Although it’s 8:00 on a Saturday morning, Carlos Mena-Hurtado, MD, strolls into the Yale Physicians Building wearing his white coat. During the week, the building is home to some of the main care facilities for the Yale Internal Medicine practice. But on Saturdays, medical, physician associate, and nursing students come together to transform it into HAVEN, a free clinic providing comprehensive primary care services to those in need. The student-run organization serves uninsured, often undocumented individuals from low-income backgrounds. Originally founded in Fair Haven, the clinic found its new home on Howard Avenue in 2017.
“In the spring of 2004, a group of Yale health professional students undertook a needs assessment in the community that found that a growing number of New Haven residents lack access to medical care,” says executive director Mariana Budge, who is a fifth year medical student. “Driven by these findings, the HAVEN Free Clinic was established in the fall of 2005 with the mission to provide comprehensive, quality and accessible primary health services to uninsured individuals in greater New Haven County.”
HAVEN, says Mena-Hurtado, who is associate professor of medicine (cardiology), is truly a haven for those who access its services. He first learned about the clinic through a medical student, Paulina Luna, who was studying the prevalence of peripheral artery disease. Many of the patients in the study used the emergency room as their primary way of receiving care. While discussing how to address this issue, she told Mena-Hurtado about HAVEN. He became intrigued about volunteering to help patients visiting the clinic, the vast majority Spanish-speaking.
“As a Colombian native, it means a lot to me to connect with my people,” Mena-Hurtado says. “Coming from a similar cultural background as mine, I understand them at a level many others don’t. It’s important to me to be able to care for them and give back from a place of privilege.”
A group of medical students enters the HAVEN office to present their first patient of the morning—a middle-aged man from Guatemala with latent tuberculosis. Mena-Hurtado briefly discusses the plan of care with the patient in Spanish while one of the students prepares free medication to help him manage his condition.
As a world-renowned interventional cardiologist, Mena-Hurtado often uses high technology to perform very advanced procedures during his day-to-day work. This is often lonely and isolating, he says, and doesn’t allow him to build the strong, multi-dimensional connections with patients for which he first went into medicine.
“This clinic gives me that,” he says. “Volunteering here is very rewarding, and the connections I form with patients are much different than the work I do during the week as a cardiologist.”
The next patient Mena-Hurtado sees is suffering from pain in her arms, legs, and feet, making it difficult for her to walk. When trying to determine the source of her pain, she had tried to explain to the group of students how she would wash her clothes by hand back in Mexico. While the students have an interpreter, it’s not uncommon for things to still get lost in translation. Mena-Hurtado is able to explain to the students that there are no standard washers and dryers where she is from, and how the device she used to manually wash her clothes works. Then, he orders an electromyography (EMG) test to better assess the patient’s extremities.
“Mena-Hurtado is remarkable,” says Harlan Krumholz, MD, Harold H. Hines, Jr. Professor of Medicine (Cardiology). “He’s so busy clinically and works so many hours, but he still finds time to do this. It speaks to Mena-Hurtado as a person, but also to the clinic itself for being able to attract someone as high-caliber as he is.”
Krumholz, who also volunteers at HAVEN, became drawn to the clinic as a retreat from the hustle of working in the medical field. While medicine can be complicated, he says, HAVEN is a place that feels “pure.”
“In the midst of a medicine that has very much become big business, HAVEN is simply about extending a hand to people in need,” he explains. “This is a place where they can feel safe. And this is a place I would like to be.”
When caring for patients, Krumholz prefers to take a comprehensive approach. When a group of medical students presents a patient complaining of sinus pain, he asks her about the most important issue she wants to address. Instead of pain, she states that she most wants help managing her anxiety—she works long, 12-hour days in a factory during the week. Krumholz reassures her that she looks healthy and robust, and she visibly relaxes on the table. “Words have a strong therapeutic effect,” he tells the students. Together, they work on a plan to help the patient obtain mental health help. “Instead of immediately throwing medications at her, I like to treat the problem more holistically,” he says.
Modern medicine, despite the growing availability of advanced technologies, still can fall short of meeting a patient’s needs. During the week, Krumholz says, the pressure of getting through the patient list often makes it hard to create the space people need to form connections with their providers. The way HAVEN is organized, on the other hand, allows him the time to help his patients feel comfortable and develop trust. And sometimes simply taking the time to talk to the patient, he continues, can help tremendously.
However, as attendings, Krumholz says, he and Mena-Hurtado are only a small part of the story. The success of the clinic is largely due to the devotion of the students who donate their time to make HAVEN possible. One of the students at the forefront is Budge, who has dedicated this year solely to running the clinic. “Students like Mariana take a year of their lives to make this place work. They’re the real story of this place,” Krumholz says. “Yale attracts such incredible students. The fact that they give HAVEN their attention and time when there are so many things they could be doing is impressive.”
Budge began volunteering at the front desk during her first year of medical school. She initially got involved because she was interested in primary care, but quickly fell in love with volunteering. Since she started, she has taken on four different positions and now is executive director. “The patient population has kept me here. They are a wonderful group of individuals,” she says. “There’s a lot of mutual trust between us, and I’m heartened by the amount of services we are able to provide.”
The services HAVEN provides, she says, extend beyond health care. Its comprehensive approach makes it unique among clinics in the area. In addition to the medical department, it also has ancillary departments to help patients with a wide variety of needs. The social services department, for example, works on issues like housing or food insecurity. HAVEN also has a medical legal partnership for patients going through civil issues such as immigration status or medical debt. It also contains an insurance department to ensure patients aren’t getting billed, and also tries to set them up with insurance when possible.
The social services of HAVEN became even more important during the pandemic, and even during this turbulent time, it saw these departments grow. With the support of community partners like the Semilla Collectiva and la Unidad Latina en Acción (ULA), they started connecting patients with funds, for instance, to help them access food.
“As a student, being able to have an effect on someone’s health care outcome is impactful,” Budge says. “I feel inspired knowing that patients trust the care here and feel that they can come to us with their medical and social needs.”