Students Work Weekends to Help Homeless

It's 9 a.m., Sunday morning. Last night's weather was cool and the predictions of rain are backed up by the gray clouds overhead. Men and women head in different directions to continue the daily struggle of homelessness. Their day started by attending a church service at 7 a.m., followed by a breakfast of scrambled eggs, bacon, grits, and biscuits with coffee or hot chocolate, during which clinic managers move from table to table in the fellowship hall asking if anyone has medical or social needs they want addressed.

Across the street is the Lord of the Streets Episcopal Church. In a basement meeting room of the mission, a group of about 20 medical, pharmacy, and social work students prepare for the day.

After breakfast, the students, who have different disciplines and experience levels, divide into four teams. The patients, with whom the students just shared breakfast, wait in the clinic down the hall. Sujit Iyer, a third-year medical student at Baylor College of Medicine, shares that the talk at his table centered around problems of violence on the street. At another table, a woman spoke to first-year Baylor student Courtney Ramirez about her new granddaughter.

Welcome to the Houston Outreach Medicine, Education, and Social Services Clinic. The H.O.M.E.S. Clinic, as it is more commonly known, is a multi-institutional, multidisciplinary, student-run free clinic under the direction of Healthcare for the Homeless-Houston. Medical students from Baylor College of Medicine and The University of Texas Health Science Center at Houston created the idea for H.O.M.E.S. They invited students from the University of Houston Colleges of Pharmacy and Social Work, and The University of Texas School of Public Health to join in the effort. The resulting clinic opened for service in January 2000 with the mission of "providing quality, accessible health care to homeless Houston residents in a learning environment that promotes the dignity of all participants."

The students oversee the management and operations of the clinic through various committees, and are provided guidance by their faculty advisors, Dr. David Buck of Baylor, Dr. Andrew Harper of UT-Houston Health Science Center, Dr. Stephen Pierrel of Baylor, and Dr. David Wallace of UH College of Pharmacy. The student effort has also been helped by a group of volunteer physicians and pharmacists who serve as preceptors for the Sunday morning clinic. Several individuals involved with the clinic have been recognized for their contributions by various organizations. Allegra Mellilo, the second-year Baylor medical student whose vision and considerable effort started the clinic, received one of two Student Community Outreach Awards presented by the American Academy of Family Physicians last year, and recently, the Association of American Medical Colleges awarded Dr. Buck with a Humanism in Medicine Award.

As the teams are assigned, they introduce themselves to one another. The student clinic manager gives each team their first patient's chart and the team heads off to meet the patient. One of teams sees "Mr. W.," who's having problems with a head and chest cold. In the exam room, the medical students gather the patient's history and perform a physical on "Mr. W."

When one medical student asks if "Mr. W." has any chills, he replies, "I'm homeless. We're cold. I'm not around fires or warmth - until I get someplace like here."

He mentions that he had been living in an abandoned house until it burned down three months ago. Since then, he has been sleeping on the street. In addition to his cold, "Mr. W." has high blood pressure and has been out of his medication for a month. A pharmacy student asks him what medication he had been taking and how it worked for him. The students finish the exam and tell "Mr. W." they will return after they talk to the attending physician.

The students move to another room to present their findings to Dr. Khanh Nguyen, the volunteer attending physician for the day. After the team finishes with the presentation, Dr. Nguyen coaxes the team to contemplate his social resources and the barriers to care that challenge him. Together, Dr. Nguyen and the students develop a plan before heading back into the exam room. In the exam room, Dr. Nguyen examines "Mr. W." further to confirm the diagnosis.

Telling "Mr. W." they will be back shortly, the group walks across the hall to the medication room. Here the other team members turn to the pharmacy students. The group selects medications to best treat "Mr. W." with guidance from Dr. Nguyen and Dr. David Wallace, the pharmacy faculty advisor.

"I find putting my third year of pharmacy school knowledge into practice exciting," says Helen Huynh. "It helps the information we learn stick in my head when I have to apply it to a patient."

The medication is counted out and labeled. Huynh and Dr. Wallace review the information she will cover before going to counsel "Mr. W." on the medications he is receiving today.

At the end of the morning, the students sit down for the final activity of the clinic. Dr. Stephen Pierrel, a faculty advisor and clinical psychologist with Baylor's Department of Family and Community Medicine, leads the reflection period.

"Some self-reflection can focus a person's experience and help consolidate it. Shared reflections allow us to build on others' insights," Dr. Pierrel tells the group.

During the session, he asks the students and practitioners to think about what they encountered during breakfast, what it was like working with a team, and what struck them about working with homeless individuals.

"I noticed how important the connection to the patient is," shares one student.

Another student follows up on the thought saying, "It gets frustrating when the interview goes from a conversation over a cup of coffee to an interrogation."

Later, Dr. Pierrel asks who has been here a number of times and why they keep coming back.

One student replies, "As a first-year medical student, studying all the time can make you wonder why you're doing it. Coming here reminds me."

After the reflection period ends, Dr. Pierrel notes, "This level of personal sharing fosters teamwork and helps inoculate against premature provider burnout."

The H.O.M.E.S. clinic is still evolving to meet its goals and patients' needs. This spring, the clinic will open a Class D pharmacy. Recently, Healthcare for the Homeless-Houston began using an electronic medical record, donated by Medscape, to link many of the sites where the homeless seek medical treatment. Soon students at the H.O.M.E.S. clinic will be able to access this record. By seeing what prior care the patient has received and adding their own findings, the students hope to help decrease the fragmentation of care of their homeless clients.

Primary care physicians and pharmacists who are interested in volunteering as preceptors may call Moderia Horn at (713) 798-6067. For more information about Healthcare for the Homeless-Houston and the H.O.M.E.S. Clinic, visit www.homeless-healthcare.org.

---

©2006 Texas Medical Center

---

E-Mail: tmcinfo@texmedctr.tmc.edu
URL: http://www.tmc.edu/tmcnews/05_15_01/page_14.html