News

BU TODAY
BY CALEB DANILOFF

Every Thursday at 7 p.m., a white van leaves the Boston University Medical Campus and makes its way to East Boston loaded with food, clothing, blankets, toiletries, and health pamphlets. On board are students from the Schools of Dental Medicine, Medicine, Public Health, and Social Work, as well as a licensed physician. For the rest of the evening, the team treats what ails Eastie’s homeless and indigent. And thanks to a $5,000 grant from the American Psychiatric Foundation, they’ll soon tackle the mental health issues that underlie many of their day-to-day tribulations.

“The majority of our clients have some form of a mental health condition,” says Matt Gonzalez (MED’12), one of the two coordinators of the Outreach Van Project (OVP). “I would argue it’s the most critical component that we can address. We can give them food and clothing and refer them to a doctor for minor medical issues or colds, but the underlying major cause of their dire situation cannot be corrected unless their mental health improves.”

The APF grant, along with a $15,000 grant from the Tufts Health Plan Foundation, will help recruit mental health workers and increase public awareness of homelessness in Boston. Most important, says Jane Yoon (MED’09), OPV’s other coordinator, it will help cover the cost of transportation for crucial follow-up care.

“Many times, after we give a referral or ask patients if they’d like to make an appointment with a doctor at Boston Medical Center, they tell us that they have no way of getting there or they can’t afford to waste money on transportation,” Yoon says. “These grants allow us to purchase taxi and bus vouchers so they have a better chance of keeping follow-up appointments after meeting with our on-site physician or mental health professional.”

MED’s Outreach Van Project, begun in 1997 by a group of BU medical and public health students, gives students a chance to get into the field and roll up their sleeves. Parked at the edge of East Boston’s Central Park, the van serves about 25 people each week. Volunteers chat up people on the streets, connect them with community services, and provide health education. Depending on their training, students also take blood pressure, document health histories, and attend to basic medical needs under the supervision of a physician.

The van project has also in recent years served street populations in Cambridge and Somerville, as well as at the Suffolk Downs racetrack, where migrants from Mexico and Central America often find low-paying work. But like many recent immigrants to East Boston, some also bring with them substance abuse and mental health problems. Some have witnessed war crimes and human-rights abuses. “We have established a solid foundation of trust with our clients by making sure to show up every Thursday no matter how bad the weather,” Gonzalez says. “Because of this, they are more than willing to open up to us with their emotional problems from their stressful lives.”

“OVP is a great way for students to get comfortable talking to patients about sensitive issues such as alcohol abuse, drug abuse, addiction, bipolar disorder, schizophrenia, depression, and high anxiety,” he says. “It’s also a great way to get a better feel for the needs of the underserved and homeless populations in Boston, so that we can further assist them in the future and be active leaders in fighting for policies that will improve their access and quality of health care.”

Originally published in BU Today: http://www.bu.edu/today/world/2009/02/20/med-students-take-pulse-east-boston-s-homeless

“Do I take care of my own worsening condition, or the poor health of my 8 year-old son?” “Do I risk losing one of my three jobs to spend the day getting a referral for my annual check up, filling out a health insurance application for my daughter and picking up my son’s asthma medication from the pharmacy?” These are just two examples of the difficult decisions that must be made by many uninsured, indigent or homeless individuals. As healthcare professionals both in practice and in training, it is essential that we understand the struggles and barriers which patients of these populations encounter.

On May 23, 2007, the BUSM Outreach Van Project (OVP) partnered with the Massachusetts healthcare advocacy group Community Catalyst to host Walk In My Shoes. This event was a simulation of some of the real healthcare issues faced by those with limited access to medical facilities and services. There was a particular focus on immigrant and homeless populations, as these are the most common encounters for OVP on any given night in East Boston. Each participant was assigned a role as either a healthcare administrator, government official, or an individual of a specific race seeking medical services. Individuals were also provided with a detailed description of health problems for themselves and their family members, insurance and financial information (or lack thereof), and obstacles (such as a language barrier, lack of transportation and existence of a disability) to obtaining the services they required.

With nearly 70 people in attendance, the room bustled as everyone became thoroughly involved in their role. One participant waited at the adult clinic for what seemed an interminable amount of time, just so a weary interpreter could show up to tell her she would need to fill out forms at the government offices to obtain insurance before she could be seen. That same participant appeared frustrated and helpless as she waited across town at the government offices yet again for an interpreter. On the other side of the table, a receptionist at the ER intake was becoming increasingly agitated by the number of patients arriving, as this rapidly increased the amount of time spent by each person in the waiting room and the amount of paperwork to be completed.

These experiences culminated in an insightful post-simulation discussion. Participants who had acted as administrators or patients expressed their uneasiness and frustration with the system. Administrators were surprised at how detached they could be and how quickly they could lose their temper when dealing with certain individuals. One administrator noted that during the simulation, she knew nothing of the patients’ complicated histories and so found it easy to turn them away or send them somewhere else in order to meet her goal of seeing as many people as possible in the shortest time. Upon hearing the patients’ stories in discussion however, she was struck by their struggles, and regretted how she had treated them. Some patients also noted aggravation in attempting to obtain free advertised mammograms from local clinics. Despite the posted notice, some of the providers claimed they were unaware that such an offer existed. Participants came to the conclusion that healthcare promotions should be more widely advertised and more easily accessible. Participants raised other thought-provoking issues during discussion, which will no doubt stay with them throughout their service to the medical community.

The event, funded in part by Harvard Pilgrim Healthcare, the Boston Evening Clinic Foundation, Tufts Health Plan Partnership and the Student Committee on Medical Student Affairs, was a complete success. The simulation increased awareness of healthcare issues, particularly those relevant to OVP’s main population, and allowed participants to experience first hand what difficulties are encountered by this growing population. The evening also served to highlight the important role that OVP has played for the past ten years, in bringing medical services to the East Boston community, and referring them to clinics, detox centers, and hospitals where their greater needs can be met.

“Sometimes I’d see my father, walking past my building on his way to another nowhere. I could have given him a key, offered a piece of my floor. But if I let him inside the line between us would blur, my own slow-motion car wreck would speed up.” On December 8, 2006, the Outreach Van Project was pleased to celebrate its 10th anniversary by hosting a dinner where we were honored to present Nick Flynn, author of Another Bullshit Night in Suck City – a blend of poetry and prose memoir of his personal struggle to understand the homeless father he never knew as a child. The 2005 winner of the PEN/Martha Albrand Award for the Art of the Memoir, read excerpts from his book, enthralling over 65 guests in attendance.

While the audience enjoyed a rich Thai dinner, generously donated by Amarin of Thailand, Nick discussed topics of great relevance to the Outreach Van Project’s mission. In addition to his candid discussion of his father’s homelessness and its impact on his own life, he also spoke about his experiences as a case worker at the Pine Street Inn. After reading several selections from his award-winning prose, Mr. Flynn set the stage for a casual question and answer session. Students and professionals alike offered thought provoking questions and insights. One student inquired as to whether Mr. Flynn’s father had ever read his book. Mr. Flynn answered that after he had given his father a copy, “…I think it was quite difficult for him, once he really got into it…but it didn’t seem to break our relationship, which I guess has happened with others. It’s a risk of writing memoirs actually.” Nick also discussed his experience reading his father’s own book, “One of the really troubling aspects of this book is I didn’t grow up with my father, I…had no connection with him at all and there were always times in my life where there were certain characteristics that I have [that would resemble his own]– even my handwriting is exactly like his…strange things like that.”

Upon closing this discussion, the night wound down as Mr. Flynn chatted with many of the attendees and signed copies of his book (made available by Barnes & Noble of Boston University). In addition to medical, graduate, public health and dental students, some notable attendees included Dr. Jose-Alberto Betances, our own frequent volunteer physician, Ms. Eileen O’Brien, Director of Elders Living at Home Program, Ms. Sarah Ciambrone, Director of the Barbara McGinnis House in Jamaica Plain, and Mr. Jim Greene, Director of the Emergency Shelter Commission of Boston. The event, made possible in part by the Blue Cross Blue Shield Catalyst Fund, was well received and we feel quite fortunate to have had such an interesting and approachable speaker visit to celebrate OVP’s 10th anniversary of service.

Addressing Homelessness in Boston

On September 21st, 2005, the Outreach Van Project had the special honor of hosting Dr. Gerald Hass in a special dinner and talk. The talk focused on “Primary Care in the Inner City” with special emphasis on the difficulties of finding medical care as low income patients, often lacking health insurance. Dr. Hass trained in internal medicine at London University in England. He then switched to pediatrics and completed his residency at Royal London Hospital and Great Ormond Street Children’s hospital. Dr. Hass visited Boston as a medical student and as a Research and Teaching fellow. In 1966 he was hired by Dr. Henry Bakst as Assistant Professor at Boston University Medical School and ran the Home Care Program. Two years later Dr. Hass became Associate Professor of Pediatrics and Chief of Pediatric Ambulatory Services at Boston City Hospital, (currently Boston Medical Center). This position allowed him to develop health care services for children in various health care communities. Working closely with Melvin Scovell and residents of the South End, a health center was conceived in 1968 and opened its doors in June 1969 as a pediatric clinic. Over the next few years this developed into the full service community owned and operated South End Community Health Center (SECHC). Currently Dr. Hass is the Physician in Chief of this community health center.

Dr. Hass aided by Tristam Blake, Chief Financial Officer, spoke of the history behind SECHC. Through anecdote we learned of a group of parents approached Dr. Hass describing their need to immunize their children for summer camp. Due to the lack of long-term care and preventative services available to this low-income community, the first attempt to address their needs was to set up immunizations in the basement of a church in the South End. This, and similar situations further advocated for the necessity to set up a clinic that provided more thorough health services. The clinic began in a children’s library and saw a community comprised of a socio-economically disadvantaged inner-city population with consequently the worst health care statistics in the city of Boston. Various state and local agencies provided funding for the initial bilingual staff, consisting of a nurse, receptionist and part-time physician. The clinic became incorporated as a free-standing, non-profit in order to qualify for Medicaid third-party payments, which were the first funds received. Funding was received from Boston’s Trustees of Health and Hospitals approximately a year later. Consequently, the inability to secure federal funding for the clinic was in effect, a hidden blessing because it allowed for SECHC to remain self-sufficient and financially independent. A twelve member community board became the incorporators, directors and owners, this allowed direct representation of local residents to best address the needs of the community.

In the spring of 2000, a 35,000 sq.ft. facility was opened on Washington street consolidating all services provided into one location. In addition, the new building contains market-rate housing and retail space which help finance the work of SECHC. The services currently provided are pediatrics, adult medicine, obstetrics and gynecology, women’s health, laboratory services, dentistry, eye clinic, mental health, and nutrition. Overall, Dr, Haas’s talk was very well received, approximately 50 students attended some of which have since gone on to volunteer at the SECHC.

A History of Outreach Part II

In February 2005, BUMC’s Outreach Van project hosted a special dinner event with Dr. Jesse McCary as the guest speaker. Dr. McCary has been working at Boston Health Care for the Homeless for the past 3 years and attends on the medicine wards at BMC. Her goal is to make an academic career out of homeless medicine, which will involve policy work, research, and education in addition to clinical medicine. Along with a small group of her colleagues, she has been writing a curriculum in Homeless Medicine that will pilot as an elective course at medical schools and residencies this coming year. Her presentation, entitled ‘Virtual Tour: Medicine on the Streets’, focused on homeless medicine and discussed her work with the homeless population in the Boston area, including Boston Healthcare for the Homeless and Long Island Shelter. The dinner included approximately 70 guests from the Boston University Schools of Medicine, Public Health, Dental Medicine, Graduate Medical Sciences, as well as physicians and administrators from Boston University Medical Center. The event was largely successful due to Dr. McCary’s well-received presentation, a high turnout of a very diverse and intercollegiate group of guests, and the recruitment of new volunteers for the coming year.

This past winter, the Outreach Van Project has been fortunate in receiving many generous donations from individuals and organizations throughout the Boston community. We would like to offer our warmest thanks to all of you who have given so much and helped our guests stay warm during the cold winter months. Here are some that deserve special mention:

• New Balance Athletic Shoe Inc., for their generous donation of new men’s, women’s, children’s shoes.
• The students, teachers, and parents of the Huckleberry Hill Elementary school of Lynnfield, MA, for their generous donation of winter apparel for kids and adults.
• Howard and Sandy Porter of Howie Mack for their many donations and continued support.
• New England Fleece Co., providing the Outreach Van with a considerable discount on warm large fleece blankets

A History of Outreach Part I

OVP Reflects on Its History