September 15, 2000
Plain white sheets hang from clotheslines strung across a large, bare room. A pair of Tulane medical students in short white coats, stethoscopes around their necks, adjust the sheets so that they fall all the way to the floor, then securely fasten them with clothespins. Patient privacy is of utmost importance.
It's late Tuesday afternoon at Bridge House, a halfway house for recovering addicts. Most Bridge House residents are homeless, though others have a home and a family to return to if they can stay clean. Many have come straight from prison or from detox at Charity Hospital. By 4 p.m., eight medical students will be here to staff a weekly clinic for Bridge House residents.
The clinic is the biggest component of Bridging Health Together, a partnership between Tulane University School of Medicine and Bridge House. The accoutrements are minimal. Exam rooms are ephemeral creations made of sheets and clotheslines. Instead of reclining on exam tables, patients lie on low slung twin beds that students must crouch over.
The big news this week is the clinic has been donated a box of paper exam gowns. This is medicine at its simplest, a throwback to the days when medical techniques weren't so sophisticated but doctors had plenty of time to really talk and listen to their patients. Here, students learn the fine art of taking a patient's history.
"We're learning to be better doctors," says Eva Lizer, a second-year student who will chair BHT next year. The students work in pairs, an upperclassman with an underclassman. Behind the white-sheet walls, they take a detailed history of the patient.
They talk about all the usual things doctors talk about with their patients-aches, pains, medications and family history of hypertension, diabetes or cancer. They also ask frank questions about drug and alcohol use, depression and suicidal thoughts. It's touchy material, and the students seem startlingly young, clean and unscarred next to residents who have been profoundly banged up by life. But the students appear comfortable with their patients and the patients seem comfortable with them.
"It's important for us to see this population," says Lizer. "It puts a human face on addiction. And I think we do a good job here. If we weren't here, these people would not be receiving care." After talking with the patient, students perform a basic physical exam.
All told, the students spend half an hour or more with each patient. They take so long partly because they're still learning and partly because they're really listening. They appreciate the relaxed, noncompetitive environment, so different from daily rounds.
After the exam, they'll confer with their supervisor, James Theis, a professor in Tulane's Department of Family and Community Medicine, who will make a diagnosis or prescribe treatment as necessary.
"These people are in a strict, stressful recovery environment," Lizer says. "We have to make sure they're healthy enough to get the most out of treatment."
Bridging Health Together began when fourth-year student Ben Springgate visited Bridge House while studying family medicine last summer. He saw that Bridge House residents had health needs that Tulane students might help meet. He talked to Hope Ewing, the director of predoctoral education in the Department of Family and Community Medicine, who agreed to support and oversee the project.
"We felt the Bridge House residents need consistent, standardized intake exams with the potential for follow-up care," Springgate said. "We also saw a need for immunizations, screening for things like HIV and hepatitis, and health education."
The clinic launched in November 1999. Since then, approximately 90 students have seen more than 450 patients. Besides running the clinic, students make weekend presentations to Bridge House residents on topics like diabetes, cancer and the effects of alcohol on the body.
Soon they will be able to offer HIV and hepatitis screening, but they've found themselves struggling with the question of whether or not it's appropriate to tell a Bridge House resident he has HIV during the stressful and difficult early phase of addiction recovery. The project is run and planned entirely by students.
Besides communication skills, they are learning things like how to manage a clinic day-to-day, how to budget, how to find the resources they need and how to make the most of very little. They've won the support of Tulane's Uptown Clinic, which donates medicine, and the Daughters of Charity, who have just given three ancient exam tables.
The tables need a little cleaning before they can be put to use, but will eventually be a big improvement in the exam rooms. But there's so much more the students need. A computer and filing cabinet for patient records. A microscope and disposable speculums for pelvic exams. A projector for health presentations.
They're learning to network with businesses and other service organizations and received good news recently when the Student Government Association announced that this year's charity ball will benefit the organization. That income will help BHT meet its most pressing needs.
Also, Springgate and Lizer spent the summer working on a grant proposal that could bring in $20,000 over four years, an amount that seems like a fortune after scraping by on a few hundred dollars for almost a year. The project has already received accolades, if not large checks. In August, the American Academy of Family Practitioners awarded the project one of two 2000 Student Community Outreach Awards. With or without funding, the good work will go on.
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