P&S Students
Student Life and Times


Expanding the Conversation:
The Columbia Harlem Homeless Medical Partnership


By Matthew Harrison
In the basement of St. Mary’s Episcopal Church in Harlem, half a dozen P&S students are already hard at work, wiping off the round folding tables, arranging piles of medical supplies, and setting up folding screens against the rear wall, all to turn the large room into a functioning medical clinic. These students, and others who will trickle in from their classes and rotations before the clinic opens at 5:30, run the Columbia Harlem Homeless Medical Partnership, which provides free medical care for more than 180 patients in more than 250 visits.
   
Pictured in the Columbia Harlem Homeless Medical Partnership clinic are, from left, Jamie Houston'08; a patient; supervising physician James Spears; and Elizabeth Blair'10.
Pictured in the Columbia Harlem Homeless Medical Partnership clinic are, from left, Jamie Houston'08; a patient; supervising physician James Spears; and Elizabeth Blair'10.

Photograph by Rojelio Reyes Rodriguez

    On this night, two patients are already waiting by the time everything is ready. Two students, one pre-clinical and one clinical, sit down with each of them to take their histories. Later, they go behind the folding screens for a physical examination. Diagnoses prepared by the students are presented to the attending physician, James Spears, M.D., who questions the students on the case and works with them to prepare a course of further care.
    An assistant professor of clinical medicine at P&S, Dr. Spears has been treating homeless and uninsured patients in his practice since 1994. During the day, he serves as the medical director at the Al Hirschfeld Free Clinic, where he treats uninsured and underinsured individuals in the entertainment industry. At the homeless medical partnership, he supervises all treatments, writes prescriptions, and offers his advice. He’s quick, though, to deflect credit for the program’s smooth operation: “The students really run the clinic. They do the recruiting. They do the organizing. They do the fund-raising. [And] they provide the health care under my supervision.”
    The clinic has become a learning experience for its volunteers and its patients. Dr. Spears insists that students speak technically to him and then explain the terminology to the patient. Sarah Fulham’11, who joined the clinic during her first year at P&S, says, “You learn the scientific jargon at the same time you’re learning how to explain it conversationally.” Meanwhile, says Dr. Spears, “The patients love hearing themselves be part of the teaching process.”
    The conversations started through the work demystify medical treatment, promote student learning, and ultimately establish a vector for positive change in the community. Appropriately enough, the clinic itself began as a conversation, over a cup of coffee. In the fall of 2004, Judy Chertok’07 met with Dr. Spears to discuss the possibility of starting a student-run medical clinic for the homeless. The next year, Dr. Chertok recruited Marc Manseau’09 and they spent the next three years finding start-up funding, identifying a suitable location, and recruiting volunteers. The clinic officially opened and began seeing patients in May 2007.

Volunteers are expected to commit to showing up every week, so they feel a sense of ownership and involvement in patient care and so patients on follow-up visits will see someone they recognize.
   Each Saturday, a few of the volunteers take their enthusiasm into the community, distributing food to homeless individuals alongside other non-profit organizations and members of St. Mary’s Church. Ms. Fulham explains how the effort builds trust. “It’s really great to see people that you’ve already started a conversation with.” Rebecca Katzman’11 says that is the same reason volunteers are expected to commit to showing up every week, so they feel “a sense of ownership and involvement in patient care” and so patients on follow-up visits will see someone they recognize.
    Over the past year, the students involved with the program have built partnerships to expand the services offered. Payam Afzali, a fourth-year student at the Columbia College of Dental Medicine, observes that “most of the patients in the medical clinic need dental treatment as well.” Beginning in March 2008, he and other dental students have performed dental examinations. Much of their work has involved researching nearby dental clinics so they can refer patients to clinics with a pay-scale appropriate for them. “We have a very strong referral program,” he says. “Within a mile and a half we have 15 clinics.” Plans are under way to bring a mobile dental van to St. Mary’s twice a month. Dental students also make patients aware of the comprehensive dental benefits that Medicaid offers. This has contributed to the medical students’ growing efforts to enroll patients on Medicaid, which is an especially tedious and difficult process given the precarious situation of the homeless population.
    The clinic also has begun a partnership with St. Luke’s-Roosevelt Hospital that allows hospital residents to help patients access psychiatric and substance abuse treatment. In addition, Columbia’s Graduate School of Architecture, Planning, and Preservation received a grant to partner with the clinic to conceptualize how to improve the physical space of the clinic.
    In August, the clinic was the subject of an article in the Lancet. In addition to describing the work of Dr. Spears and the student volunteers, the article raised the larger question of the role of student-run free clinics considering the health care crisis in the United States. Now that’s a conversation worth having.

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