Undergraduate, medical students aim to provide care beyond medicine
UC Davis medical students, physicians and undergraduates are using telehealth to continue providing primary care services to patients through the seven student-run clinics amid the COVID-19 pandemic.
Telehealth has become critical in ensuring that patients continue receiving care during the pandemic, while also keeping physicians and their staff safe.
Prior to the pandemic, UC San Diego Health — which already had an established telehealth system — used telehealth for around 1% of their outpatient visits. Three weeks after a national emergency was declared, UC San Diego Health’s telehealth visits went from 6% to over 60%, according to a CalMatters infographic.
For student-run clinics, the switch to telehealth began after March 10, when Dr. Mark Service, vice dean for Medical Education at the UC Davis School of Medicine, sent an email urging clinics to consider suspending all clinic activities.
Alfredo Lopez Aguirre, the executive administrator for Clínica Tepati, said the clinic was ready to operate remotely at the beginning of Spring Quarter.
During the first weeks of the quarter, however, he said the clinic only focused on medicine refills and urgent questions.
“At the end of finals, we practically had to move everything online before the quarter started,” he said. “It’s been hard advocating for the patient right now because, with the pandemic, we had to literally close our doors and establish a whole new protocol.”
Now, the clinic is offering its usual services, excluding those offered by its specialty clinics. Undergraduate students who are still in the area help out with delivering medicine refills to patients.
Since Tepati doesn’t have access to its facility and equipment, volunteers aren’t taking new patients, instead directing their efforts toward providing additional resources for their existing patients.
“We’ve rolled out a resource guide where we collect resources from around the community and Sacramento area,” Aguirre said. “It’s another way we can advocate for the patients and the resources we need. Since many of our patients are uninsured and undocumented, we’re rolling out a Visa gift card program for patients so they aren’t worried about paying for medicines.”
Other clinics, like Bayanihan Clinic, were already thinking about providing services through telehealth before the pandemic.
Ivy Yuson, the clinical affairs coordinator for Bayanihan, called the time the pandemic created for them a “blessing in disguise.”
“We’ve been working on ways to contact people through telehealth platforms prior to the pandemic, but it never came to fruition because we used the clinic’s past experience seeing patients in-person to continue doing what we were doing,” she said. “Now, we can bring it back to the clinic in case patients aren’t able to make it in.”
Bayanihan, according to Yuson, isn’t currently accepting new patients. Every Saturday, they’re refining gaps in their knowledge and improving their telehealth procedures, continuing to stay in contact with the UC Davis School of Medicine. Undergraduate volunteers are setting up a dental clinic and improved diabetic counseling as part of additional services offered remotely. Psychiatric, wellness and primary care services are still offered by medical students, physicians and physician’s assistants.
While Bayanihan had been developing telehealth protocols before the pandemic, Yuson said implementing those protocols was still a stressful process.
“At the very beginning, I was just very overwhelmed by how much autonomy students had in discussing [student-run clinic] protocols,” she said. “I didn’t know where to focus my attention. From a student perspective, I had to continue finals week. But from a clinic standpoint, patients need healthcare services and that can’t always wait.”
Joan Viteri Memorial Clinic, which aims to provide health care for sex workers, intravenous drug users and other high-risk populations, is the lone student clinic remaining physically open to patients. Both its main clinic and outreach clinic, which goes to Sacramento encampments and offers medical services, continue to operate.
Jasmine Daragahi, co-director of Joan Viteri, said though the main clinic isn’t taking patients with respiratory issues due to a lack of COVID-19 tests, the outreach clinic was just given 200 COVID-19 tests to use on people experiencing homelessness.
Daragahi said it was important that the clinic remained open because not all services can be administered remotely.
“One service we continue to offer is abscess draining, because abscesses can be deadly if left untreated,” she said. “The clinic was named after a woman who passed away from a treatable abscess. We take those services really seriously and a lot of our patients choose not to go to other providers because they get mistreated. We want to serve them.”
Undergraduate volunteers, however, are not involved in the clinic’s in-person work given health restrictions and patient safety, she said. They are working to make face coverings and will be inputting patient records when COVID-19 tests get administered through the outreach clinic.
Barriers to accessing telehealth
The decision to keep Joan Viteri open for accessibility reasons addresses a major shortcoming with telehealth: Technological barriers can prevent prospective and current patients from receiving care.
CalMatters’ Ana B. Ibarra and Elizabeth Aguilera said telehealth was initially meant for inner-city and rural communities, where access to a clinic is less guaranteed.
Those communities are where student-run clinics operate and serve. Video visits bypass one barrier to accessing healthcare: transportation.
Still, not everyone in those communities has ready access to the Internet, phones or computers. Informing patients about changing services has been one challenge for student-run clinics. Though clinics have been advertising changes to their schedule and updates to services on social media, Aguirre said the clinic has seen a reduction in current patients.
“We see up to 25 to 35 patients during our normal Saturday clinics — now it’s anywhere between 10 to 20,” he said. “Technology isn’t always our patients’ forte because a lot of them are on the spectrum and older. While we have a sign at our physical location, only a few patients will see our clinic number and information when they drive by.”
He said volunteers have started calling patients who hadn’t come in recently to both check-in and update them on the clinic’s services.
Language can also be a barrier to helping patients. Paul Hom Asian Clinic, Shifa Clinic, Bayanihan and Clínica Tepati are geared toward helping the Asian and Pacific Islander, South Asian and Muslim, Filipino and Latino populations specifically.
Hannah Pan, one of the undergraduate co-directors at Paul Hom, said she began volunteering at Paul Hom because she was excited to use the language she grew up speaking at home to break down linguistic barriers to care.
“I think a lot of us take for granted the fact that we can walk into a doctor’s office and immediately address our health concerns,” she said via email. “For a lot of our patients, language and culture […] prevent them from being able to communicate effectively with their doctors.”
The clinic offers services in six languages: Cantonese, Mandarin, Korean, Taishanese, Vietnamese and Hmong.
Patient advocates — undergraduate volunteers — at Paul Hom are providing translation services, getting on three-way calls with a patient and a medical student or preceptor during health consultations, the only service the clinic is currently providing beyond medicine refills.
Daragahi said that in the process of transitioning to telehealth, not having undergraduates coming into Joan Viteri created a linguistic gap in care.
“A lot of our patients are Spanish-speaking and a lot of our undergraduates provided translational services,” she said. “Our medical students [working] right now don’t speak Spanish, but we’ve had some of our undergraduate volunteers sign up to provide those services in the future, so hopefully that gap will be remedied soon.”
While Joan Viteri’s outreach clinic remains open to serve the unsheltered population, Willow Clinic, which primarily serves people experiencing homelessness, has partnered with several Sacramento organizations to ensure patients are aware of the service changes.
Jeremy Hockenberry, who leads the Smoking Cessation Committee with Willow, said their organizational partners, such as Sacramento Street Medicine, have been delivering care kits with flyers informing the unsheltered about the recent change in services.
“Within the last week, our preceptor has allowed us to have new patients, but it was at first difficult for patients to understand we wouldn’t be at Salvation Army [where we currently give services],” he said.
To ensure patients can get connected to resources or make it to local pharmacies, Willow volunteers have been organizing rideshares to take patients to those locations. They currently offer medicine refills, referrals for social services and COVID-19 patient education through the technology at the Salvation Army.
Patient reaction, looking ahead
Hockenberry said that recently, more patients have been understanding the telehealth protocol shift.
“They’re excited we’re still here to support them and that they get to have their meds refilled,” he said. “Some of them haven’t been able to make it to the clinic in months or used their meds consistently.”
Positive patient reactions to student-run clinics’ shift toward telehealth have been common.
Pan said via email that Paul Hom’s patients seem very receptive toward the novelty of telehealth.
“Patients are very comfortable with addressing their concerns over the phone and still talk to us in the same way they would normally do in an in-person visit,” she said.
And Yuson said Bayanihan’s patients have been responding similarly.
“When I called patients to check up on them and see if they wanted to reschedule, they were so understanding of the situation — they even checked up on me,” she said. “It was a humanizing experience that really broke the barrier between being a coordinator to the clinic community and being a person.”
She said Bayanihan volunteers also provide healthcare services and entertainment to Filipino veterans, who she referred to as veteranos, and in lieu of monthly visits to the Filipino War Veteran Legion’s events, volunteers continue to contact veteranos.
“It’s not necessarily anything specific on the healthcare end,” she said. “We just wanted to make sure they had all the info and resources they needed, but also to check up on them and ask about their families, their work, anything they want to talk about.”
Whether or not the clinics must continue telehealth during Fall Quarter, Aguirre said it was important for volunteers to remember their respective clinic’s mission and why they continue to provide service.
“Something I always tell folks at Tepati is that we should work within a community framework and that Tepati was built on the foundations of helping the Latino community — that’s the mission that really set this clinic, to fill this gap in healthcare,” he said. “Tepati belongs to everybody. Everybody puts in their effort.”
Written by: Janelle Marie Salanga — email@example.com