Health students establish free community clinic

While some Yale students were savoring their last few days of Thanksgiving break at home, others spent this past Saturday hard at work in the New Haven community.

Students from the schools of Nursing and Medicine, including the Department of Epidemiology and Public Health and the Physician Associate Program, are collaborating to open Yale’s first student-run free clinic at Fair Haven Community Health Center. The clinic, which became fully operational Saturday, is available for uninsured patients who either reside in Fair Haven or are homeless.

Mallika Mendu MED ’08, co-director of the clinic, said the idea came after medical students decided that there was not enough assistance for people in the community in need of medical care and that Yale was one of few prestigious institutions that did not run a free clinic.

“We’re at Yale, but we’re surrounded by New Haven,” she said. “There was really more we could do.”

The original vision for the clinic came last year from Karen Archabald MED ’07 and Ryan Hebert MED ’08, who, along with a group of several other students, assessed New Haven’s need for a free clinic. After looking into various locations, the students decided on Fair Haven when the community agreed to host the new program. The Fair Haven Community Health Center will continue to treat patients when Yale’s free clinic is not in session.

The clinic’s founders then enlisted the approval of Robert Alpern, dean of the School of Medicine. Mendu said Alpern’s support for the program from the beginning has helped them to keep moving forward even when options looked slim.

“I think it’s terrific,” Alpern said. “It tells how committed our students are to serving the community and underprivileged.”

The clinic’s founders handed its operations over to Mendu and Maggie Samuels-Kalow MED ’08 in June, after having researched model clinics at schools including Mt. Sinai, Stanford and New York University. But the model that ultimately inspired the Yale students was Einstein Community Health Outreach, a program run by the Albert Einstein College of Medicine that has been successfully active for eight years. After Mendu and Samuels-Kalow were selected as directors of the clinic, they began working to put the vision into practice, starting with three basic needs: personnel, supplies and labs.

Yale’s new program will cater to a largely Hispanic, completely uninsured group of people, many of whom will be undocumented immigrants, Mendu said. Patients will be screened to evaluate whether they are eligible for insurance. If they are, they will be placed into the regular Fair Haven pool to make room for the patients who need urgent care.

Michael Montano ’03, a former Fair Haven resident and coordinator of a local community-action organization, said any initiative like the free clinic is a welcome addition to the area.

“I think national studies have shown that Hispanics have lower access to health care, and that’s particularly true to Fair Haven,” Montano said. “And any effort to change that is good for the community.”

Patients will also be referred to non-medical community services, such as soup kitchens, to help them deal with their non-health-related issues. The social services team responsible for these tasks will be made up of a variety of first- and second-year health-care students.

“Our goal is to provide comprehensive primary care as well as health education to give individuals the tools and information to improve their health and the health of their families,” Samuels-Kalow said in an e-mail.

Mendu and Samuels-Kalow’s first step was to assemble a board with members in charge of coordinating pharmacy, referrals, recruitment, education, budget, community outreach, social services and research. All of the positions are on a volunteer basis and were filled by first- and second-year students from the health professional schools.

“Ours will be the only clinic that we know of that has not only medical students but PAs, nursing students and public-health students,” Mendu said.

Their next task was to convince Fair Haven that running a clinic from their facilities on Saturdays from 9 a.m. to 1 p.m. was a good idea. Katrina Clark, executive director of the Fair Haven clinic, pledged her support to Yale’s clinic by mid-July.

As with many nonprofit organizations, the issue of funding posed a considerable challenge. The clinic model only called for one paid position, a medical director, for which Alpern and the School of Medicine agreed to pay the cost. The position is filled by Dr. Laurie Bridger, who will be assisted by Mary Bartlett, a nurse practitioner, and Dr. Mario Perez.

In addition, the Office of Education agreed to supply any other personnel costs for the first year, and the PA department will pay for supplies for the first year. Dr. Richard Donabedian at the Yale-New Haven Hospital donated lab services, and his lab will analyze blood that is drawn from the clinic’s patients.

The students raised funds for the generic, low-cost pharmaceuticals that will be on site through various avenues including the medical school’s Diwali show, which raised $3,000, and grant money from the Hunger and Homelessness Auction that took place before Thanksgiving.

Mendu also said it was crucial to enlist the services of School of Medicine faculty members. Her goal was to get two faculty to precept the clinic sessions every Saturday, along with faculty to agree to see referrals from the clinic who need more specialized care or a consultation. As of now, they have secured agreements from faculty members in Orthopedics, Renal, Cardiology and Electrophysiology, Urology, Neurology and Cancer Genetic Counseling Services.

In addition, the Department of Radiology has agreed to read X-ray films, although the taking of X-rays is still being negotiated. The Winchester Chest Clinic will see all of the clinic’s tuberculosis patients. The clinic will also enlist the aid of Connecticut Mental Health Services, which runs a Spanish-speaking clinic as well, Mendu said. The clinic will send patients with domestic-abuse, mental-health and substance-abuse problems there.

A crucial component of the clinic will be its education factor. The clinic will offer four 20-minute classes in Spanish and English, which will take place during the clinic’s hours of operation. Topics of instruction include general health, nutrition, family planning, sexual health and men’s health. Mendu said educating their clientele is important in order to make a lasting contribution to the community.

“In a way, that might be the best thing that we do,” she said.

Initially, the clinic will see patients drawn from Fair Haven’s waiting list, then walk-ins, and after about a month, the clinic will begin more publicity to make people aware of its services, Mendu said. It will also be an exclusively adult clinic, not only because pediatrics would require an entirely different staff, but also because most children are eligible for some form of insurance. But if a lot of children do come to the clinic, they will re-evaluate their plans, Mendu said. The students will also run a women’s clinic once a month.

When a patient enters the clinic, he or she goes to triage, which will be supervised by first-year PA students, then to social services and then either to the waiting room or to an education session prior to being seen by a clinical team.

The clinical teams are made up of fourth- and fifth-year medical students, second-year PA students and second-year specialty nursing students. They are responsible for getting the patient’s history, diagnosing the patient and then presenting their findings to the attending physician, who then figures out the best course of action. At this point, the patient is referred to a member of the medical school faculty if further consultation is required.

Initially, the staff will simply write prescriptions, but after some time, the clinic plans to institute a program to help patients pay for their drugs on a sliding scale based on their income, Mendu said. The clinic stocks a number of over-the-counter medications as well as antibiotics and Plan B, an emergency contraceptive.

While the clinic’s costs are covered for this year, funding for next year’s clinic is still a pressing issue. Mendu and Samuels-Kalow are in the process of applying for a number of grants, including ones from pharmacies such as Rite-Aid, Walgreens and CVS that will go toward pharmaceutical supplies. They will continue to receive money from Alpern and the School of Medicine every year.

As of now, the clinic will be run each week by over 290 volunteers who have agreed to donate their time and energy to the cause, Mendu said. She also said the clinic is still seeking Spanish-language translators, perhaps from the Yale undergraduate student body.

Samuels-Kalow said she hopes the clinic will allow residents of the Elm City to take advantage of an opportunity they otherwise could not have because of language and financial barriers.

“I am also excited about encouraging students who are interested in care for underserved populations and providing them with an opportunity to interact with a community they might not otherwise get to see,” she said.

Alpern was optimistic about the impact that Yale students would be able to make on the New Haven community.

“[The students] took the lead on everything,” he said. “They had to find a location, doctors, a source of money to pay for drugs, a radiologist to interpret X-rays. It’s a whole group of people all showing the best side of Yale.”

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