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On March 6, 2004, I and a group of my fellow medical, public health and social work students made a small dent in the problem of providing health care for the uninsured when we opened the CoSMO (Columbia Student Medical Outreach) Primary Care Practice in Washington Heights. This opening was the culmination of four years of dreams, dedication, and hard work by a group of committed CUMC students. On opening day we provided free medical care to four uninsured adults. Several of them had serious known and treatable diseases that they had allowed to go untreated because they could not afford to pay for necessary medical care, blood tests, or medications. Our being there meant they got those much-needed tests and medications.

My passion, for a long time, has been injustice in health care and ensuring health care access for all. More than 41 million people living in the United States do not have health insurance, and, as a result, do not have access to routine medical care. Delays in diagnosis, an inability to obtain needed prescription drugs and access preventative and primary care services lead to a mortality rate among the uninsured that is a shocking 25 percent higher than those with health insurance. Among Latinos the problem is greater than in most other U.S. populations, with a full 30 percent lacking health insurance. Many feel helpless in the face of a problem of this magnitude.

When I heard, during my first year at P&S, about student-organized free clinics at other medical schools, I knew we needed to bring a similar project here to Columbia. But it seemed too big an undertaking. It was during a cab ride back from a conference at the New York Academy of Medicine, after listening to a presentation about Albert Einstein's student-organized ECHO free clinic, that I took a deep breath and proposed to a group of fellow first-year medical students that we consider doing something similar at Columbia. A few days later a group of five or six of us met on the steps outside of Hammer and CoSMO was under way. We had no idea where to begin. We talked to other student-organized clinics, we talked to faculty, we talked to preceptors. At first we heard an awful lot of comments like "Impossible," "Just go volunteer somewhere," "It's been tried and failed," "Don't waste your time." We were not giving up that easily, though.

Soon enough we found a few encouraging voices. I mentioned our idea to Ivy Fairchild in the Office of External Relations, with whom I was then working on a project to enroll children in Child Health Plus. She enthusiastically told us that it was totally doable and even helped bring in Dr. Walid Michelen, [assistant clinical professor of medicine], who also encouraged us and agreed to be our medical director. Dr. Mary McCord [associate clinical professor of pediatrics] soon became our faculty adviser and our constant source of guidance. Senior Associate Dean Linda Lewis was immediately supportive but told us this type of project had been attempted unsuccessfully in the past. Still, she was glad to see we were trying again and offered to help in any way she could. Now we were on our way. Our new allies helped us tremendously as we learned to navigate the complexities of the hospital and university and to figure out the details of how to start a health center.

It would take another three full years to unravel the details of health care practice administration, obtain administrative approval from the hospital, write grants, and secure needed services and space through donations. Dr. Karen Kerner, [assistant clinical professor of medicine and medical director of Urgicare] and the Urgicare Center at 21 Audubon generously agreed to let us use some of their space on Saturday mornings. Dr. Daniel Hyman [assistant clinical professor of pediatrics and chief medical officer, Ambulatory Care Network of NYPH] helped us tremendously by giving us crucial NewYork-Presbyterian Hospital approval and support. The hospital generously agreed to donate lab services so our patients could get free lab tests. The Department of Radiology agreed to read X-rays and the Department of Pathology signed on to read Pap tests. The New York-Presbyterian Pharmassist program agreed to work with us to provide medications to patients through pharmaceutical assistance programs; we also received generous private donations that ensure we can provide free medications to all our patients. The Urgicare center donated phone and call services that allow our patients access to one of our volunteer attending physicians 24 hours a day, 7 days a week – in this way we offer truly comprehensive primary care and keep patients from having to go to the ER for basic primary care issues or questions.

CoSMO Primary Care Practice now operates every Saturday from 9 a.m. to 1 p.m. at the Urgicare Center. It is staffed by a volunteer attending physician and medical, public health, and social work students. The volunteer attending oversees third- and fourth-year medical students who see patients in a model identical to that used in clinical rotations. First- and second-year medical students work at the front desk assisting with patient flow and administrative duties, perform intake interviews and take vital signs. Medical and public health students work together on community outreach, health education in the waiting room, and evaluation and needs assessment for our project. A social work student, with a supervising social worker, is on site to talk with patients about issues such as domestic violence, housing, employment, and to provide referrals to appropriate community social services. In addition, an on-site enroller from Alianza Dominicana will screen all patients for eligibility for Medicaid or Child or Family Health Plus. Eligible patients will be enrolled and referred to a regular local health care center for their care.

CoSMO has now become a broad-based student organization. We have a governing council chaired by me and my co-founder, Nelson Jaeggli'04. Our chair-elect is Andie Sesko'05 who will be taking over when Nelson and I graduate in May. The governing council consists of the chairs of each of our committees. We have hundreds of medical and public health students excited about volunteering their time at CoSMO. We will hold a training session for all interested volunteers in mid-April [Contact Adam Haugo at Adam.J.Haugo.99@Alum.Dartmouth.org for more information].

The CoSMO Primary Care Practice will not only fill a gap in health care, it will also provide an invaluable service-learning opportunity for the future health professionals here at Columbia. The ethics of service and community participation are vital concepts for the development of health professionals-in-training. This project will offer students a chance to learn about primary care medicine and the medically underserved, while instilling a lifelong commitment to service, providing early leadership opportunities, and increasing appreciation of a multidisciplinary team approach to health care.

Seeing CoSMO open its doors on March 6 was by far one of the most exciting days of my life. It is still difficult to comprehend how a dream that we started working on four years ago has now been translated into a small victory in the war against injustice in health care in this country. For now, we are up to eight patients; soon we hope there will be more than 100 patients who have a regular source of primary care because of our efforts.

Ms. Cramoy is headed to Boston in June for a residency in pediatrics at Boston Children's Hospital.


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