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Graciela Rayome, pictured here in Legislative Hall in Dover, was a research intern with the Delaware Healthcare Association.
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.
Move this whole section up, swapping places with the section above it.
Christina Crooks Bryan (right), director of communications and
policy at the Delaware Healthcare Association, is a 2006 UD political science graduate. She has mentored intern 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
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
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
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
The Public Administration Fellow program is run by the Institute for Public Administration in the Biden School of Public Policy and Administration.
Article by Diane Stopyra; photos by Kathy F. Atkinson
Published Feb. 20, 2020