HANDS-ON TRAINING
At community clinics, UNM students get lessons in grass-roots medicine
During the weekly Tuesday night clinic at an Albuquerque shelter for homeless men, the first client examined by a team of University of New Mexico health sciences students had been hit by a car just 15 minutes earlier.
Fortunately Jesse James Kershner, who had been riding his bike when the car struck him, was not seriously injured. Could be he’s acquiring an immunity to collisions with moving vehicles.
“I’ve been hit by cars about 17 times,” Kershner, 36, said as Samuel MacDonald, 22, a first-year medical student at UNM, checked him out for bruises and possible fractures.
Assisting MacDonald with the exam were Anthony Jones, 20, a second-year UNM nursing student, and Juanita Martinez, 29, a first-year UNM physician assistant student.
“Anything else?” MacDonald asked his fellow students after he finished going over Kershner.
“We could do a strength test,” Martinez suggested.
“That’s a great idea,” MacDonald said.
Real problems
Every Tuesday evening, students from UNM’s Health Sciences Center — future physicians, nurses, pharmacists, physician assistants, physical therapists — come together to run a clinic at the Albuquerque Opportunity Center, which offers shelter and other services to homeless men. It is one of several clinics UNM health sciences students provide for various underserved populations in Albuquerque.
At the AOC clinic, supervised by an attending health care provider, the students examine the men and listen to their concerns, which often range beyond medical problems.
“Sometimes these guys just want someone to talk to, which is fine,” Jadzia Jetty, the fifthlevel nursing student coordinating this past Tuesday’s clinic, told the UNM volunteers assembled there that evening. “But try to keep the visits short because we have lots of people to see.”
The students may provide some care themselves or, if necessary, refer patients to the hospital or follow-up visits at a health clinic.
“If you need to call 911, go to the front desk,” Jetty told this past week’s group of students as they split into teams and set off to see patients.
Lindsay Fox, a faculty member with UNM’s Physician Assistant Program, was the attending health care provider at last week’s clinic. She said the clinic not only gives students the chance to practice their medical skills, but also the opportunity to learn from colleagues studying other medical disciplines.
Fox said a vital part of the learning process stems from students interacting with a population— in this case, men accustomed to being avoided and treated without respect — they might not often encounter.
It’s grass-roots medicine. Students often have to use whatever they can find — the light from a phone to examine a patient’s throat, a belt to aid in physical therapy exercises — to get the work done.
“It reminds you about why you get into medicine,” Fox said. “Here you are not flooded with paperwork. This is just taking care of a human being.”
Physician assistant student Martinez appreciated that fact.
“We work with actors (portraying patients), and they are good,” she said. “But people here have real stories, real problems.”
And often they are problems that can’t be treated in the normal way.
“Eat well and get a good night’s sleep just isn’t the kind of advice homeless men are able to heed,” said Peggy Murphy, a fourthyear nursing student.
Holistic medicine
The problems are different, but every bit as real, for the clients at One Hope Centro de Vida Health Center on Virginia just north of Central. Operated by East Central Ministries, most of the health center’s clients are Spanish-speaking immigrants.
Founded in 2006, the center sees 70 to 100 clients a week. UNM health sciences students, UNM family medicine residents and faculty from UNM’s School of Medicine and College of Pharmacy volunteer at the health center’s Wednesday night primary care clinic, behavioral health clinics, women’s health clinics and diabetes workshops.
Conditions confronting the clients here include diabetes, high blood pressure, high cholesterol levels, depression, anxiety and low income.
Alexa Argyres, 25, a fourth-year UNM pharmacy student, has been volunteering at the center twice a month since June.
“It is unlike any other clinic,” she said. “It is more holistic medicine. It’s about taking care of the whole person, not just addressing the illness. It is also about addressing the barriers to medical care. Everyone here is really good at knowing the resources that are available and making referrals.”
One Hope does not take insurance because it is a community-based, volunteer-run center. Patients pay a $25 fee for clinic visits, but that is sometimes returned so they can afford to buy prescribed medications.
Dr. Arthur Kaufman, distinguished professor of family and community medicine at UNM, started bringing UNM health sciences students to One Hope soon after it opened. He said it gives the students and medical residents a different perspective.
“What drug is key if the patient only has $10 or $20?” Kaufman said at this past Wednesday’s primary care clinic. “We get generic drugs at Walmart.”
Kaufman said that by volunteering at One Hope, students get a good lesson in investing in a community and sticking with it.
“It’s a model for a community clinic,” he said. “We are not just in and out. And it’s not just training for the students. By dealing with problems here, we don’t have as many people hitting the (UNM) emergency room at hideous costs.”
Charging batteries
Kaufman said the One Hope experience also teaches students and residents to respect and pay attention to the community health workers who run the center.
These workers are from the community that is being served. They speak the language and understand the full array of problems confronting the community. And they act as liaisons between patients and health care providers.
“They don’t have the degrees on the wall, but they have the trust of the community,” Kaufman said.
Once such person is Lidia Regino, an immigrant from Mexico who has lived in this East Central community since she was 10.
A former director of One Hope, Regino still helps out at the center. She thinks the UNM students get a lot out of their time here.
“In some clinics, they are not allowed to see patients,” she said. “Here, it is very handson. Some are doing exit interviews. It’s the whole package. Make sure the patient understands the diagnosis, why they got the medicine they did, what the side effects are. They learn to practice medicine in a different way. What can the patient afford? We have pharmacy students looking for coupons.”
Tae-young Nam, 29, a first-year medical student, has been volunteering at One Hope since August and finds the experience inspiring and invigoration.
“I learn so much here,” he said. “We are in the classroom the first two years (of medical school). I have never studied so hard. But the clinic reminds me of what I will be doing one day. There is little I can do as a firstyear medical student. I get more out of it than the patients I see. It fills my battery.”
Stressful lives
At the AOC clinic, Cody Fritts, a third-year UNM medical student, talked with James Christian, a 45-year-old homeless man with diabetes. The disease has resulted in Christian losing the lower part of his right leg, all the toes on his left foot and, recently, his right index finger to amputation.
Christian told Fritts he has been having trouble getting to where he needs to be to get the insulin he should be taking daily.
“My biggest issues are not having the money to buy the right kind of food, and stress,” Christian said.
Fritts asked Christian what had been causing the stress.
“Whatever life throws at me is kind of stressful right now,” Christian replied.
Fox said many of the physical complaints from the homeless men at the AOC clinics are musculoskeletal because they spend so much time on their feet and walking. But here, a client’s medical history might also include getting stabbed in the heart with a screwdriver.
“We lend a professional ear to the things they go through in their day-today lives,” Fritts said. “Some of the stories I have heard here have really shaken my faith in humanity.”
But the men and their stories is what keeps him coming back. These men and their stories are among the reasons he wants to be a doctor.
“I think we do incredible work here,” he said. “There is incredible need.”
IT’S ABOUT TAKING CARE OF THE WHOLE PERSON, NOT JUST ADDRESSING THE ILLNESS. ALEXA ARGYRES UNM PHARMACY STUDENT