Yale Daily News
As COVID-19 cases continue to rise in New Haven, the HAVEN Free Clinic has adapted to telehealth models and expanded its services to meet community needs.
The clinic provides primary care services to uninsured patients in greater New Haven. It also provides a variety of ancillary services pertaining to reproductive health, behavioral health, social services and more. The clinic is completely run by Yale students — with 35 serving on the Board of Directors and 300 volunteers from both the undergraduate and professional schools — and it serves about 500 patients annually. When the pandemic hit in March, the clinic’s student leadership board decided that it would be best to keep the clinic open in some capacity.
“We knew we couldn’t close,” said Gabriel Betancur MED ’23, one of the clinic’s executive directors. “That’s not an alternative for a free clinic that serves some of the most vulnerable populations in New Haven.”
According to Betancur, the clinic decided to switch to using telehealth services and has used Zoom as its primary platform. For the three to four months after March, the clinic was doing all of its services through telehealth models, and was not seeing patients in-person. Starting around July, they adapted to a hybrid model with both virtual and in-person visits.
Now, about 20 percent of the clinic’s visits are in-person, while the rest are over Zoom, Betancur explained. Patients with urgent needs are also able to come into the clinic for in-person appointments. He noted that the clinic’s original pre-pandemic hours were on Saturday mornings and it has moved back to this schedule.
The clinic’s direct medical service department usually sees about 10 patients for medical visits each week, and other ancillary departments such as the reproductive health department may also see patients, according to another Executive Director Rebeca Vergara Greeno MED ’22. She added that the maximum they are able to host in the building is four to five patients per hour. These restrictions are modeled off of what the clinics in the Yale New Haven Hospital and Yale Medicine have implemented.
Along with continuing its direct medical services, expanding the clinic’s social services has also been an important priority.
“The Social Services Department was an important department during the pandemic because the social needs that came up were exacerbated by the pandemic,” Claudia de Bruyn SPH ’21, another executive director of the clinic, said.
Many of the patients the clinic serves faced job losses or reduced hours during the pandemic, so the clinic aimed to acknowledge income as a barrier to healthcare, according to Greeno. She added that several patients are also undocumented, and were not able to recieve money from the federal relief program such as the stimulus checks.
By working with Semilla Collective, a local nonprofit that works with immigrant communities, and its mutual aid fund, the clinic was able to provide $100 in cash assistance to each of its patients, according to de Bruyn. Community partnerships with Unidad Latina en Acción, an organization defending the rights of immigrants and workers in New Haven, and 4-CT, a state direct assistance program, also helped in providing financial support.
De Bruyn also noted that as the clinic’s patients started getting backed up on rent and were threatened with evictions or mounting debt, the clinic also worked with JUNTA, a non-profit organization for Latinx communities in New Haven, to offer rental assistance.
The clinic’s pharmacy department also had to adjust its services as the need for medications rose, according to Abriana Tasillo MED ’23, one of the clinic’s pharmacy directors. The department sometimes dispenses medications that it receives as donations, but mostly works with its patients to help them find affordable medications at other pharmacies. However, due to the financial burden imposed on patients due to the pandemic, Betancur said that many have not been able to afford their medications.
“Once this all hit and patients lost jobs, many patients expressed the need that they weren’t able to pay even four dollars a month,” Betancur said. “I know oftentimes it may shock you but that is the reality of a lot of patient situations.”
The clinic was able to shift its budget to provide more funds for the pharmacy department to use in obtaining medications and delivering them to patients, according to Betancur. The clinic also used funds for getting medical equipment.
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De Bruyn said the clinic also expanded their services to delivery services, and volunteers helped deliver supplies such as blood pressure cups, glucometers and medications for patients at home.
De Bruyn said she has found both positives and negatives in using telehealth models. One advantage is a lowered barrier to receiving healthcare.
“If a patient just needs a refill, just to check in, something quick, they don’t need to come all the way to the clinic because that can also be a barrier to care,” de Bruyn said. “Even after the pandemic, we want to keep telehealth around as an option for patients.”
She stated that even after the pandemic is over, the clinic is considering keeping telehealth as an option for patients.
However, the biggest disadvantage has been the lack of face-to-face contact with patients, according to Tasillo. She also stated that because many of their patients do not have access to online resources, it is difficult to have telehealth appointments.
“A lot of our appointments are via phone rather than being through the video,” Tasillo said. “Which means you lose the face-to-face interaction and you also lose the visual cues that you can get over video. If you want to look at a rash or if you want to do a quick virtual assessment, you can’t do that over the phone.”
One recent concern for the clinic has been vaccine access for uninsured patients.
The clinic has been in contact with faculty at the School of Medicine and has been trying to advocate for access.
“Unfortunately, uninsured and particularly undocumented patients are lower on the list of priorities for any sort of state or national response,” Greeno said. “So you have to intentionally draw attention to these populations to make sure that their voices are heard. Otherwise, they will just completely get cut out.”
The clinic is located in the Yale Physicians Building on 800 Howard Avenue.
Sai Rayala | sai.rayala@yale.edu