A clinic that teaches caring

By Elizabeth Simpson |

The Virginian-Pilot

For Cara Wright, taking someone's blood pressure at a free clinic on Southampton Avenue in Norfolk is pretty straightforward.

Not so the other tasks the third-year medical student has taken on this year:

Finding money for medical supplies. Persuading fellow Eastern Virginia Medical School students and community doctors to help treat the uninsured. Figuring out what to do when patients don't show up for appointments.

That has given the 30-year-old Northern Virginian student new insight into the needs of the uninsured in the community where she's spent the past three years.

Wright and a crew of classmates run the Health Outreach Partnership of EVMS Students - or HOPES - clinic.

The evening clinic, set up in a suite in Norfolk's public health building, is the only -student-run free clinic in the state. Four medical students started it in January 2011, and hundreds of others in the school's medical, physician assistant and public health programs have helped treat some 600 uninsured patients.

Dr. Teresa Babineau, an EVMS graduate and director of community outreach there, oversees the clinic, and doctors from EVMS and throughout the community volunteer their time as attending physicians.

While students have always been involved in the Hampton Roads community - shadowing doctors in hospitals and medical clinics - the school is trying to deepen its outreach.

Dr. Karen Remley was brought on to be founding director of the school's M. Foscue Brock Institute for Community and Global Health earlier this year. Remley, who used to be the Virginia health commissioner, is pulling together all the community service efforts students are involved in, developing more initiatives and weaving them into the core of the school's curriculum.

Two elements are critical to her task: Making sure the students work as partners within the community to improve health and creating ways to measure their efforts.

"There's a big difference between saying 'I want to serve,' " she said, "and going to leaders in a community and saying 'Let's work as partners. What do you need?' "

Other projects include:

* "United for Children," in which medical students work with pupils from P.B. Young, Sr.Elementary School, along with the United Way of South Hampton Roads and other partners, to improve the health, education and financial stability of the neighborhood.

* Identifying areas in the community where CPR training is needed, providing the training and measuring whether it has an impact on heart attack survival.

* Tracking demographics and circumstances of older diabetics in the community who suffer falls; the goal is to find ways to prevent falling, which is the leading cause of injury among those over 65.

Community service is nothing new for medical schools, but EVMS is also trying to find ways to incorporate those principles into its curriculum and create models that other schools could use. For instance, the school makes working in the women's free clinic a requirement for students in their third-year obstetrical clerkship.

Launching the free clinic was a project that students came up with on their own.

The students worked with Norfolk city officials to secure room at the Public Health Department on Thursday nights. They first saw patients with general health problems. Other specialties, such as mental health, orthopedics and dermatology, were gradually added.

Ryan Tomberg, 27, is a third-year med student who helps run the general clinic.

"You get involved with every aspect," the Boston native said. "There's a lot of work that goes on outside the clinic."

He has tracked down specialists to treat patients who needed more care than the clinic could provide: "You're working with patients on a very personal level. Basically, you're being their advocate."

This work on the ground level also showed him the need in the community, a front-row seat on the drama unfolding nationally regarding the uninsured and the Affordable Care Act: The general clinic, for instance, reached capacity in April and can accept no more new patients right now.

Some of the clinic's patients would qualify for Medicaid if Virginia expanded under the Affordable Care Act - a move that would insure some 400,000 residents. However, the state has not committed to that, and a legislative panel is exploring the feasibility of expansion.

So the students coordinate schedules, man phones, take medical histories and confer with attending physicians to help fill the gap.

Wright, the EVMS student, was moved to start a women's health clinic in March 2012 after sitting in on an infant mortality review board that highlighted what contributed to specific babies' deaths in the community.

Pregnant women qualify for Medicaid, the state-federal insurance for the poor and some disabled, but it can take time to complete the paperwork, so Wright believed that a women's health clinic could help tide them over. Uninsured women in need of cervical cancer screening and treatment for sexually transmitted diseases also could benefit.

Wright and another med student pitched the idea and met with Dr. Alfred Abuhamad, chairman of the obstetrics and gynecology department at EVMS, to oversee the treatment. They also met with other OB-GYNs in the community to find volunteer physicians.

LabCorps, a medical laboratory company, agreed to donate 30 Pap smear tests a month so women could be screened for cervical cancer.

Then fliers were distributed at bus stops, hair salons and churches throughout Norfolk, letting women know about the Wednesday night clinics.

One evening in October, two medical students took a medical history of Donna Eure, 53, of Norfolk. She works part time, but her job doesn't offer health insurance. She talked to the students about some gynecological concerns she had, and she shared her struggle to monitor her diabetes.

"I couldn't afford to buy the strips because they're so expensive," she said.

At one time, Eure worked for an airline and had good insurance, but she had to quit that job because of vertigo, a dizziness sometimes caused by an inner ear condition. She's been without health insurance for a few years now. Her primary doctor told her about the free clinic.

And while she's appreciative, she misses the familiarity of seeing a regular doctor, someone who knows her medical history.

"The only thing I dislike is, every time, you get a different student," Eure said. "Some of the students don't know the questions to ask."

But she's visited both the general and women's health clinic for treatment:

"It's a learning process for them, along with us."

Another patient, 22-year-old Cody JollySubway, but the eatery doesn't provide her health insurance.

Normally, when she would get sick, she would go to the emergency room. But she said she feels better about going to the free clinic.

Patients who need additional services are referred to EVMS specialists or to the Ambulatory Care Clinic at Sentara Norfolk General Hospital.

Patients in the women's health clinic are sometimes seen by Abuhamad, an internationally known obstetrician. He also does volunteer work overseas, training midwives in Haiti to monitor pregnancies using portable ultrasound equipment.

The countries he travels to have high rates of infant and maternal mortality, but the same theme repeats itself right here in Norfolk and Portsmouth. The cities have two of the highest infant mortality rates in the state, which in turn has a higher rate than the nation as a whole.

Unlike some of the countries he travels to, pregnant women here have access to government insurance, but they often don't know that.

"This exposes students to problems we don't see in the hospital," Abuhamad said between patient conferences with the students. "It's one-on-one learning about their family issues, their problems in accessing care. What's so impressive is, it's done by students who have a busy daily life."

Wright said she was frustrated in the beginning at the high no- show rate of patients: "I thought, 'What am I doing wrong?' But it's not about me. I had to think about what were the impediments to them coming."

The students came up with an idea to provide patients with bus tickets for follow-up visits.

"These are things we don't teach in the classroom," Abuhamad said. "It's knowledge that's acquired in the clinic."

Elizabeth Simpson, 757-446-2635, [email protected]

about the clinic

The HOPES women's health clinic is open from 6 to 9 p.m. on Wednesdays for low-income Norfolk patients in need of contraception, early pregnancy care, sexually transmitted infection treatment and diagnosis, and other gynecological issues.

The women's health clinic also treats women under the age of 18 for obstetric and gynecological issues.

The clinic works on an appointment-based schedule and cannot accept walk-in patients.

Call 446-0333 if you are a new patient or 446-0366 if you are a returning patient.

The HOPES free clinic for general health problems has a full patient load and is unable to accept new patients.