Yale School of Medicine (YSM) students in New Haven and beyond have been eagerly volunteering to help during the COVID-19 crisis. They are participating in many ways, but with a shared desire to not be on the sidelines when there are so many needs.
The examples below provide a window into the innovative, collaborative, and community-focused efforts that YSM MD, MD-PhD, Physician Associate (PA), and Physician Assistant (PA) Online students are involved with, often with support from Yale faculty, staff, and community members. For students whose clinical rotations and sub-internships were postponed because of COVID-19, the opportunity to add value elsewhere has been an impactful way to address the disruption to their clinical experiences.
Reducing the social isolation of older individuals:
Laura van Dyck, a 5th year MD student planning on going into Geriatric Psychiatry, has been speaking often with her 98-year-old grandmother, who is in an assisted living facility in Pennsylvania and who, because of COVID-19, is now socially isolated and anxious. This inspired van Dyck to reach out to nursing homes in and near New Haven to organize conversations between older residents and medical students, “I realized how important it was for my grandmother to be able to socialize over the phone and thought why can’t I help older people in the New Haven community in the same way. It was very moving, in a chaotic time, to have 20 other YSM students respond right away to me, when I wrote seeing if people wanted to help with this effort.”
Van Dyck has been collaborating with the recreation directors at The Willows, The Whitney Center, and Evergreen Woods nursing homes to organize calls. Van Dyck knows many nursing homes are overwhelmed right now, but hopes to connect with more over time and welcomes any to contact her at Laura.firstname.lastname@example.org.
Sourcing more personal protective equipment (PPE):
Guneet Janda, a first-year MD student, along with about 30 other first-years, two nurse practitioner students, one graduating MD student, and a couple of residents are working to source PPE for Yale New Haven Hospital (YNHH) and neighboring hospitals, including those in southwest Connecticut where there is a high number of COVID-19 infections. After reading about medical students in New York City and San Francisco undertaking efforts to collect PPE, they reached out to the students for advice on best practices, and then contacted hospitals, who confirmed they would welcome donations.
Janda and his team are using social media to spread the word about the need for PPE and their willingness to pick it up and deliver it to hospitals. And they are cold calling businesses such as hardware stores, construction companies, hair salons, and laboratories in search of PPE. The businesses have helpfully pointed them to suppliers who may have useful stocks.
While the first-year students are engaged with online classwork, Janda explains they “felt helpless sitting on the sidelines and wanted to do something.” Anyone with PPE to donate can email email@example.com.
Supporting outreach to non-COVID patients:
On March 16, second-year MD student Annika Belzer was on her clinical rotation, when she learned all student rotations had to be put on hold for the next eight weeks because of COVID-19. She spoke with her preceptor, hospital resident Peter Kahn, MD, MPH, ThM, about how students could help with the COVID-19 situation in an indirect way.
Those discussions quickly turned into the Yale Medical Student Task Force (MSTF). In partnership with the Department of Internal Medicine, about 100 MD and MD-PhD students are calling patients who have had their outpatient appointments cancelled, or rescheduled as virtual visits, due to COVID-19, to check on them and make sure they do not have any urgent medical or prescription needs. The students relay the information to the patients’ providers, and on-call faculty members address any urgent needs.
The first week involved a pilot with the Endocrinology Section: students contacted about 600 patients over three days. The week of March 30 will focus on Cardiovascular Medicine. The six second-year students who serve as faculty and student liaisons (Hannah Batchelor, Belzer, Mariana Budge, Sarah Fitzpatrick, Emily Gudbranson, and Anna Zhao) are excited that they, along with other student leaders (Diego Armengol, Samer Hassan, Lucy Kohlenberg, May Shum, Muriel Solberg, and Erin Yeagle), with the help of Kahn and faculty advisors Frank Bia, MD and Peggy Bia, MD, were able to rapidly create a structure that allowed many students to have an impact.
They have received positive feedback from patients who, for example, were “really glad to know they have not been forgotten,” and providers, for whom this extra support has reduced their non-COVID workload.
Gudbranson says “it is heartwarming to see how many people wanted to help and we now have a community of about 100 students engaged.” Notably, the AAMC has reached out about the program, and the students hope this can become a model for others.
HAVEN Free Clinic:
HAVEN Free Clinic is a critical resource for uninsured, low-income New Haven residents, but as coronavirus continued to spread and social distancing became imperative to stem the health crisis, it became clear that HAVEN needed to find a way to minimize exposure for patients and volunteers. Faculty and student leaders of HAVEN decided that completely shutting down was not an option, so they are finding new ways to continue serving their patients.
The leadership team determined the best plan was to switch to telehealth. Fifth-year medical student Pavithra Vijayakumar, Jones Fellow and one of the executive directors of HAVEN, says, “volunteers were comfortable with this approach because it was becoming standard of care nationwide,” including at Yale Medicine.
Starting March 16, Yale School of Public Health student volunteer Melia Bernal’23, and Yale College student volunteer Natalia Reyes Becerra ’20, called all patients, triaging their needs and educating them on the transition to telehealth. Those with COVID-19-related inquiries were directed to the YNHH COVID hotline. On clinic days, clinical team members conducted visits by taking histories over the phone, refilling medications, and placing referrals to specialty care after presenting remotely to attending preceptors. After two successful Saturdays of providing care by phone, the clinic is now exploring how many of their patients would be able to receive a video call.
Vijayakumar noted that adapting to telehealth has been a good learning experience for students in providing care in a resource-limited setting. She goes on to add, “the transition has been a huge team effort and we are grateful for all the volunteers and the support of the HAVEN faculty advisors, Margie Hebert, MBA, at Yale Medicine, and the leadership at Yale School of Medicine and Yale School of Nursing.”
Elena Sullivan, a second-year PA student and senior clinical team member, echoes these sentiments, “the student volunteers and supervisors at HAVEN have taken innovative approaches to ensure the health and safety of our patients, peers, and the New Haven community. I am so proud to be a member of such a dedicated team.”
HAVEN also acknowledges that those hit hardest by the pandemic are vulnerable communities like the one HAVEN serves, so volunteers are actively connecting patients to important community resources that address mental health needs and food and income insecurity.
For example, Maria Dalzell, a first-year PA student and one of the directors of the Education Department, says the team continues to call patients and counsel on nutrition, fitness, and chronic disease management and, “recognizing that our patients may not have access to their usual resources such as groceries and gyms, we are collaborating with them to find the best way to stay healthy during this shelter-in-place period,” adding “our goal is to let patients know that we are still here for them, and that we care about their health!”
Even with the tremendous efforts from volunteers and community organizers, HAVEN leadership says much more still needs to be done to protect the New Haven community from the pandemic’s effects.
Patient navigators for refugees:
Second-year MD student Lucy Kohlenberg, who led the Yale Patient Navigator Program (YPNP) until January, reached out to Integrated Refugee and Immigrant Services (IRIS) to help when the COVID-19 crisis began, along with first-year students Chandler McMillan and Michael Amick and second-year student Samer Hassan. YPNP is a student collaboration (medical, PA, and nursing students) that aims to address barriers to care by connecting patients with community-based health and psychosocial resources.
Many of YPNP patients are affiliated with IRIS, so, as Kohlenberg explains, “we have decided to collaborate further with IRIS now, because there is a gap in Covid-19 news and resources that are accessible and available to those who do not speak English or who have limited technology access. Additionally, many refugee families are newly introduced to the US healthcare system, which is already exceedingly difficult to navigate for most Americans and more so at this time. As navigators, we will be reaching out to families via phone (and interpreter when needed) to provide them with information on COVID-19 and community resources.”
Training PAs and military collaboration:
Second-year PA Online student William Eisenhart is using his military experience and connections, and current PA training, to play an active role in the fight against COVID-19, and to ensure other PAs also can make a difference.
Over the past month, Eisenhart has been collaborating with the Special Operations Medic-Coalition (SOM-C), Fort Belvoir Community Hospital, and Interservice Physician Assistant Program (IPAP) students and preceptors. (IPAP is the PA training program for all the armed forces.) Because Special Operations Medics have unique experience working in austere settings, creating pop up clinics, and supporting populations with minimal supplies, they realized they could provide valuable guidance during the COVID-19 crisis.
Eisenhart created a PowerPoint presentation on military ventilators in civilian hospitals, including the limits of a specific ventilator, to discuss with the IPAP students at Fort Belvoir, who will be in combat settings with ventilators. “I am doing what I can for the PA students to be value added in a triage or ICU setting if that surge occurs,” Eisenhart explained.
EMS and hospital volunteer:
Indumathi Dhakshinamurthy, a second-year PA student, has volunteered with the Stratford EMS since 2015, and says “when I saw pages being sent out for extra help, I thought it would be a great way to continue serving my community during this time of crisis and jumped at the opportunity.” She explains that “despite the COVID-19 crisis, we are still rendering care for medical and traumatic emergencies and ensuring their timely transport to a local ED.”
She also is an employee at Bridgeport Hospital’s Emergency Department. “The ED is always seeking more hands to help out, especially now when new assignments are being added such as COVID testing.”
Dhakshinamurthy says that while “clinicals are suspended, I plan to continue helping my colleagues and community in whatever way I can.” She also expressed thanks to others in the community, “it’s also amazing to see the community come together and donate PPE and even meals for the whole department. Local restaurants are hurting, but they still somehow find a way to help out their ED and EMS, which is beautiful.”
MD-PhD student Elizabeth Woo, a third-year student, is home in Chicago during the clerkship suspension. However, she was eager to engage from afar and is helping get groceries to older individuals. As she explained, “there are stories after stories about how elderly community members, even after making it to the grocery store, couldn't get the necessities because by the time they got there, those goods were all gone. And unlike me, who could then quickly run over to another grocery store, that would take much more time, effort, and greater risk for exposure for the elderly community members. While we all are combating fear and worry during this pandemic, for our elderly community members, those fears and anxieties may be much more amplified, and that was a burden that I wanted to share in and help with.”
The YSM Office of Student Affairs created a listserv where organizations needing volunteers could describe their needs, and students could sign up to help. This has led to a wide range of volunteer opportunities, including providing childcare for residents and faculty on the front lines of the COVID-19 crisis, organizing Red Cross blood drives, conducting literature searches for clinical faculty, and helping at the Downtown Evening Soup Kitchen.