On a cold Saturday morning in January, dozens of people gathered in the basement of the Episcopal Church of St. Paul and St. James, near New Haven’s Wooster Square. They came for warmth, companionship, free clothing, and the weekly food pantry run by Loaves and Fishes.
Some also came for free blood pressure and blood glucose screenings provided by Yale students in the health professions. Teams from the School of Medicine, the School of Nursing, and the School of Public Health have been coming to the church for about 10 years as part of the Neighborhood Health Project (NHP). The mission of the NHP is simple—under the tutelage of volunteer physicians, the students offer screenings and advice about nutrition and exercise. “A lot of our patients have high blood sugar and high blood pressure,” said Sarah Aspinwall, a public health student who’s one of four clinic coordinators. “A lot of that is a diet and exercise issue.” Last year the clinic also gave free flu shots to almost 100 people, with vaccine provided by New Haven’s health department.
The screenings are the easy part. If the tests reveal a problem, the students refer their patients to a source of free or low-cost health care in New Haven. That’s the hard part—many of their patients are unemployed or have limited resources.
One of the patients that morning was 36 years old and recently arrived from Mexico. He hadn’t worked in two weeks; before that he had worked intermittently in remodeling. He was worried about his frequent urination and recent weight loss. Carrie A. Redlich, M.D. ’82, HS ’86, FW ’87, M.P.H. ’88, professor of medicine (occupational medicine), and this week’s preceptor, had questions for the patient: When was the last time you saw a doctor? How much weight have you lost? Why are your pants so loose? Does anyone in your family have diabetes?
First-year physician associate student Lauren Monoxelos had already done the screenings—the patient’s results were off the charts. Jessica Wang, a second-year medical student and one of the clinic coordinators, repeated the tests. Still off the charts. There’s only so much the staff can do at a screening clinic, so Redlich made an appointment for the patient at HAVEN, a student-run free clinic on Grand Avenue.
This case offered a lesson beyond the mechanics of strapping a blood pressure cuff on a patient’s arm. “For me one of the biggest shockers in terms of interfacing with the medical system has been that when you’re studying it, you think the low-income population will just sign up for Medicaid and they’ll get care,” said Danielle Correia, a second-year public health student and clinic coordinator. “It seems very simple on paper, but when you’re actually in that context you realize the sheer complications of what signing up for Medicaid involves. What if they’re just above the poverty line but still very low-income?”
Then there are the lessons in bedside manner. “The thing that we sometimes underestimate is how important it is to get comfortable with patients,” said NHP faculty advisor Jeffrey R. Bender, M.D., HS ’83, the Robert I. Levy Professor of Medicine (Cardiology) and professor of immunobiology. “This is a great way for students to start getting a sense of how to talk to people, make them immediately comfortable, and engender trust from the outset.”
“It’s really rewarding,” said Wang. “We are helping people get access to health care who would otherwise have a very hard time doing so.”
Update: In April the Neighborhood Health Project (NHP) received a Yale University Seton Elm-Ivy Award for its contributions to New Haven. NHP was recognized for “providing education and improving access to health care for low-income patient populations in New Haven. ... the volunteers serve a vital role as medical brokers, explaining the context of a patient’s results and offering simple steps to improve a patient’s health status within his or her means. By ensuring access to community primary care centers in the New Haven area such as Hill Health Center, Fair Haven Community Health Center, and HAVEN Free Clinic, NHP plays a central part in providing continuity of care for those most at risk.”
Accepting the award on behalf of NHP were student directors Sarah Aspinwall, Danielle Correia, Jessica Wang, and Esther Park. Faculty advisors Jeffrey Bender, M.D., HS ’83, the Robert I. Levy Professor of Preventive Cardiology and professor of immunobiology, and Paul Genecin, M.D., director of Yale University Health Services, attended the ceremony.