student-run free clinic project: lessons in compassion, community, and courage

For 25 years, UC San Diego Student-Run Free Clinic Project has provided free high-quality care to underserved communities, while inspiring the next generation of health professionals. Free thorough ongoing care is provided in community settings to people who have nowhere to turn and do not qualify for access to care. The clinic philosophy has four tenets: empowerment - creating environments where patients take charge of their lives and achieve wellbeing, a humanistic approach - embodying Rogerian principles of empathy, respect, and self-awareness, a transdisciplinary model, one where the patient and community are the teacher. This philosophy permeates the life of the clinic. These values are taught, modeled, expected, and observed in curricular components throughout the four years of medical school. 250 medical, 75 pharmacy, and 100 predental students are involved each year as well as students in law, social work, and acupuncture. Students learn to be healers, artists, teachers as they become health professionals. At each clinic session student leaders gather the team in a large circle, and lead a sharing of recent stories and experiences reflecting the core tenets. All work is directly supervised by licensed clinicians, many of whom were once free clinic students. During the era of COVID, care became virtual. Promotors helped patients learn to use Zoom to receive care. Visit attendance increased to 100%. Our Spanish language empowerment group met online. The clinic already provided healthy food bags to patients at medical visits. Students and volunteers organized to deliver food and medication to people’s homes.

Summing Up an Immeasurable Year

COVID-19 has drastically impacted healthcare delivery across the United States and globally. This article outlines the strategic challenges of a free clinic in Milwaukee, Wisconsin, during the pandemic and describes various responses to these challenges. Communication with patients and staff, loss of volunteer practitioners and employee relations are spe- cifically explored. The author argues that implicit aspects of the free-clinic business model positively impacted clinic re- silience and suggests that lessons in workplace culture could be applied across sectors, with the aim of improved resilience during difficult times in the future. RÉSUMÉ Le COVID-19 a eu un effet considérable sur la disponibilité des soins de santé aux États-Unis et dans le monde. Cet article décrit les défis stratégiques confrontant une clinique gratuite à Milwaukee, Wisconsin, pendant la pandémie et recense di- verses réponses à ces défis. L’article explore en particulier la communication avec les patients et le personnel, la perte de praticiens bénévoles et les relations avec les employés. L’auteur soutient que certains aspects implicites du modèle d’en- treprise que représente la clinique gratuite ont eu un impact positif sur la résilience des cliniques en général et suggère que certaines leçons provenant de la culture d’entreprise de celles-ci pourraient s’appliquer à des secteurs différents dans le but d’améliorer leur propre résilience lors de futures périodes difficiles.

Reallocation of Carotid Surgery Activity with the Support of Telemedicine in a COVID-Free Clinic during COVID-19 Pandemic

The aim of this study is to report the reallocation of carotid surgery activity with the support of telemedicine in a COVID-free clinic during COVID-19 pandemic. Patients with symptomatic carotid stenosis or asymptomatic vulnerable plaques were reallocated to a COVID-free private clinic which began to cooperate with the National Health System during the emergency. Quick training of staff nurses was performed. Surgeons moved to the COVID-19 free clinic. Remote cerebral monitoring was performed with the support of telemedicine. Twenty-four patients underwent standard carotid endarterectomy with eversion technique. Five patients (20.8%) had recently symptomatic stenosis, and the remaining 19 patients (79.2%) had a risky asymptomatic carotid stenosis. No technical issue with remote cerebral monitoring was detected. In the early postoperative period, no neurological/systemic complication was observed. Three patients under dual antiplatelet therapy (12.5%) had neck hematoma. All patients were discharged the day after surgery. In our preliminary experience, reallocation in a COVID-free clinic allowed us to maintain a functioning carotid surgery activity during COVID-19 pandemic. A multidisciplinary approach and support of telemedicine were crucial. Training of unskilled nurse staff was necessary.