Med students take it to the streets
NBC Nightly News / Aired on January 2, 2013
At California's UCLA School of Medicine, there's a unique prescription for teaching medical students. The UCLA Mobile Clinic brings students out of the classroom and onto the streets where they provide care for those who have nowhere left to turn. NBC’s Diana Alvear reports.
Student Street Clinic Helps Homeless
By Mike O'Sullivan, Voice of America News / October 12, 2012
LOS ANGELES — Medical students in California are getting real-world experience by helping the homeless on the streets of Los Angeles. They are filling gaps in the health-care system while learning about their future profession.
The patients sit on folding chairs along the sidewalk in Hollywood, as students unload supplies and medical records from a truck. They are creating a makeshift clinic on the street.
The first stage is triage, assessing the needs of poor and homeless at this once-a-week mobile clinic. It is run by students from the University of California, Los Angeles, who operate similar clinics in different communities on other nights.
They provide medicine and offer clean socks and reading glasses to those who need them. They bandage injuries and monitor vital signs.
Another charity offers nutritious meals to the patients. Students in social work and law also come to offer assistance, getting long-term help from the government or private agencies for those people who qualify.
Patient Charles Brownridge comes here every week, as much for companionship as health care. “I like the atmosphere, the food, and they give pretty good service. They are training, sort of like rookies doing an apprenticeship. And it is fun to be around youngsters. It is a nice atmosphere.”
Physician Walter Coppenrath helped start this street clinic 12 years ago when he was a medical student. He now teaches at UCLA and sees patients at a nearby medical center. He says this mobile care is crucial for this population.
“Small infections on your foot might be able to be handled by just changing your socks, but when you [are not] able to wash in a bath or change your socks," said Coppenrath. "They can actually lead to limb-threatening infections.”
The care is given to those who do not get help in other places, says medical student Steffanie Becerra. “They see us as their only point of care within the medical system where they can get their medications filled, a lot of people with hypertension or diabetes who really have no other choice but to come here because they just can not afford the medications elsewhere,” she explained.
The mobile clinic helps both patients and students, says undergraduate Kevin Norris, who plans to become a doctor.
“We really treat them as individuals deserving of respect because so many of the homeless people here in Los Angeles are really just looked down upon and largely ignored by much of the population,” Norris stated.
He says that once a week these people get the attention and the care they deserve, and the volunteer work helps him understand his future role as a physician.
UCLA Mobile Clinic Project Benefits Both Sides of the Clipboards
UCLA Mobile Clinic fosters students' skills and compassion as they care for needy patients.
By Erin Loury, Los Angeles Times / July 16, 2012
Tom Fadial, a third-year UCLA medical student, listens to the heart of patient Stanley Rudolph, 75, a homeless Korean War-era veteran, who took advantage of services offered by the Mobile Clinic Project. "I'm what they call off the grid," Rudolph said. (Allen J. Schaben)
As a warm summer evening takes hold, a white delivery truck rolls to a stop at a West Hollywood corner and is joined by a throng of T-shirt clad students. Within minutes a street scene springs to life, full of pop-up canopies, tables, folding chairs and young faces in motion.
This is college night — of a different kind.
Every Wednesday, UCLA students studying medicine, law and public health transform a nondescript section of sidewalk near Romaine Street and North Sycamore Avenue into an open-air health clinic and help center for the homeless. It's also a training ground where clinical skills and compassion are practiced in equal measure.
"We're here where they feel most comfortable," said Kevin Norris, one of the program's undergraduate coordinators.
The volunteer, student-run Mobile Clinic Project at UCLA, funded by grants and donations, represents a unique collaboration across disciplines, providing training for undergraduates and professional school students alike.
For a decade, the group has operated just down the street from a food truck run by its partner, the Greater West Hollywood Food Coalition. In this one place, the homeless can find a hot meal, medical and legal services, and a welcoming respite from the loneliness of the streets.
A team of 30 students creates a kind of field clinic — setting up tables for boxes stuffed full of client files, unfolding green camping cots and stringing blue tarps around them to create private exam rooms.
Most of the interaction takes place on folding chairs, where medical students conduct physical exams. Undergraduate caseworkers with clipboards sit at their feet asking questions to piece together health and social histories.
Eric Tam, a fourth-year neuroscience undergraduate, drove the truck this day and says the work is motivating and illuminating. "It's not just health, you're learning about life in general."
Their clients are gay and transgender, HIV-positive, meth addicts, veterans. It's a mix that helps the future doctors and health professionals cultivate a sense of common humanity with an array of patients, said Walter Coppenrath, a family medicine doctor with Kaiser Permanente and one of the group's professional advisors. It makes them "much more comfortable in uncomfortable situations," he said.
One of the first clients to arrive is Rodney Brackin, 48, a regular for the last eight months. Today, he has a sore arm. Speaking haltingly with a slight stutter, Brackin says he likes to talk to the students about TV shows and movies. Brackin rarely has a medical need, he just likes the students' company, Coppenrath said.
The students check blood pressure, dispense medication and search for lice. But their primary objective is to connect clients with conventional health centers, including the Step Up on Second mental health facility and Ocean Park Community Center in Santa Monica, the Saban Free Clinic in Los Angeles and the Venice Family Clinic. The students provide bus tokens and taxi vouchers to help their clients get there.
The team usually sees 25 clients in a night. An additional 40 people may come for a hygiene kit — small essentials like shampoo, toothbrushes, vitamins.
Inside the open truck, students staff a counter lined with drawers of supplies and medication. They field their teammates' requests for antibiotics and topical ointments, asthma and hypertension medication. Donations are piled against another truck wall, boxes and backpacks full of clothes and toiletries. Today, they set out a table with several pairs of shoes.
Nearby, law students and an advising attorney sit at a table with laptops and a printer, guiding clients through such issues as eviction notices, court appearances and how to pay for tickets by performing community service. Managing legal problems can allow clients to better focus on their health, organizers say.
For students, the street clinic offers a change of pace from the classroom, and practical — if at times chaotic — field experience. "You're trying to listen to their heart, to their lungs, and there's street noise, there's conversations going on," said Boba Benghaly, a second-year medical student. Compared to the project's other indoor venues, such as Step Up on Second, she said, the sidewalk setup "is the most challenging, the most energetic."
By 9 p.m., the team members wrap up their work and reload the truck. They form a circle under a street lamp, pass around a super-sized bottle of hand sanitizer and recap the frenzied evening. There's an initiation tradition: New members introduce themselves and bust a favorite dance move.
Then the students disperse, chattering as they head toward their cars. Brackin, the last lingering client, heads the other direction and disappears around a corner.
Brochure: UC Health - Community Impact
Student-Run Clinics - Mobile Clinics - Saving Lives Rain Or Shine
After losing his job, Spencer has been on the streets for 10 years. Just a few blocks from the Hollywood Walk of Fame, the senior citizen still gets the star treatment at UCLA’s student-run Mobile Clinic Project, which has helped him control his diabetes and improve his health. The interdisciplinary clinic has served the homeless of West Hollywood every Wednesday night rain or shine for more than a decade, providing compassionate care and small necessities such as socks and gloves.
“They save lives,” Spencer said.
The mobile clinic was inspired by the Suitcase Clinic, which is run by UC Berkeley School of Public Health and UCSF Joint Medical Program students who provide low-income and homeless people with free services including foot washing, vision screening, dental care and legal advice. All UC medical school campuses have student-run clinics, with the mobile clinic being a joint project of the UCLA College of Letters and Science, School of Medicine, School of Public Health, and School of Law. Many volunteers are undergraduates, who gain invaluable experience.
“You get to see how things are in real life,” said third-year student Josue Reynaga
Bruin Heroes Award, Fall ’11: Mobile Clinic Project
The UCLA Volunteer Fellows have recognized the UCLA Mobile Clinic as the next Bruin Heroes Award recipient.
From the UCLA Volunteer Center
Mobile Clinic Project at UCLA works towards helping the homeless population in West Hollywood by providing for a number of needs: medical care, health promotion, disease prevention activities, legal advocacy and referrals to health and social services. Because of their wide range impact and their commitment to addressing a social need through a variety of outlets, the UCLA Volunteer Center Fellows awards the Mobile Clinic Project the Bruin Heroes Award for Fall 2011.
The project officially launched in 2002 after a group of public health students were informed about the West Hollywood homeless population need for medical care by the Greater West Hollywood Food Coalition (GWHFC) in 1999. The students soon discovered there were a number of other barriers faced by the homeless population. The group then reached out to medical and law students as well as undergraduates for their help in creating an outreach program, which became the Mobile Clinic Project.
Mobile Clinic has since been working with the GWHF, a volunteer organization that serves food to the homeless population in West Hollywood each week. The project has also expanded to include over fifty undergraduate volunteers from all majors as well as a number of medical and law students.
“We are a very interdisciplinary project,” Mobile Clinic Operations Coordinator, Kaylin Nguyen, said. “No matter what you’re interested in, whether it’s nonprofit, medical, legal, or social issues, if you’re interested in something, you can explore it here. There’s something for everyone here.”
Undergraduate volunteers commit 50 hours a quarter to the project and they even work during the summer. Along with serving food with GWHC, Mobile Clinic volunteers attend site every Wednesday in West Hollywood where they meet with the homeless population. Volunteers set up tables, help take down the medical history of their clients, hand out medication and supplies, and refer clients to other resources. Volunteers must also visit clinics in Santa Monica on Saturdays where they help the homeless population with mental health issues.
“We’re really allowing our volunteers to interact with the community we’re working with,” Nguyen said. “They are working with the clients, finding out the resources not available for their clients as well as about the barriers, mentally and socially, that the clients encounter.”
For the Mobile Clinic Project, it is not only important to outreach to their site population, but it is also essential that their volunteers learn about the very issue they are working towards solving.
The Greater West Hollywood Food Coalition - Helping The Homeless and Hungry Since 1987
Our goal isn't just to give a free meal, but to help those in need. See who we are, what we do, and what makes us unique.
Produced and Directed by the GWHFC's very own Joanne "Trixie" Sullivan. Visit http://GWHFC.org for more information.
Taking It to the Streets
The students of the UCLA Mobile Clinic Project bring basic healthcare to where the rubber meets the road.
By Dan Gordon. Photography by Ann Johansson
In his sleeveless T-shirt showing off a prowling panther on one arm and assorted symbols on the other, Michael doesn't pull any punches when he talks to the UCLA medical students who are trying to help him on the streets of West Hollywood, and what he describes "blows their minds."
"People drawing up water out of a toilet to inject drugs. Straight men having sex with men for money. It's a shock to them, but that's good," Michael says, his blue-grey eyes gleaming in the waning light on this crisp evening in September. "They're going to be doctors – they need to deal with things like that."
Michael speaks from his own experience. Somewhere in his 40s, he has a nearly toothless grin and an engaging and excitable nature. He has been homeless off and on since he was a teenager and says he has shot crystal meth nearly every day for the past eight years. He is struggling to stay clean now so he can be approved for needed heart surgery, and a large measure of his motivation comes from these very students. "Part of what made me start to care was the young people who come here and volunteer, talking to me and treating me properly," Michael says.
Being listened to. Treated with respect. For a population that is most often shunned – the homeless and transient men and women who populate the city's backstreets – those two things are worth the world. And when listening and respect come with a healthy dose of medical care, so much the better.
For 10 years, students with the UCLA Mobile Clinic Project have been taking it to the streets, putting up their makeshift M.A.S.H. every Wednesday evening near the same street corner – Sycamore Avenue and Romaine Street – just a few blocks from Hollywood's historic Walk of Fame. A box truck that the group leases from the university carries folding chairs and tables to set out on the sidewalk. Tarps and poles create spaces for exams that require privacy. Medications – both over-the-counter and prescription – are dispensed from an improvised pharmacy in the back of the truck, and there are supplies of donated clothing, shoes and blankets to hand out to anyone in need.
UCLA's Coach John Wooden said: "You can't live a perfect day without doing something for someone who will never be able to repay you." If ever there was a group of young people who have taken that principle to heart, it is the students who volunteer with the UCLA Mobile Clinic Project.
Jeremy DeMartini is among them. "It's easy to get caught up in the competitiveness of medical school and forget that the reason you're going through this is to help people. Every day, our 'clients' (they are never referred to as patients) are overlooked and scoffed at by people who pass by them on the streets. I can imagine the frustration and despair this would bring," says the second-year student in the David Geffen School of Medicine at UCLA. "It is little wonder that they are so appreciative when we give them an outlet to share their experiences, feelings and hopes, which are not unlike everyone else's."
Each week, the students see a dozen or so clients, many of whom are initially drawn to the location by the warm meals that are provided nightly by the Greater West Hollywood Food Coalition. In addition to the first- and second-year medical students who, under the watchful eye of an attending physician, provide basic care for acute and chronic issues such as foot problems, respiratory tract infections, hypertension and diabetes, undergraduates act as caseworkers, taking social and medical histories.
All the students are attentive to their clients, taking time to get to know them and learn about not just their health issues, but also their personal lives and the challenges they confront every day. The project has expanded over the years to also include law school students providing legal counseling and has set up services at three other locations in Santa Monica.
Like Michael, many of the clients come back to this West Hollywood street corner week after week. Spencer is 69 and all smiles under a rumpled beige hat, a single braid dangling from his white beard. He's been coming to the Mobile Clinic Project since it began in 2000, and he happily volunteers to help break in the first-timers. The clinic helped him get his blood sugar under control; now Spencer likes to help teach nervous students how to draw his blood.
Daniel is a middle-aged man who suffers from chronic schizophrenia. He says he experiences headaches when his hypertension isn't controlled, and he believes the clinic is the one place where he can get his meds. Homeless off and on for the last 15 years, he declares, "I feel safe here."
Every effort is made to encourage clients with serious chronic conditions to receive ongoing care from a regular physician, often referring them to community clinics that have agreed to work with the project. "We don't want to take patients away from existing and working systems of care," says Walter G. Coppenrath III, M.D. '04, who helped to launch the Mobile Clinic Project's medical services when he was a student and now is the program's lead attending physician. For urgent matters, clients are given cab vouchers or bus tokens – and in the most emergent situations, placed in an ambulance – to get to a hospital.
But addressing the clients's health complaints really is the easy part, Dr. Coppenrath says: "The medicine is simple. The situations are complex."
For these clients, the context of their lives is as important – sometimes more so – as their medical conditions, Dr. Coppenrath says. To tell a homeless person he or she should apply ice for 20 minutes to reduce swelling is to be blind to his or her living circumstances. Assuming a homeless client is going to follow up on a plan of care is not always realistic.
"The social history is a huge component of providing care in this community," says Mojdeh Toomarian, medical-student coordinator for the West Hollywood site. "You have to learn about the challenges the client faces in his or her day-to-day living,"
Diffidence is not an option. "At first you're afraid of offending," says Lauren Wolchok, a second-year student. "You wouldn't ask most people, 'Do you hear voices?' But in this population, which has a high prevalence of paranoid schizophrenia, people don't react like you were wrong to ask them. The same applies to sexual history – it's important, and you can't be embarrassed to ask about it."
What Wolchok and other students quickly learn is that most of the clients – accustomed to being ignored by the people who pass them daily on the streets – welcome the opportunity to open up about their lives. At the end of one night, a client gave Toomarian a bracelet he had found as a token of his thanks. "He said, 'It was really nice that you talked with me for two hours,'" Toomarian recalls. "That's when I realized that although we are limited as to how much medical care we can provide, we do a lot simply by listening."
The rapport built with clients through these conversations serves another important purpose. "This is a population that used to be called service-resistant," says Dr. Coppenrath, a family-practice physician. "That's a misnomer. They're resistant to the types of services they've had in the past." Virtually every Mobile Clinic Project client has had unsettling experiences with the healthcare system – whether it has been waiting 24-to-36 hours to be seen in the emergency room or having a physician tell him or her to lose weight and stop doing drugs, oblivious to their daily challenges.
Part of the project's mission is to provide a bridge for the population to reconnect with the network of social, legal and medical services that are available to help them. That step is done by gaining trust and lowering the barrier to the service. So when a medical-student volunteer shows up wearing a freshly pressed white coat, he or she is quickly told to lose it. "A white coat out here creates a barrier," Dr. Coppenrath says. "When you remove that cloak, it changes the relationship. It becomes people helping people: 'I have knowledge, you have stories to tell me, let's work together.'"
Harm-reduction is at the core of the project's approach. "We don't judge or criticize," says Jessica Howard-Anderson, medical-student coordinator for one of the project's clinics at a service-access center for the homeless in Santa Monica. Instead, students work with clients to reduce their risk factors. Substance abusers, for example, aren't coaxed to quit but might be counseled on the importance of using sterile needles. As clients learn that the students aren't there to scold and are interested in building a relationship unconditionally, they become more trusting and likely to return for follow-up visits.
Because the clinic doesn't refuse care to clients who are under the influence or otherwise belligerent, there can be uncomfortable moments. A hand-lettered sign entreats: "Mobile Clinic is a safe place. Please keep weapons, drugs & alcohol at least 2 blocks away." Safety precautions are in place, as is a de-escalation protocol that all volunteers learn before going to a site. Whenever a volunteer feels unsafe or threatened, he or she asks for the "blue thermometer," setting off a chain of events in which the student is removed from the situation and a veteran coordinator intervenes. But such cases are rare. "The population is self-policing," says Koy Parada, Ph.D., who was a doctoral student in the UCLA School of Public Health, where the concept for the project originated, and today remains involved as a faculty adviser. "If there's a problem, long-time clients often will defuse the situation themselves before it escalates."
At the end of the evening, the students and their supervisors gather under their portable lights for a debriefing. The group invariably includes at least one student who is beaming in the aftermath of a meaningful client interaction. It is a powerful, formative experience that will help to shape many of these students's future careers.
"This makes me to want to become a physician who will listen when others do not," DeMartini says.
Ele Lozares-Lewis, M.D., hasn't forgotten her experience as a project volunteer six years ago. It was pivotal in her decision to pursue a career in family medicine working with underserved populations. Dr. Lozares-Lewis is currently a third-year resident at Santa Rosa (Calif.) Family Medicine Center. Working with the homeless population as a student "wasn't easy emotionally, but it felt comfortable," she recalls. "The population was so grateful for any help we could give them."
For Dr. Lozares-Lewis, the experience also had a significant dose of déjà vu. She had been planning on studying film production when her life spiraled out of control in the 1990s. Hooked on speed, she lived for five years out of abandoned warehouses and ate from soup kitchens in San Francisco as she struggled to put her life back together. She vowed that if she succeeded, she would do something to give back to the community. She did succeed and came to study neuroscience at UCLA, where the Mobile Clinic Project gave her that opportunity.
Her story is emblematic of a reality that comes as a surprise to many medical students interacting for the first time with the homeless population: "They learn that a lot of the clients they see are not all that different from them or their family members," Dr. Lozares-Lewis says.
But if interacting with some of society's most neglected individuals reminds students not to lose their empathy amid the rigors of medical school, it can also force them to grapple with the reality that despite their best efforts, dramatic success stories are all too rare. More typical, sadly, are the stubbornly self-destructive clients who struggle with mental illness or fight a losing battle with sobriety, if they fight at all. Many are severely depressed. It's heartening for the project volunteers when they are able to find shelter for clients in need, but there are also times when the system fails, and a bed with a roof over it is nowhere to be had.
"With this population, you have to change your frame of reference," Dr. Coppenrath says. "We can't fix all of their problems in one visit. We can give them a good night, and maybe a good week. We can try to give them a good month and work toward getting them a good year.
"But you need to start small," he says. "If you go out thinking you're going to be able to save every person in a single encounter, you're not going to get very far."
The Clinical Experience that Taught Me the Most - Dr. Walter Coppenrath
Walter G. Coppenrath III, M.D. '04, was a student in the David Geffen School of Medicine at UCLA when he wrote this essay about his experience as a volunteer with the UCLA Mobile Clinic Project. It was awarded second place in the Arnold P. Gold Foundation Humanism in Medicine Essay Contest, and was published in the October 2002 issue of the journal Academic Medicine. It is reprinted by permission.
The Clinical Experience that Taught Me the Most
I was three days late. I had considered the possibility of Tiny leaving AMA from the convalescent home, but I was still saddened when the head nurse told me that he had left on the first of the month and that he would not be allowed back. I had believed Tiny would welcome the chance to be housed and clean, but now, three days into the month, as I drove around looking for him, I realized just how naive I had been.
Looking for a particular homeless man on the streets of West Hollywood is a bit like searching for a needle in a haystack, but Tiny, standing at just over 7 feet tall and weighing nearly 400 pounds, was one huge needle. With a little luck, I thought I could locate him. Just what I planned to do then, I had no idea.
As I drove back to the site where the UCLA Mobile Clinic had picked him up, I recalled the events of that day just three weeks before. One of his friends, "Fats,'' informed me that Tiny could no longer walk and that no one could get within 10 feet of him without retching. Fats drove with me to the park where Tiny lay. He was hard to miss, sprawled on the grass, his jeans splattered with dirt and feces. I had approached cautiously.
The smell was overpowering. I told him that his friends wanted me to look him over, to which he nodded his consent. He began to roll up his pant leg so that I could visualize the injury. Peeling off the toilet paper wrap, yellowed from pus, revealed what had been and remains the worst wound I have ever seen: the visible striations of the tibialis anterior were covered by a thin dirty film; thick yellowish plaques bordered the scaly, blackened flesh. The ulcer stretched from just below his knee to his ankle, which on a man seven feet tall is nearly a foot and a half. The smell was beyond decay – it was death. A fellow student and I quickly debrided the injury as best we could, dressed the wound, and with care and help, loaded him into my car.
Now, as I walked through the park, I realized just how angry I was. No one had seen Tiny. ''Tell him I am looking for him,'' I said. How could he do this? How could he turn down this opportunity to get well? After all we did, after all I did – drove him to the hospital, waited until he was admitted, pleaded with doctors not to take his leg, visited him in the home – how could he do this to me? And this last thought stopped me cold: when had this become about me?
Working on the streets of West Hollywood with the Mobile Clinic was an enjoyable diversion from medical school, but the streets were his life. Maybe it was something that I just had to accept. But no, I would not give up. I wouldn't let him go just because he was homeless and I could make myself believe that it was a choice he made. It didn't have to be like this. Yes, I thought, I need to understand where he is coming from, but no, I don't have to accept his fatalism.
As I left the park, I revised my message, ''If you see him, tell him that I hope he's okay.''
An hour later, with the sunlight fading, I was nearly ready to give up. I was heading towards the freeway when I saw Tiny, the near giant, slouched on a bus bench on Vine just south of Hollywood. I parked and walked over.
''Hey,'' I began.
The color that had been returning to his face in the home had quickly disappeared back on the streets. The 72 cm PICC line that had been inserted on the second day after he was admitted was gone, replaced by track marks.
''You okay?'' He sighed and sniffled.
''I am not mad.'' I said, ''I was for a while, but I'm not now. I just want to know if you are okay.''
We sat there for a while in silence.
''They had too many rules.''
''Last week,'' I laughed, ''you got all the bacon you could eat. You said they were treating you great, what changed?''
''I don't know. They were getting on me. I left on my own terms. They weren't going to kick me out.'' And then the big man broke. His massive hands covered his face and he began to cry. ''I didn't shoot it all,'' he said. I raised my chin towards the absent line. ''I wouldn't do that. I wouldn't shoot through that, so I pulled it out.'' He began to sob, ''I don't want this. I'm sorry. I don't want this.''
''Okay. It's okay.'' I hoped that it would be. ''What do you want to do?''
''I want to go back.''
''I already asked. They won't take you back. We're going have to start over.'' I paused. ''Can you do that?''
He was silent for a long time. With his eyes closed he nodded. We got in my car and drove back to the hospital, where we waited for hours in the ER, where people whispered and moved away, where nurses treated him roughly and with contempt. ''Weren't you here for this already?'' they asked. He was unwelcome, and I began to understand how someone would want to leave. But he didn't. We didn't.
Tiny is in a new board and care home now. And when I take him out to lunch back to his stomping grounds and he yells to old friends with pride, ''I'm clean – four months!'' I realize that sometimes clinical doesn't always mean a hospital or even a clinic, sometimes it means just sitting on a bus bench listening and waiting for the moment that someone is ready for change.
Postscript: Robert Guinn, known on the streets as Tiny, stayed clean and lived indoors for the remainder of his life. He died in 2009.