December 10, 2007

A student-run clinic faces
some grown-up challenges

In two years, HAVEN Free Clinic, a treatment center run by students in Yale's health schools, has become an important community resource, but with success comes a new set of hurdles.

Left to right, Ryan Schwarz '10, Sara Whetstone '09, and Emma Barber, '10, the HAVEN Free Clinic's student leaders, discussed the history and future of the clinic during a recent Medical Student Council's Perspectives on Medicine program in SHM's Beamont Room.

What began a few years ago as little more than wishful thinking on the part of a handful of medical students has grown into “a real success story for the medical school,” according to Associate Dean of Student Affairs Nancy Angoff.

That success story is the HAVEN Free Clinic, which, in just two years, has grown from serving about six patients a week to becoming an important community resource that treats about 550 patients a year. Now that clinic organizers have successfully completed phase one - introducing a much-needed service - the time has come, they say, to start focusing on phase two - managing the clinic’s growth and ensuring that it become a sustainable community resource.

HAVEN’s history and future was the subject of the most recent Perspectives on Medicine program offered by the Medical Student Council. The three students who serve as the clinic’s leadership this year -Sara Whetstone ’09, Emma Barber ’10 and Ryan Schwarz ’10 - described how, with limited time and resources, students are working to serve patients. They also outlined the challenges future clinic leaders will face.

The idea of creating a free clinic for low-income community residents was hatched about four years ago. Angoff recalls that a group of students approached her and said, “We want to start a free clinic. Other medical schools do it.” So Angoff told them they’d need to research how these other schools run their clinics and develop a business plan. Instead of being derailed by this task, the students rose to the challenge and came back with an “amazing” plan, Angoff says. “It was thoughtful, detailed and professional.”

Not long afterward, on November 19, 2005, the HAVEN Free Clinic was launched. Run in partnership with the Fair Haven Community Health Center and housed in their building, at 374 Grand Ave., the clinic is open Saturday mornings from 9 a.m. to noon. It provides free primary care, including prescriptions, referrals and counseling, to uninsured patients from the community. Students from the medical, public health and nursing schools and the Physician Associate Program run the program under the supervision of physicians from Yale and the community.

Whetstone, who is HAVEN’s director, says the clinic’s guiding principle is that health care is a right, not a privilege. She described a typical patient encounter: A 42-year-old woman from Ecuador came to the clinic complaining of headaches so intense they interfered with her ability to work and care for her family. Her caregivers learned that she hadn’t been to a doctor in years, often went hungry when her paycheck ran out, and that her undocumented status kept her from seeking help for fear of deportation. 

“Understanding health means understanding the patient,” Whetstone said, which, given the demographics of Fair Haven, means having an interpreter on site. “We make sure every patient can be understood,” Whetstone said. “This is an environment that lends itself to listening.”

But as successful as HAVEN has been, the experiences of the past two years also have illuminated the challenges the clinic’s leadership will face down the road. Schwarz spelled them out:

• Continuity of care: Patients rarely see the same health care provider more than a couple of times. In addition, there is turnover among the students who staff the clinic because they graduate and leave town. 
• Capacity: Patients need appointments, although walk-ins are seen if it’s an emergency. Currently, the waiting time is about a month, and with the number of patients growing weekly, that is only going to grow longer. Clinic organizers don’t want to stop accepting new patients, but they also don’t want patients to go untreated for long stretches of time.
• Cultural barriers: In order to bridge the gap between students and patients, clinic organizers want to establish stronger alliances with community-based organizations. “They know our patients better than we do,” Schwarz says. “We need to make sure we’re on top of what our patients’ concerns are. It’s one thing for us to surmise what they are; it’s another thing for them to tell us.”
• Expansion of provider network: The clinic has enough student volunteers, Schwarz says, but getting physicians to give up their Saturday mornings isn’t an easy sell. 
• Standardize and simplify patient records: There hasn’t been much consistency so far, Schwarz said, but that will soon change. The clinic has acquired new software that will be customized to handle the program’s record-keeping needs.

For more information on HAVEN and how you can get involved, log onto http://freeclinic.med.edu/.

—Jennifer Kaylin

Photo by John Curtis

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