UT Student-Run Clinic Offers Real-World Experience in Medicine and Social Work

By Marisa Charpentier in 40 Acres, Blog, Nov | Dec 2017 on November 1, 2017 at 8:00 am | No Comments

It’s a sweltering Sunday afternoon in August. Inside the basement of the Trinity Center in downtown Austin, students clad in scrubs and business casual attire trickle down the stairs. With blue- and cream-colored walls and basketball hoops hanging on either end, the space looks more like a high school gymnasium than a health center. The students unfold tables, aligning them in an assembly line fashion. Near the entrance, they line up chairs to serve as the makeshift waiting area. At the front of the room, they set up metal cabinets stocked with over-the-counter medications and medical supplies. In one corner, a student sets up privacy screens, and in another, social work students unpack water bottles, granola bars, combs, lotions, and donated clothing. In about 20 minutes, the space is transformed into a functioning clinic.

Since its founding in 2011, the C.D. Doyle Clinic has been a place for students to sharpen their skills and connect with Austin’s homeless community. The student-run free clinic operates Sunday afternoons, providing services to anyone who enters, including those uninsured and without an ID. Founded by a group of UT Medical Branch students, the clinic was named after a friend of the clinic’s original directors who died from Ewing’s sarcoma. The staff consists of volunteer physicians, UTMB and Dell Medical School students, and undergraduate and graduate students from UT’s social work, nursing, and pre-health programs. Volunteers check vital signs, provide acute care, help with medication refills, and offer social services. The clinic is conveniently located across from the Austin Resource Center for the Homeless (the ARCH) and the Salvation Army, where many homeless individuals congregate.

Today, like every Sunday, the students and the attending physician gather in a circle and introduce themselves and their roles. Second-year Dell Medical student Leonard Edwards warns everyone that today might look different. The city of Austin and community groups have made changes to policies affecting the homeless population in this area. As part of a 30-day pilot program to reduce crowding and drug dealing around the ARCH, Austin Police Department is monitoring the facility at all times. Caritas of Austin, a nonprofit that serves food to the homeless in the area, also changed its regulations from serving anyone to only serving those staying at the ARCH or who are signed up with case management at the ARCH.

At 2 p.m., the clinic doors open. Two patients who have been waiting outside step through the doors and Undergraduate Director Alma Arellano checks them in. Five volunteers head outside to the ARCH to pass out flyers advertising the clinic. Out there, it’s an entirely different scene. About 40 or 50 homeless people line the building, filling up every square inch of shade they can find. Some have towels over their foreheads to keep cool. One person has an inflatable mattress set up on the sidewalk. A group is gathered around a makeshift table. Officers roam around the crowd. Social work master’s student Kara Robbins says this is only a fraction of the people normally here. Because of the new regulations, many are gone. (It’s hard not to question where they’ve gone, but no one seems to know.)

“Free clinic!” the students advertise. “Free AC and water right across the street!” They pass out slips of paper with the C.D. Doyle Clinic logo on them. Some people ignore the students, others are interested. A woman with a rolling suitcase approaches Robbins. She explains her shoulder may be dislocated and she might need to get it looked at. She goes on for about three minutes, as Robbins nods and listens. A man says he has a rash and Robbins assures him the clinic can help with that, handing him a flyer. When the students turn the corner and walk down the alleyway between the ARCH and the Salvation Army, they dodge vomit on the ground. The heat seems to be enough to encourage everyone to head inside, but most don’t. One man complains of chest pains but refuses to come in. “You can’t convince everybody to come,” Edwards explains. “I fully recognize that this population has a healthy distrust for the medical system. These are the people that the system just doesn’t have room for kind of by design, which is why I’ve been coming here for years.”

Back inside the clinic, patients try on donated clothes, volunteers check vitals, and social work students connect individuals to the Medical Access Program, a program that links individuals to healthcare services primary care and prescriptions. After each patient’s visit, the volunteers encourage them to visit the social services desk. The clinic recognizes they can only do so much for a patient medically, but connecting them to MAP can have a lasting effect. “We’re a way for them to get their foot back in the door,” Edwards says. “It’s like a stepping stone. We’re not set up to be somebody’s primary care.”

A group from local nonprofit Divine Canines walks therapy dogs down the row of patients in the waiting area. Once a month, volunteers bring therapy dogs to the clinic for patients to interact with. On one side of the room, medical students and the attending physician talk with individual patients. That’s a big reason why a lot of patients come in, according to Robbins: just to talk. “A lot of times people come in and talk about how they feel as if their voice isn’t heard,” Robbins says. “They don’t have support. They don’t have anybody to talk to. I feel like our clinic definitely provides that for them. ”

Darryl Brandenburg, the clinic’s longest returning patient, comes regularly to get his vitals checked and talk to the students. He’s been homeless since 2012. After his wife died, things went downhill. He has a full beard and kind eyes. Whenever he makes a joke, he doesn’t break eye contact until you laugh. A student takes his blood pressure (his is 112 over 72, he says), and he visits with the therapy dogs, all of which he knows by name.

Here, everyone knows Brandenburg. He’s a wealth of resources for the homeless: He knows what churches offer meals when, which bus will get you where you’re going, and the places that’ll let you sleep outside at night. And he stays busy, volunteering at churches and centers whenever he can. At the C.D. Doyle Clinic, he’s on the board of directors, giving members insight into the city’s homeless population, and he spreads the word about the clinic around the community. “[The clinic] is a good place to learn your craft, and it’s pretty relaxed,” he says. “I think that’s why people like it. People talk to you. They don’t just push you away. You’re not just a number.”

Listening to patients is what Shayan Bhathena, BA, BS ’17, spends her time at the clinic doing. She’s been volunteering at the clinic since June 2016 and started conducting a research project in February, about homeless individuals’ barriers to healthcare. So far through her interviews with patients, she’s found that the biggest barrier is transportation. “Everyone has a story,” Bhathena says. “You can’t just prescribe a patient something and say ‘go pick up your prescription and you’ll be fine’ if that patient doesn’t have a way to get their prescription.”

An hour before the clinic starts to close, the man complaining of chest pains outside still hasn’t come in. Edwards brought another medical student outside to try to convince him, but it didn’t work. “Balancing emotions is really troublesome for me,” Edwards says. He sometimes stays after hours after the clinic has closed just talking to people. “Before we close today, I’m going to see that guy again and see if I can convince him to either come in here and let me help him or let me drive him to the ER,” he says.

As 5:00 p.m. approaches, students start folding up tables and chairs. They’ve seen about 20 patients for the day, a typical number for the clinic. Students like Robbins and Edwards will be back next week to aid individuals in need and learn something they can’t get from a class lecture. “The patients, the attendings, the people I’ve worked with have revealed that this is what I want to do for the rest of my life,” Edwards says. “I have learned more from patients here than I have in my own first year. It’s a different type of learning. I feel like I’m ahead of the game in being able to connect with patients, which is not something you learn in the classroom.”