HOMES Clinic offers a “House of Yes” for Houstonians Experiencing Homelessness During Coronavirus Pandemic. But Where Are the Rest of Houston’s “Student Run” Free Clinics?

Press Release: HOMES Clinic offers a “House of Yes” for Houstonians Experiencing Homelessness During Coronavirus Pandemic. But Where Are the Rest of Houston’s “Student Run” Free Clinics?       

Authors: Nicholas Peoples, Mary Fang, Dr. Dana Clark

Article:    

HOMES Clinic in downtown Houston, operated under Healthcare for the Homeless Houston (HHH) [1], has an unusual staff and an even more unique patient population. Every Sunday morning at 7:30, medical and pharmacy students throughout the Texas Medical Center put aside their hectic training and come together to run a free clinic. And their patients? Houstonians experiencing homelessness.

Such “student-run” free clinics are a keystone of medicine. They prioritize the most disadvantaged groups and train future physicians to engage with their community. Although HOMES has a licensed physician and pharmacist on-site, every aspect of the clinic is entirely student managed. Some students take histories and perform physical exams. Others participate in a needs-assessment to anticipate what services patients need most. And still others are trained as adjuvant social workers: connecting patients to rehab, housing services, and finding a primary care physician. The “student-run” model is so effective because care is delivered by a physician, but all other responsibilities are “task-shifted” to motivated and skilled volunteers. When students volunteer with underserved populations, they are more likely to do this in their future career. And when homeless individuals get a hand up to get off the streets, the community is made better for everyone.

But what kind of care can a “student-run” clinic really provide? To answer this, just consider the story of a woman we’ll call Susie. Susie had been living under a bridge and had prior negative experiences with healthcare, but came to us because she was personally invited by our staff. We took the time to provide a comprehensive visit that ultimately ran two hours. This enabled us to build a foundation of trust, provide her with lunch, and sort through her complex medical records. We discovered that Susie had a positive HIV test in the ER over 10 years ago, but no one had ever told her. Disclosing that news fell through the cracks while she was being evaluated for other acute issues. At every subsequent doctor visit, no one else told her either (they likely assumed she already knew, or didn’t read all her medical records). It was a student-run free clinic – specifically devoted to meeting the unique needs of people like Susie – that caught this diagnosis, empowered her with knowledge of her HIV status, and immediately linked her into treatment. Moreover, when diseases like HIV are caught and their spread is limited, our communities become safer, too.

What makes HOMES truly unusual, however, is that it is the only student-run free clinic in the entire city of Houston. By comparison, consider that Chicago, a comparably sized city, has at least 15 such clinics [2] serving the full spectrum of vulnerable populations, from uninsured children and refugees to LGBTQ+ youth and IV drug users.  Within Texas, for a more local comparison, Long School of Medicine in San Antonio has seven clinics [3] and UT Southwestern in Dallas five [4]. So in Houston, home to the world’s largest industrial medical complex and three top-ranked medical schools, where are the rest of our student-run free clinics?

The TMC trains approximately 1,840 medical students and produces 450 new physicians each year [5]. There is an explosion of interest among young medical professionals to be on the frontline of caring for our city. And in the era of COVID-19, where there is unprecedented need and more restrictions than ever on service organizations [6], student-run free clinics are uniquely positioned to help bridge these service gaps. Given their astounding paucity in our city, though, it begins to resemble a sort of hidden desert within a booming medical oasis.

Harvard physician Paul Farmer breaks healthcare delivery down into “four S’s”: staff, stuff, space, and systems [7]. Houston has all four in spades. What’s needed is the political will to utilize them. HOMES Clinic, for instance, was born when HHH established agreements with participating schools (system) to allow medical and pharmacy volunteers (staff) to operate out of Cathedral Clinic (space and stuff) on Sundays. We now help extend HHH’s reach on Sundays and proudly staff a House of Yes for Houstonians experiencing homelessness, who are far too often told “no.” But our house is getting full. What about uninsured children? LGBTQ+ youth? Under-insured minority communities? The list goes on — and with such grand challenges come grand opportunities.

The creation of HOMES Clinic is a replicable process, and Houston deserves to have a House of Yes for everyone. It’s time to capitalize on the enormous resources we have available and realign “health” with “care” in our communities. This starts with inspiring new conversations between our local academic powerhouses, service organizations, philanthropic institutions, and advocacy groups about the role student-run free clinics can play in our community. These simple conversations have the power to shape major contributions to our city and therefore merit our invigorated attention.

Biography                                                                                                                              

Nicholas Peoples and Mary Fang are medical students at Baylor College of Medicine and serve on the Board of Directors at HOMES Clinic. Dr. Dana Clark is an attending faculty physician at Baylor and has been involved with HOMES Clinic and Healthcare for the Homeless Houston for decades.

Corresponding Author:

Nicholas Peoples. Cell: 281-475-5426. Email: Nicholas.peoples@bcm.edu

References

1. https://www.homeless-healthcare.org/
2. https://cfcc.mystrikingly.com/
3. http://studentrunclinics.org/
4. https://sites.google.com/view/utswsrfcs/free-clinic-committee
5. These estimates are derived as follows: Every year, BCM admits a class of approximately 180 students, UT McGovern ~250, and UH School of Medicine ~30-50. The MD program lasts four years at each school, resulting in ~460 MD graduates each year and a total enrollment of ~1,840 medical students in the Texas Medical Center at any given time.
6. https://www.commonwealthfund.org/blog/2020/essential-social-services-are-struggling-survive-covid-19-crisis
7. https://auroraprize.com/en/staff-stuff-space-and-systems