On Saturday mornings, most Yalies are recovering from the night before and looking forward to a day without classes. A group of students, however, is getting ready for a day of hard work at the HAVEN Free Clinic.
Since it first opened its doors in 2005, HAVEN has been located on 374 Grand Avenue, in the heart of Fair Haven, a neighborhood of eastern New Haven that is home to a sizable immigrant community. HAVEN provides medical services free of charge every Saturday from 9:00 a.m. until noon. The clinic runs in partnership with the Fair Haven Community Health Center, a healthcare provider that charges on a sliding scale and operates from the same building when HAVEN is closed.
HAVEN is staffed by students from Yale’s Schools of Medicine, Nursing, and Public Health, and caters exclusively to uninsured patients who cannot access long-term medical care in other health centers. Service is limited to residents of Fair Haven between the ages of 18 and 65. Since the clinic does not advertise, patients are usually referred there by friends or family. Most patients come to the clinic seeking primary care: to check up on a pain that they have had for weeks, for a general examination, or to get their blood pressure tested. Demand is high—patients have to schedule appointments up to eight weeks in advance. On average, the clinic receives 800 visits a year.
The demographics of Fair Haven present special challenges to HAVEN. In the estimation of one of the clinic’s directors, Kate Standish, MED ’14, 90 percent of the patients are immigrants and almost 60 percent are undocumented. Partly because the clinic does not ask its patients to provide proof of their immigration status, many of HAVEN’s low-income patients speak little or no English. In an effort to overcome this difficulty, the clinic employs the services of 27 bilingual student-interpreters, many of them Yale undergraduates.
“The mission of our clinic is to serve patients who lack health insurance,” Standish said in an e-mail. “In Fair Haven, that happens to be a primarily Hispanic population. Recent immigrants often have jobs that do not offer health insurance, and many are not eligible for government insurance programs. In other neighborhoods or cities, the demographics of the uninsured would be different.”
Explaining the need for places like the Free Clinic, Standish said that although community health centers such as the one with which HAVEN shares a building provide healthcare at low costs, many uninsured patients cannot afford even the lowest of fees. Without a place where they can access long-term primary care, many patients in vulnerable demographics are forced to receive treatment in emergency rooms at hospitals, often incurring heavy costs. “In general, ERs do not deny care to anyone,” Standish added, “but they do charge everyone.”
A patient’s visit to HAVEN takes the form of a journey through a number of stations. After checking in at the front desk, patients meet with a clinical team of three volunteers: a junior clinician, a senior clinician, and an interpreter. The senior clinician, usually a second- year professional health student, administers primary care. The junior clinician, who tends to be a first-year medical student, is responsible for guiding patients to different departments of the clinic—the laboratory if they have to draw blood, or the pharmacy to pick up prescriptions.
The interpreter is present at all times to facilitate communication between the patient and the two clinicians. In addition to the clinical team, every patient has to be seen by a licensed medical doctor, also known as a “supervising attending.” The doctor, however, does not have to be present throughout the entire visit.
To guarantee that every patient will receive appropriate care, each volunteer receives specialized training. For example, volunteers working in Patient Services—the department in charge of scheduling appointments, registering newcomers, and making calls to patients—have to be fluent in Spanish even if they do not act as interpreters. For interpreters, training entails learning medical terms as well as developing ways to communicate information without becoming too technical in their use of language.
In addition to department-specific training, all volunteers are trained in how to deal with situations in which the patient cannot speak directly to his
or her physician.
Most of the Clinic’s volunteers are first-and second-year students from Yale’s graduate schools of the health professions. Susan Combs, MED ’14, HAVEN’s director of patient services, explained that because medical students spend the third year of their program working at a hospital, most of them prefer to volunteer during their first two years. Sometimes students will volunteer again in their fourth year, while they are conducting research.
Although they acknowledge the challenges of volunteer work, all of the student-staffers interviewed report positive experiences at the Clinic. Combs said that she has been volunteering at HAVEN since her first year as a medical student. Balancing academic and philanthropic commitments can be difficult, but Combs said that working at the clinic has been worth her while. “It’s more of a positive emotional experience for me. I enjoy the relationships I have with the patients,” Combs said. “It’s such a cool place to be a part of.”
Ted Lee, SY’ 12, who is the only undergraduate on the clinic’s governing board said said that working at HAVEN has proven to be both a way to learn and to give back.
“It is a good way to practice and use my Spanish skills, but that’s not the main reason,” he said. “The most important thing is that you get to help people. One day I came into Patient Services and there was a walk-in, and he had cut himself somehow, and had a huge gash in his arm, and I was all of the sudden thrown into an interview in Spanish to ask him what had happened, what was his past medical history, and see if he was eligible for care at HAVEN. It really is hands-on learning, in a way most Yale students don’t ever experience. It is really satisfying to see that you can do real work for real people, to be able to do something that you know is appreciated.”
Gladys Rodriguez, MED ’14, who oversees the interpreters, said that as a college student she had shadowed several doctors. Working at the clinic, she thought, would be a similar experience.
“I wanted to use something I know—the Spanish language—and also learn about medicine at the same time,” Rodriguez said.
Working at HAVEN, however, turned out to be much more for Rodriguez than merely an educational experience. “There is a lot of responsibility,” she added, “and you have to be careful as you are taking care of a person’s health.”
Standish said that working with the Fair Haven community has made her more aware of certain issues that might not be as apparent at other health centers.
“It has highlighted to me the barriers that everyone faces in accessing health care,” she said, “but particularly those who don’t speak the language or are fearful of their immigration status.”
Beyond language barriers and legal considerations, HAVEN volunteers face other problems commonly associated with immigrant populations. Ferrin Ruiz, MED ’13, a senior clinician, said many patients face social stressors and difficulties at home that make them especially vulnerable to depression. When immigrants leave their home countries, Ruiz explained, they often leave their families behind. As such, they lack a social net and can experience loneliness, which makes dealing with the challenges of life in another country much more difficult.
Ruiz tries to offer as much help as she can, even if sometimes it is just listening to the patient talk about his or her feelings. “It’s heartbreaking,” she said, “but they are very grateful.”
Despite the high prevalence of mental disorders, the clinic does not have the resources to provide mental healthcare. Nevertheless, all patients are tested for depression as a part of standard medical screening. Patients who need care beyond HAVEN’s capabilities are referred to one of the clinic’s many partner health centers, where they are treated free of charge.
“Our clinic is focused on providing primary care,” Standish said. “For other services, such as specialty consults and mental health, we refer out. In the case of mental health care, there are limited providers, particularly for the uninsured, and we often refer our patients to Fair Haven Community Health Center when they are in need of mental health care. Another option in New Haven is the Hispanic Clinic at the Yale-affiliated Connecticut Mental Health Center.”
In part because of the high number of referrals, the clinic is constantly trying to expand its services and provide treatment beyond primary care. Among the more recent programs is the Latent Tuberculosis Initiative. Standish explained that tuberculosis is common among immigrant populations, many of whom come from countries where the disease is endemic. The program entails a nine-month course of treatment for individuals who have the disease without symptoms.
Another such initiative is Advancing Nutrition and Dietary Outcomes, which was founded in 2009 to help patients lead healthier lifestyles. Patients whose body mass index exceeds 25 are required to meet for a one-on-one session with the program’s counselor to discuss eating and exercise habits. Exactly how long patients are enrolled in the program varies depending on the individual’s needs.
The Women’s Health department has also seen some recent changes. The department used to consist exclusively of support groups, which met weekly to discuss issues such as coping with being away from one’s family. Now there are volunteers who are available to counsel patients regarding birth control and prevention of sexually transmitted diseases.
On a lighter note, the clinic also offers Zumba classes in the mornings, for patients who are feeling energetic and in the mood to hit the dance floor at 9 a.m. on a Saturday.
“We have worked hard to give our patients all the things they need,” said Adelina Hung, MED ’12 , a clinical services advisor who has been working at the clinic for several years. “We are more organized, more efficient, and we provide more services than ever before,” she added, commending the way the clinic has grown in the past few years of operation.
The clinic’s expansion, however, has not been devoid of difficulties. Since HAVEN is funded entirely through donations, financial concerns are always present. For the past three years, the clinic has received 80 to 90 percent of its funding from the Gilead Foundation, a non-profit organization that seeks to improve the health and well-being of under-served communities around the world. There are also a number of other foundations and individual donors who help finance the clinic.
Before the Gilead Foundation’s large gift, the clinic had relied on small individual donations, as well as grants from the Yale School of Medicine. In addition to the Gilead Foundation, the clinic has received an emergency grant from an alumnus. The grant would allow services to proceed as normal for a year in case there were no other funding available.
Despite these difficulties, the clinic’s staff remains enthusiastic and committed to improving the lives of the residents of Fair Haven. “A lot of people at Yale focus on a lot of really important global issues,” said Lee. “I don’t mean to discount all the work people do in other areas of the world, but a lot of times we forget about the terrible conditions of people a ZIP code away. I think it’s amazing that there is this outlet for Yalies to help New Haven residents in such a tangible way.”
—Contributed reporting by Nicolás Medina Mora