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New Administrative Leader Takes Reins at CUMC
In the Community
| P&S Students Launch Project to Provide Health Care for Homeless |
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The clinic is the brainchild of Marc Manseau, P&S’09, a first-year P&S student in 2004, and Judy Chertok, P&S’07, then a second-year P&S student and now a resident in family medicine, who were looking for an intensive community service opportunity. A year earlier, Dr. Chertok had explored the idea of setting up a student-run homeless clinic with James Spears, MD, assistant clinical professor of medicine at P&S, but she couldn’t find enough like-minded students to join her. “Judy and I talked and agreed to try to make this project happen,” says Mr. Manseau, now on a research year. “We spoke with Dr. Spears, recruited several more students and it took off.” “Taking off,” is actually an understatement for the three years of hard work required to hammer out the details and find clinic space where homeless patients would feel comfortable. St. Mary’s, an Episcopal church on West 126th Street with a history of activism in West Harlem, offered its basement one night a week. The Center for Urban Community Services (CUCS) already ran a drop-in center and housing program there. Now all that was lacking were patients. The students posted flyers about their Tuesday evening clinic, made announcements at the church’s food pantry and a nearby soup kitchen, and on Saturday afternoons walked the neighborhood with a CUCS worker and church members to distribute sandwiches and circulate information about the clinic. Other referrals came from the African Services Committee, created to help immigrants from Africa, and the NYC Department of Health and Mental Hygiene. Outreach efforts follow a similar pattern today. Soon patients began to trickle into the clinic, 79 of them during the pilot period, with some returning again and again. While half were uninsured, only about 25 percent actually lived on the streets; about 50 percent had their own apartments. The rest were precariously housed, doubling up or living in transitional housing. But no explanation about living arrangements is required for anyone to receive care. “We will see anybody who walks in the door,” says Elizabeth Blair, P&S’10, who coordinates clinic affairs. The patients arrive with a range of health problems – from colds to more serious illnesses. “Some people come in with five or six major medical problems that can be long and complicated to work out,” says Carl Erik Fisher, P&S’09, one of CHHMP’s founders, who says the most common illnesses seen during the pilot period were hypertension and history of stroke, and skin, genitourinary, gynecological, neurological, and musculoskeletal problems. Everyone Benefits Taking histories and performing physical exams is a team effort. “The model is that a preclinical student, who is someone in the first two years of medical school, and a clinical student, who is in the last two years and beyond, pair up and jointly interview the patient,” says Dr. Spears, who has worked with the homeless since 1991 and volunteers as the clinic’s attending physician, along with Susan Bowers-Johnson, MD, assistant clinical professor of medicine. “The preclinical student learns how to take a history, how to be comfortable speaking with the patient. When they go behind the partitions to give the examination, then it’s the clinical student who takes the lead.” The students are equipped to do some basic lab tests, such as urine dipstick analyses and finger stick blood glucose tests. Equipment that will permit more elaborate tests on site – especially for the uninsured, for whom many tests are out of reach – is on the students’ wish list. After presenting each patient’s case to Dr. Spears, the students plan additional interventions with his guidance. Patients who need further care are often referred to the Center for Family and Community Medicine clinic at the Herman “Denny” Farrrell Jr. Community Health Center on 158th Street. Other patients who need follow-up are sent to their primary care doctors, if they have them, or asked to return to the clinic. Some patients are given over-the-counter medication on site; others leave with prescriptions signed by Dr. Spears. Students, who cannot sign prescriptions, learn how to write them from Dr. Spears. The word “organic” pops up frequently in conversations with the students, who want the clinic to evolve in response to community needs. After noting that many of their patients lacked dental care, for example, they formed a partnership with students at the College of Dental Medicine to come to the clinic to provide basic advice on dental hygiene. The school’s two-chair dental van may also start coming to St. Mary’s once a month. The students also are working on bringing a volunteer social worker or psychiatrist to the clinic and obtaining free prescription drugs to dispense to patients. Upgrading services costs money, though, and the students have written grant proposals in search of funds. So far, they have received a substantial financial commitment from Mel Kramer, PhD, a Baltimore-based epidemiologist who is a supporter of Columbia’s Center for Family and Community Medicine. CHHMP has also received a $2,000 grant from Alpha Omega Alpha, the medical honor society. Without exception, the students, all of whom commit to four years with the project, call it an extremely fulfilling experience, both educationally and emotionally. “There are few things I’d rather be doing than working with my wonderful colleagues at P&S and the terrific community partners on this project,” Mr. Manseau says. “To help fellow human beings who don’t happen to be as fortunate as I am is extremely rewarding.” Says Dr. Spears: “Clearly, the Columbia-Harlem Homeless Medical Partnership is a win-win situation for both students and patients. Patients receive compassionate primary care at no cost while students benefit in numerous ways. These are fabulous students who really want to make a difference in the world. It is gratifying to work with them.” —Eric Oatman |
