suffers from mental illness and/or drug and alcohol addictions, Sandesara saw first-hand how precariously millions of Americans live, particularly those with few or no health care benefits. “People who don’t have health insurance can be one debilitating illness away from being homeless,” he says. Unable to work or make mortgage or rent payments, these men and women – and, increasingly, their children – are forced to rely on the network of agencies and programs that provide basic services.

Immersing students in real-life situations is one of the hallmarks of the Hart Leadership Program (HLP). During the SOL experience, students like Sandesara receive support from HLP faculty and staff, including feedback on their weekly “letters home,” which combine narrative reporting with critical reflection. (Select letters home are posted on the SOL portion of the HLP website.) SOL not only exposes students to the impact of public policy on real people, it also helps them recognize the systemic and entrenched nature of social problems. Students must then strategize about what needs to change, and conceive the leadership needed to create those changes within complex systems.

As part of the Terry Sanford Institute of Public Policy, the Hart Leadership Program is firmly grounded in the inherently interdisciplinary field of public policy. Rather than relying solely on data to arrive at policy conclusions or recommendations, HLP director Alma Blount says that community-based research prompts students to see the multifaceted nature of such problems as homelessness, HIV/AIDS, and youth violence.

For Sandesara, personal interactions with the single parents and laid-off workers who streamed through AHCH made him realize the constant burden that homeless people are under just to fulfill their basic needs.

“This sounds strange, but the homeless never have a day off,” he says. Shelters require people to leave very early in the morning, the lunch meal site is usually in a different place than the dinner meal site, and agencies that help with Medicare/Medicaid or food stamps are somewhere else entirely. Because AHCH is the only organization in New Mexico that provides health services exclusively to homeless people, the wait to see a physician or social worker can routinely be two to three hours. Given this reality, Sandesara quickly understood why he and his colleagues often saw medical conditions that had been postponed until they were critical.

When he returned to campus in the fall, Sandesara and the other SOL students were enrolled in “Integrating Community and Classroom,” the SOL capstone course taught by HLP and SOL director Alma Blount. The seminar offers students an opportunity to reflect on their summer work in community-based organizations, both to make sense of their experiences and to integrate what they have learned with concepts about service, citizenship, and leadership.

The curriculum includes such themes as linking civic engagement to policy change in communities; helping groups face difficult problems within complex systems; taking the risk to challenge others despite controversy and criticism; and the inner work of leadership, including finding one’s own moral compass and set of values. The heart of the course is an investigation of a social issue encountered by each student during the community internship experience.

For his social issue portfolio, Sandesara decided to explore whether the challenges facing the homeless in Albuquerque could be ameliorated. His research paper, “Integrated Clinics as a Solution for Competing Priorities to Urban Homeless Healthcare,” recommended consolidating the various departments and services that provide shelter, food, disability and other benefits, and health care in one or two central locations.

“It’s expensive to do this,” says Sandesara, “but when people choose to ignore their health because they have competing priorities, they wait until they have a major health crisis and end up in the ER without health insurance. Taxpayers pay for that. So it actually costs a lot less in the long run to provide accessible primary care. And getting people to look at the long run is very difficult. That’s an adaptive challenge -- persuading people to focus on long term rather than immediate solutions.”

Outside of SOL, Sandesara has found that his leadership development training comes into play in a variety of ways. An A.B. Duke Scholar, he is an active member of such organizations as Diya, Duke’s South Asian-American student association. “SOL taught me to conduct leadership in a much more effective way,” he says. “During meetings I’ll find myself using tools that I learned in Alma’s class, such as holding people to the subject at hand, using different leverage points, focusing on the bigger question or purpose, and giving the work back to the people. These tools really help to get focused on an issue, and it makes meetings much more efficient and productive.”

This summer, Sandesara will be a SOL Tier II student, an option for returning SOL participants who want to conduct a second summer of research. (Tier II students are exempt from the spring house course and fall capstone course.) Sandesara will travel to India’s Gujarat state, his family’s place of origin, and work in the Muni Seva Ashram, a charity hospital complex, which offers a range of medical, educational, vocational and social services for the rural poor. While the environment will be different from Albuquerque in a number of ways, Sandesara is looking forward to comparing how the two agencies handle case management and outreach efforts.

Sandesara credits the SOL program with changing his views about approaching problems and challenges. “I have learned to emphasize the importance of long-term planning to a society that has an astoundingly short attention span,” he says. “We can only address fiscal and social dilemmas if we recommit ourselves to the long-term. I want to force people to think about problems, to confront them with the weakness of certain segments of our society, but also show them the possibility of change. True leadership only occurs when it’s no longer the choir to whom you’re preaching, but the people outside the chapel. Then you don’t have to do all the preaching; you can and must let other people spread the gospel.”