Pulse
A Hot Meal and a Health Check
Medical students bring health care to the homeless.
On a mild Wednesday evening in October, turnout at the Loaves and Fishes-sponsored dinner at Holy Rosary Catholic Church in Minneapolis is light. About 100 people sit in loose groups around cafeteria tables in the church’s basement. The adults talk, while the kids, fueled by full stomachs, chase each other around.
At one end of the basement, four young women are loading orange tackle boxes filled with basic medical supplies onto a cafeteria table and putting up posters advertising free cholesterol and glucose screenings. Dressed casually in jeans and sneakers, they don’t look like doctors, and three of them aren’t, yet. They are first- and second-year students at the University of Minnesota Medical School who are getting an early taste of what it’s like to be a physician. The fourth, Kara Denny, M.D., is their preceptor for the evening.
Denny and the students are all volunteers with the student-run organization ISTOP, or the Inter-professional Street Outreach Project, founded by second-year medical student Carolyn Treacy Bramante. ISTOP provides free basic medical care and information, health screenings, and referrals to the homeless and needy at the Women of Nations shelter in St. Paul, and Holy Rosary and St. Mark’s Episcopal Cathedral in Minneapolis.
A native of Duluth, Bramante says she got the idea to provide medical care to the homeless several years ago while volunteering with a meals program in Cleveland, Ohio. She noticed people had lacerations and fungal infections. “My thought was if someone was working with them and had medical supplies, they could do some good,” she says.
When Bramante enrolled in medical school in 2007, she began laying the groundwork for ISTOP. She spent the first year identifying the need among Minnesota’s homeless, networking with organizations that serve them, and investigating liability concerns. What she learned, Bramante says, was that the demand for health care for homeless people outstripped the supply, and there was need for a program that delivered basic medical care.
With help from a number of organizations and individuals including Physicians for Human Rights; Streetworks Collaborative, which sends outreach workers to soup kitchens, shelters, and other places to connect homeless youth with services; and faculty advisor John Song, M.D., the first ISTOP clinic was held last February. The idea has taken off. As of this fall, about 75 medical, nursing, physical therapy, and public health students had taken part in the outreach clinics, which take place about five times a month.
Students are attracted both by ISTOP’s humanitarian focus and by the opportunity to interact with real patients—a rarity during the first two years of medical school, Bramante says.
“It’s a really good learning tool and gets us out of the classroom, and it’s a good way to give back,” says second-year medical student Jill Suzukida, one of the volunteers at Holy Rosary. “You spend so much time studying and kind of focused on yourself and school, it’s kind of nice to be able to reach out and do a few other activities.”
A Growing Need
More than 9,000 Minnesotans are homeless on any given evening, according to the most recent census conducted by Wilder Research in 2006, and that number has grown as the economy has slowed. More than one-third of the homeless are children.
People who are homeless and those living in extreme poverty face a lot of barriers to getting health care, says Song, including a lack of income, lack of insurance, problems with transportation and child care, and for some, a distrust of institutions including those that provide medical services.
Song, who founded the Phillips Neighborhood Clinic, a university-operated, student-staffed clinic that serves people who are homeless, uninsured, or undocumented, says that ISTOP volunteers reach those who won’t seek care elsewhere. They help reduce medical costs by treating people early, before they end up in the emergency room. “We know that there’s a population that no matter what you set up in terms of a free, fixed clinic cannot or will not seek care in a clinic setting,” he says.
A large part of ISTOP’s mission is to provide health education. Volunteers answer questions about flu season hygiene, prenatal care, and sexually transmitted infections. They provide limited wound care, screenings, over-the-counter medications, and nonmedical items such as condoms and socks. The students and preceptors also refer those who have more serious concerns to places such as the Phillips Neighborhood Clinic, which offers more comprehensive medical care two nights a week.
A Learning Environment
The ISTOP clinics are generally staffed by two students and one preceptor physician. Students not only get one-on-one time with a professional, but they also learn more about a population they don’t often come in contact with, Song says.
The people ISTOP volunteers see suffer from the same ailments as other people, but because of lack of sanitation, shelter, and safety, they are at greater risk for infectious diseases, infestations, and tuberculosis, as well as problems related to exposure to the elements. They also don’t have the same treatment options. “Whatever you prescribe or initiate, you need to do it in the context of somebody who may not have a place to store medications, or get bed rest, or have access to water even to take their medications,” Song says.
At Loaves and Fishes, it isn’t long before the first patient approaches the ISTOP table, a 4-year-old boy holding tightly to his mother’s hand. The boy has had a fever for several days, and his mother had taken him to the emergency room that morning. During dinner he complained that he felt sicker. The family is from northern Minnesota, and they want to know if it’s all right to drive home, or if they should go back to the emergency room. Denny examines the boy, then sends the family home with children’s Tylenol and instructions on dosage. They had been giving him adult medication in smaller doses. The students also hand out small bottles of hand sanitizer to the other children in the family and to people passing by.
The second patient of the evening is a tall, slender man with a makeshift bandage around his wrist and thumb made from what looks like paper napkins and strapping tape. The man explains that he sliced his thumb on broken piece of picture glass. Although the bleeding had stopped, he wanted to know if he needed stitches. Denny examines and then rebandages the man’s hand while the students observe, and suggests that he visit the Phillips Neighborhood Clinic the following evening.
A group of Spanish-speaking men ask about flu vaccinations. ISTOP co-chair Jacob Feigal, a second-year medical student, tells them in Spanish where the vaccine is offered. ISTOP has fliers in English, Spanish, and Hmong listing neighboring clinics.
“As a student, this is probably some of the best experience I’ve had with hands-on care,” Feigal says of ISTOP. “We really get a lot of hands-on time, a lot of time to interact with patients, which is half the game, if not more sometimes, just learning how to interact and ask the right questions, ask open-ended questions so people can just tell their story.”
ISTOP’s organizers hope to host clinics more frequently in the future but are struggling to find professional preceptors to staff them. “The only truly limiting factor we have is having dedicated professionals to help precept students and provide some of this care,” Song says. “The need’s out there, the students are out there who want to provide this care, but they can’t by themselves.”
*For more information about ISTOP or to volunteer, contact Carolyn Treacy Bramante at ISTOP.umn@gmail.com.
—J. Trout Lowen