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After five years, HAVEN clinic still thriving

Yale Medicine Magazine, 2012 - Winter


A student-run free clinic on Saturday mornings provides health care to New Haven’s uninsured.

The staff meeting starts at 8:30 on Saturday mornings. Thirty or more students in medicine, nursing, public health, the Physician Associate Program, and graduate and undergraduate programs—supervised by volunteer physicians, nurse-midwives, and physician associates—gather on the second floor of the Fair Haven Community Health Center to orchestrate a free clinic called HAVEN (HAVEN stands for health care, advocacy, volunteerism, education, and neighborhood.) over the next four hours. The session coordinator for the day, Kate Standish, entering her second year as a medical student, assigns teams of senior clinical team members (nursing or third- or fourth-year medical students); junior clinical team members (first-year medical, physician associate, or nursing students); and interpreters (students fluent in Spanish) to work with attending physicians. Charts are distributed, bagels inhaled, and the teams descend to the first-floor exam rooms where they will provide care to uninsured and underserved patients in New Haven. About 90 percent of HAVEN’s patient base are immigrants.

Since it opened five years ago, the clinic has seen hundreds of patients, filled countless prescriptions, referred patients to other health care providers in New Haven, and provided an opportunity for medical, nursing, and physician associate students to learn in a clinical setting. Six years ago students approached Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs, with the idea of launching a free clinic in one of New Haven’s poorest neighborhoods. The students, though enthusiastic, had little in the way of a business plan. “I told them, ‘You know a free clinic isn’t free,’ ” said Angoff.

The students regrouped and presented Dean Robert J. Alpern, M.D., Ensign Professor of Medicine, with a prospectus that overcame his initial reservations. He agreed to provide a $20,000 grant. In June, in his State of the School address on reunion weekend, Alpern called HAVEN “one of the great stories” of the School of Medicine.

The clinic also relies on the support of the Fair Haven Community Health Center, which provides the space on Saturday mornings. “Without them,” Angoff said of the health center’s staff and administrators, “it could not exist.”

HAVEN’s mission is hardly novel: trainees serving the poor and in the process learning at the bedside is a pillar of American medicine. But HAVEN is also the largest weekly lesson offered by the medical school in how to work in health care. By involving nursing, physician associate, and public health students, the clinic is a place where future doctors learn to collaborate with other health care professionals—a valuable skill as primary care increasingly falls to physician associates and nurses. And unlike those in many free clinics, students at HAVEN really do work. From running the social services referrals department to scheduling and providing lifestyle counseling, student volunteers at HAVEN get a 360-degree window of access into a patient’s life.

“Whatever it means to live with illness, one can’t possibly understand that until one works with patients,” said Angoff. “HAVEN is an opportunity right from the beginning to understand that.”

Medical student Lauren Graber spent a year as the inaugural John A. Jones–HAVEN Fellow, an honor that means she was responsible for organizing the clinic and performing community-based research. Graber said HAVEN provides students with a chance to care for patients consistently through their time at the School of Medicine. “Because of the collaboration between different years and experience, we have first-years re-teaching older students about the social contextualization of care,” Graber said.

Contextualization of care is a big topic among HAVEN volunteers. HAVEN is rooted in understanding New Haven’s immigrant population—what countries they come from, how they earn money, where they get (or don’t get) their groceries. It’s that holistic approach to care that appealed to Emily Thomas, a medical student who serves as the education co-director of HAVEN.

“These patients need additional education and support in order to be healthy,” said Thomas. Thomas works with the patient lifestyle counseling program, ANDO (“I walk” in Spanish), which helps treat chronic disease with nutrition and exercise. On a Saturday in June, she found herself making soy smoothies, introducing a Zumba (dance-fitness) class, and counseling a woman who wanted an IUD. To steer more patients to ANDO, and such departments as social services and women’s and men’s groups, medical charts now carry a sticker that reminds team members to screen patients for food insecurity and daily habits. “For me medicine is not performed in a vacuum,” said Thomas. “You have to understand the patient first.”

After more than 250 Saturdays and 1,000 patient visits per year, the directors of HAVEN have learned that their clinic can’t do everything. An in-house pharmacy was abandoned, and urgent care cases are now referred to Yale-New Haven Hospital or to Project Access, a program in which specialists donate free care. Most notably, HAVEN patients are now transferred to the regular Fair Haven clinic after one year. Standish said that haven sees itself as a “portal to care,” not a long-term solution for its patients.

But the clinic is a boon to students at the School of Medicine who are looking to explore a career in primary medicine or to apply the science and medicine that they learn in the classroom. “The first year of med school is focused on basic science and classroom learning. At HAVEN I go into the community and learn how to provide clinical care in the type of environment I want to work in,” Standish said.