Caring After Hours

Medical School volunteers run free weekend clinics for underserved patients.

November/December 2012

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Caring After Hours

Photo: Toni Gauthier

It was a mid-September weekend, and for medical students Meg Tabaka and Lily Yan, Monday would bring a test on the renal system. But Sunday was not for cramming. They had something more compelling to do: join their fellow Stanford volunteers at the Arbor Free Clinic in Menlo Park.

Tabaka, Yan, grad student Nicole Clarke, MS '12, and premed student Kaylin Pennington, '09, are the tight-knit quartet who share manager responsibilities for the Arbor site, located at the U.S. Veterans Affairs facilities. A second site, the Pacific Free Clinic, is held at a high school in San Jose and emphasizes outreach to Asian immigrants. Known jointly as the Cardinal Free Clinics, the program serves individuals who don't have—or haven't found—anywhere else to go. Drop-in visitors have been known to drive from places three or four hours away. Patients usually lack health insurance, some are homeless, and many are hindered by language barriers or scheduling difficulties.

The once-a-week clinics were founded on the efforts of students from the School of Medicine and remain reliant on them, in combination with volunteer doctors, physician assistants and other staffers, including translators. Diagnostic screenings and preventive care are key functions, as well as directing patients to facilities for ongoing primary care. Personnel on hand can treat a wide range of ailments and will arrange transport to emergency rooms when necessary. At Arbor, some patients with more complex problems get referrals to free appointments for seven specialty services: neurology, cardiology, dermatology, musculoskeletal, ophthalmology and mental health, plus a women's clinic. There are no pediatric services because various government programs focus on those.

Considering how much the clinics provide, it may seem unfair to dwell on any shortcomings. But one gap looms so large that the staff has no hesitation about spotlighting it as a way of seeking help: Not enough doctors volunteer.

On its best days, Arbor will have three doctors available for each session. Usually, no more than five patients are assigned to a single doctor. If too many show up, they can't all be seen. And most of the time, only one or two doctors are present.

Ian Tong, a doctor and clinical assistant professor at the med school, receives a small stipend as co-medical director at Arbor. He understands that physicians face enormous demands on their time. That goes for him as well, as he juggles a hectic schedule that includes his job as medical director for veterans outreach at VA Palo Alto. But after a shift at Arbor, he says, "I always feel more energy." He's quick to note the dedication of the doctors who already volunteer, but adds, "Yes, let the call go out, we need physicians."

Each of the four managers has responsibility for the different slices of the clinic's many functions, from scheduling and volunteer training to maintaining records and ordering supplies. They have planning meetings once a week, and the sessions are a reflection of their commitment, happening over breakfast or dinner as part of the bond they feel. "This is a really tight team," says Tabaka. "Working together means we support each other."

On that mid-September Sunday, patients included Deborah Higgins, 57, back for a neurology appointment after first visiting in June. It had taken a while to sort out a next step, but with help from Clarke, she was able to return for a consultation with Josef Parvizi, a neurologist and associate professor at the med school.

Higgins's neck tilts involuntarily to the left because of a condition previously diagnosed as cervical dystonia, which causes neck and shoulder muscles to pull and turn the head. There are spasms and pain. She had moved in April from Oregon to the Bay Area, unemployed and without health insurance. But she had heard about the Stanford clinic while standing in a grocery store line, 60 miles east in Tracy. Now she was hoping that she somehow could receive Botox treatments, which had been beneficial in the past, or perhaps become part of an experimental study.

After a review of her medical history, Parvizi checked her physical symptoms, careful to ask if he was hurting her as he pressed on her neck and moved her head. Not really, she said, especially considering, "I've had a couple of kids."

Parvizi's immediate good news for Higgins was that she would be given a low-cost prescription, which was enough for her to exclaim that it was "almost like a fog has been lifted." But Parvizi also said he'd explore an option for getting her Botox injections. A day later, Clarke received word from Parvizi that the Stanford Botox clinic would admit Higgins without charge and request that the manufacturer donate the neurotoxin for her injections. It was a better-than-usual outcome for such specialized treatment, but a typical example of the clinic's efforts to pursue every possible avenue of help for patients.

Arbor, which sees patients on Sundays, was founded in 1990 based on a research proposal. It has always been organized by students with faculty guidance, and it musters funding from contributions and the Medical School's office of community health. The Pacific clinic is open Saturday mornings and has been in operation since 2003.

Budgets are limited, and the scope of challenges always seems to be expanding. But volunteers like Clarke, Pennington, Tabaka and Yan never seem to lose resolve.

"I don't have to ask which one of them is on each Sunday," says Tong. "They're all going to be here anyway."

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