Clad in scrubs and white coats, every Saturday a group of undergrads and graduate students leave their college dorms and apartments to head east to the Elm City’s Fair Haven neighborhood. They are first-years in the medical school, nursing students, graduate students seeking public health degrees and undergraduate volunteers; some found their way here in the name of community service, others to gain the clinical expertise seldom found inside the classroom.
Whatever the motivation, this group of 200 volunteers is the driving force behind the HAVEN Free Clinic, Yale’s only completely student-run free health clinic located at 374 Grand Ave. Every Saturday from 8:30 a.m. to 2 p.m., this team of Yale students from disparate backgrounds provides free primary care to uninsured adult residents of neighboring Fair Haven.
Founded in 2005 by a group of Yale medical students, HAVEN has conducted over 6000 patient visits in eight years, offering a variety of services ranging from primary care, education initiatives and social service programs. In partnership with the Fair Haven Community Health Center and Yale University, HAVEN’s mission is to ensure primary medical care to an underserved population while adding a dimension to the medical education of volunteers.
“I applied to be a volunteer while in nursing school and then I became one of the directors,” said Mary Gallagher, one of the clinic’s three executive directors and a third year nursing student. “It’s nice to see people get the care they need and give back to the community that I feel like gives us so much.”
CONNECTING WITH PATIENTS
When Keny Rodriguez, a 26-year-old Spanish-speaking resident of Fair Haven, came into the clinic on a recent Saturday for her blood test results, HAVEN’s primary care protocol kicked into gear.
Patients arriving to the clinic are first seen by a medical team of one senior medical student, one junior student and one interpreter, if necessary. After settling on a course of action, medical teams return to the patient to schedule any necessary lab work, future appointments, referrals or consultations with social services.
In Rodriguez’s case, her two student physicians — both fluent in Spanish — were able to pick up right where they left off from Rodriguez’s previous few visits.
Xin He MED ’15, a fifth-year medical student in charge of Rodriguez’s medical team, emphasized the clinic’s concern for continuity in patient care. She said she makes an effort to schedule her patients’ return visits for Saturdays on which she will be volunteering so they are not tossed from physician to physician.
Patients requiring more complex medical care than what HAVEN can offer are referred to Yale-New Haven Hospital, one of the largest medical facilities in the United States located on York Street. In keeping with the clinic’s more personal way of handling patients, however, HAVEN volunteers accompany their patients on any referral appointments.
“One patient couldn’t find out where to go for her mammogram in Yale-New Haven Hospital,” said Rebecca Vitale MED ’15, a HAVEN Clinical Advisor and dual student in both the public health and medical schools. “She just didn’t know how to ask for help. For me, knowing when we send our patients off all over New Haven that they have someone who understands their cultural context and can translate their language is something I really value.”
APPLYING THEIR PASSION
Mary Bartlett, one of the HAVEN’s medical directors since 2005, remembers one couple from the clinic’s early days who needed services HAVEN could not provide. Upon being transferred, however, the couple had become so attached to student volunteers that returned to drop ice cream off for the volunteers’ regular meetings.
These connections between physicians and patients are not rare at HAVEN and ultimately reflect the reason so many volunteers — about 30 to 35 on any given Saturday — find themselves at 374 Grand Ave. For instance, one undergraduate volunteer, Yumiko Nakamura ’15, has seen the same patient three consecutive times and has established a relationship with her beyond basic medical history, adding that they keep each other informed on their respective lives.
Like Nakamura, ten other student volunteers interviewed appreciate their close contact with patients, thorough work-ups and emphasis on overall patient health. This experience, they said, reminds them why they got into medicine in the first place.
“This is a time when you can actually remember why you’re doing this,” Vitale said. “The first two years of medical school are all in the classroom. That wasn’t the reason I got into medicine. I like spending my time doing something I actually believe in.”
Undergraduate volunteers, which make up about 34 percent of all HAVEN volunteers, said they appreciate the access HAVEN gives them to a community they might not otherwise interact with. Much earlier in their medical education than professional school volunteers, undergrads mainly serve as interpreters or assume positions outside of the clinic.
Michael Marcel ’16, a sophomore interested in global health, practices his Spanish making referral phone calls for HAVEN patients. Marcel said HAVEN reminded him that concerns about global health do not only exist abroad but also affect underserved populations in the New Haven area too.
One aspect that differentiates HAVEN from other student-run clinics is the availability of services beyond primary medical visits. An entire department dedicated to education alone counsels patients on healthy diet and exercise programs, even offering free Zumba and weight-resistance classes.
SERVING UNDERSERVED COMMUNITIES
Located just a 10-minute drive east from Yale’s central campus, Fair Haven is a largely Hispanic and African-American neighborhood which has traditionally been plagued by crime, poverty and drug problems.
Before the opening of the HAVEN Free clinic, there was little to no access to primary care for residents unable to pay for insurance. Since the clinic’s opening, access to HAVEN’s free resources has saved the clinic’s patients an average of over $10,000 in medical debt, according to Bartlett. As patients often wound up in emergency rooms for basic primary care, the option of not only utilizing HAVEN, but also of being transferred to other medical facilities nearby for free if necessary, has a huge impact on the lives of uninsured patients, Bartlett said.
HAVEN is able to minimize patient costs to such a degree due to substantial funding from private donors and grants from the Gilead Foundation, a nonprofit established in 2005 which seeks to improve health care in underserved communities both nationally and internationally.
“Supporting student-run free health clinics is an important focus area for our foundation,” said Howard Jaffe, who serves as president of the Gilead Foundation. “The HAVEN free clinic was one of the first clinics we supported and has served as a model for our contributions to other student runs clinics.”
In addition, HAVEN’s partnership with Yale University and Yale-New Haven Hospital almost always means patients can be transferred to or seen at the hospital for free, so long as appointments are made through the clinic.
HAVEN’s mission to provide medical services to as many people as possible regardless of their ability to pay runs parallel to the Affordable Care Act, a federal statute signed into law in March 2010 aimed at lowering insurance rates and health care costs. However, changes in the health care industry due to the Affordable Care Act will not necessarily affect HAVEN’s operation directly: The majority of HAVEN patients are undocumented immigrants, most of the men and women HAVEN serves will be exempt from the individual mandate required by the bill, according to Parwiz Abrahimi, a HAVEN social services director. For those who are eligible to purchase state insurance exchanges, HAVEN will help them obtain proper insurance, Abrahimi said.
“If we can help HAVEN’s eligible patients obtain access to quality medical insurance and plug into another primary care clinic, then that is still fulfilling our mission’s central goals even if we are not the ones that will be seeing them,” Abrahimi said.