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Graciela Rayome, pictured here in Dovers Legislative Hall, was a research intern with the Delaware Healthcare Association.
Article by Diane Stopyra | Photos by Kathy F. Atkinson
On a recent afternoon, 21-year-old Graciela Rayome pulled on her best navy blue blazer and entered Dovers stately Legislative Hall. In a leather chair on the second floor, under the watchful eye of long-deceased governors and military heroes depicted on the walls, she sat surrounded by politicians and lobbyists 30 years her senior.
Im not intimidated because I know at least the pages are younger than me, she said, referencing the teenaged Senate helpers. Im just excited to see the political cogs turning in real time.
A senior public policy major at the University of Delaware, Rayome is also an Undergraduate Public Administration Fellow. Translation: Shes been accepted into a competitive program that, outside of regular coursework, requires building knowledge that will improve lives in Delaware and beyond. In Rayomes case, this means serving as a research intern for the Delaware Healthcare Association. According to its website, DHA is a statewide trade and membership services organization that exists to represent and serve hospitals, health systems, and related healthcare organizations in their role of providing a continuum of appropriate, cost-effective, quality care to the people of Delaware. In her role, Rayomes tasks include legislative tracking, hence her presence at the state house on this day. On the agenda? Monitoring Senate discussion about a bill meant to improve outcomes for mothers and newborn babies in Delaware.
Shes doing graduate-level work, said Christina Crooks Bryan, director of communications and policy at the DHA and a 2006 graduate of UDs political science program. At a time when there is so much change and innovation happening in healthcare, its been wonderful to have the perspective of an enthusiastic young person.
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Christina Crooks Bryan (right), director of communications and policy at the Delaware Healthcare Association, is a 2006 graduate of UDs political science program. Now, mentored Graciela Rayome (left), a senior studying public policy at UD.
Rayomes interest in the field can be traced to her childhood when, at age 9, she was diagnosed with Type 1 diabetes. This marked the beginning of a long, intimate relationship with the American healthcare system.
Ive been in and out of hospitals my whole life, so I know the strengths and weaknesses from a patient perspective, said Rayome, a member of the College Diabetes Network support group at UD. Ive seen devoted nurses and doctors taking so much time to interact with me and determine the care I need. Ive also had negative experiences, where Ive witnessed mismanagement of care and a lack of communication and coordination.
One such experience happened during Rayomes first year at UD. Having left her home state of Tennessee to attend the university, she was coping with a lot of change, and her diabetes management, she said, went off the rails. Proper management includes taking insulin to control blood sugar. (A typical bodys pancreas produces the right amount of insulin for whatever a person eats.) She entered a state of ketoacidosis, a condition in which the body breaks down fat too quickly producing a buildup of acids in the bloodstream called ketones. Untreated diabetic ketoacidosis can be fatal, according to the Mayo Clinic.
In the emergency department, I felt like another number, Rayome said. And I dont think they looked at my file too closely, because they took me off insulin. I ended up in the ICU, where I began hallucinating.
Fortunately, after three days and some course correction from the hospital, Rayome recovered enough to go home. But her medical woes were made all the more burdensome the following year when her father lost his job and, with it, the familys health insurance.
Id always had trouble finding places that would accept it, anyway, she said of the familys health insurance plan. And now Im in health-insurance limbo. Its such a hassle. But it made me realize: Something needs to change.
Enter Raymoes internship at the DHA, which she hopes will kickstart a lobbying career devoted to identifying and eliminating systemic problems within the healthcare industry. So far, in addition to her work monitoring the progress of healthcare legislation, shes completed several important projects. Among them is a policy brief something she learned to write during her Public Policy Analysis Class at UD on Delawares Certificate of Need program.
Theres been much chatter about the efficacy of this program, which requires hospitals to provide extensive regulatory documentation or paperwork overkill, depending on your point of view when applying for extra facilities or equipment. To get to the bottom of the debate, Rayome spent last summer comparing Delawares certificate-of-need guidelines with those in other states. Her final report helped a steering committee comprising policy managers from each hospital in Delaware come to their decision: The states program doesn't need to be abolished entirely, but it could use some modifications to cut down on red tape.
Having such influence as a college student just getting her professional footing is a little overwhelming, Rayome said. But the opportunity to have a real, tangible impact when doing research as an undergraduate is so rare, and I dont take that lightly. Im grateful.
She is also passionate when she goes on a tear about something healthcare related, her boyfriend sometimes has to stop her: Gracie, I have no idea what youre talking about. And the more time she spends getting acquainted with the field, the more this passion grows.
Like a lot of people, I worry a great deal about this whole healthcare situation, Rayome said. But and this may sound weird confronting the problems directly actually makes them less stressful. As a typical citizen, you dont necessarily know whats going on. But I get to see behind the curtain and know where things are in their development process. It lends a sense of control.
This is part of the reason that, with her current internship coming to a close, Rayome is looking ahead to her next opportunity: interning in Washington, D.C., for Sen. Bob Casey of Pennsylvania, who serves on two committees related to healthcare access.
Casey is especially focused on reversing the opioid crisis, a cause that is close to Rayomes heart. During a recent summer break, she worked in the psychiatric ward of a hospital in Tennessee, where she experienced first hand the realities of the epidemic. Then, in her role at the DHA, she was able to assist with planning for the Delaware Goes Purple project, an initiative of the Sussex County Healthcare Coalition meant to reduce stigma surrounding opioid addiction.
Its one of many recent projects, Rayome said, thats bolstered her sense of hope.
Theres a persistent healthcare narrative in this country that everything is getting worse and nothing is getting better, she said, moments before entering the Senate chambers. But Ive learned theres a lot of good people working behind the scenes slowly but tirelessly to make healthcare less exhausting and more accessible. Theyre making the world a better place. So, when youre feeling discouraged, remember them.
The Public Administration Fellow program is run by the Institute for Public Administration in the Biden School of Public Policy and Administration.