Schweitzer Fellows Escar Kusema and Jose “Tito” Porras have established a free health clinic at Upper Valley Haven, a homeless shelter in Wilder, VT, where they are providing primary care services to residents and other vulnerable community members. Their Fellowship project has taught them just how difficult it can be for people who are homeless, people who lack health insurance, and other underserved communities to access proper healthcare and maintain their health when living in such dire circumstances.
In one instance, they got a homeless woman they suspected of suffering atrial fibrillation an appointment at their community site, Good Neighbor Health Clinic, and then to an appointment at Dartmouth-Hitchcock Medical Center the following day. Kusema was able to accompany the patient, who had not seen a doctor in a year, through a series of tests and discussions with doctors about test results, treatment options, the need for more tests, and the dispensing of drug prescriptions. At each step of the way, her advocacy helped reduce the time it took from intake to diagnosis. She reminded doctors that transportation and costs were huge issues for the patient. As a result, the patient received all her treatment in one day and left the hospital feeling assured and knowledgeable about her condition as well as how to purchase her medication through Hannaford supermarket’s discounted prescription program.
“I was exposed to how expensive, time-consuming and terrifying it can be to navigate through the healthcare system to get an answer to one question,” says Kusema. “Through this, I learned that it is important to be aware of the patient’s experience and do what I can to reduce time and expense by, for example, being careful with tests and prescriptions.”
Another time, Upper Valley Haven referred a husband and wife to Kusema and Porras. Reluctant to seek help, the couple took some convincing by Porras that the visit would be worthwhile. As it turns out, the wife was struggling with substance abuse, anxiety, and depression and was visibly uneasy through much of her interaction with Porras and a male Good Neighbor physician. She informed them that her depression had been successfully treated in the past with an antidepressant but she had discontinued the medicine due to its cost. Porras and the doctor told her there were affordable alternatives available through the Good Neighbor Health Clinic and the woman seemed more comfortable. Further discussion revealed her history was more complicated than either of the men had initially anticipated, but the woman was uncomfortable discussing it with them. When they offered to have her speak with a female physician, the woman seemed hopeful and relieved by the prospect.
“I am constantly amazed by how much of an impact you can make on someone’s life in less than an hour’s time,” says Porras. “Before I met this woman, she had been self-medicating for years with cutting, drugs, and alcohol, all because she didn’t realize that free healthcare with a qualified individual was available within walking distance. She did not realize that her prescription for a life-changing medication could be made affordable.”
Such interactions are all in day’s work for Kusema and Porras, both students at Dartmouth’s Geisel School of Medicine. Their Fellowship collaboration began when Kusema, who had been volunteering at the Good Neighbor Health Clinic, became interested in working with the clinic on a sustainable method of improving outreach to vulnerable patients by going directly to them, rather than always expecting them to find their way to the clinic.
“Given the demands of medical school, I knew achieving a sustainable model would require help from a partner with similar passion and goals,” says Kusema. “Tito happened to be that partner. During the Albert Schweitzer Fellowship Information session at Dartmouth, Tito expressed an interest in exploring the issue of healthcare access in the Upper Valley. We were quickly brought together and began planning a project.”
Kusema and Porras initially considered using a van to deliver healthcare at various locations, but soon realized the logistics of funding and maintaining a vehicle was prohibitive. They decided to focus on offering care to homeless people and Good Neighbor put them in touch with Upper Valley Haven, which welcomed the creation of a clinic at their facility. They hope to sustain and grow the program by enlisting other students interested in continuing their flagship clinic and replicating their model at other area shelters.
Porras says he was surprised by the diversity of his patients. “Each individual that we meet comes from a unique background that requires careful consideration when dispensing healthcare,” he says. “While it’s true that we are pursuing a strategy to provide healthcare and education to a specific target population, it is also the case that for each individual we must adapt reflexively to ensure that we meet our goals.”
Realizing her limitations as a person was an important part of Kusema’s experience with the project. She admits that her idealism gave way to practical reality—and that’s not a bad thing: “My hope was that we would begin at one shelter and quickly move to other shelters,” she says. “We would make sure every patient had our full support and help to cure all of their health struggles. But I quickly realized there was no way we could do all this and 1) maintain a good academic standing in medical school; 2) eat, 3) sleep, and 4) live as balanced as human beings.”
Kusema believes her Schweitzer Fellowship has given her a solid foundation of experience on which to build a medical career rooted in service to others. “I am thankful because the Schweitzer program set me on the right path by giving me the opportunity to start a clinic; serve a community; and grapple with the steps involved in doing so,” she says, calling her Fellowship “the single most important experience of the first two years of my medical school education.”
Porras also sees a long-term professional benefit to his Fellowship. “Being a Schweitzer Fellow is much more than a temporal experience that we leave behind once we complete the fellowship,” he says. “This is very much a process of adopting an ideology and applying it to our own lives so that our future actions reflect the mission of the Albert Schweitzer Fellowship. As a professional, the Fellowship has prepared me to embrace the continuous struggle for healthcare equity. Providing access to healthcare is no simple task but each day I am seeing that collaboration and an investment in the lives of those around you can make the challenge much less intimidating.”