clinic chronicle - Cardinal Free Clinics

CLINIC CHRONICLE
A Publication from the Cardinal Free Clinics
Promoting access to health care for the medically underserved
Fall 2005/Winter 2006
Arbor and PFC
Collaborate with the
Patient Advocacy
Program
By PRISCILLA GONZALEZ
PROGRAM COORDINATOR
T
his summer, Arbor and
Pacific Free Clinic officially
joined the Patient Advocacy
Program. The Patient Advocacy
Program focuses on patient
education and prevention for
underserved patients. Now in its
second year, the program includes
a year-long course co-led by Dr.
Gabriel Garcia and Ann Banchoff at
the School of Medicine. The course
provides advocates with a strong
foundation in community and free
clinics, cultural competence in
underserved populations, and the
role of the physician in the health
care context. Undergraduates who
are part of the course are trained
as patient advocates at one of the
partnering clinics, which now
includes Arbor and Pacific Free
Clinics, Samaritan House, MayView
Community Health Center, and
Ravenswood Family Health Center.
The program emerged out of
the need to provide patients with
individual attention focused on
health education and prevention
by identifying behavioral risks
affecting a person’s health. In order
to assess a patient’s health needs,
advocates are trained to conduct the
“Staying Health Assessment (SHA),”
(see ADVOCACY, page 6)
Volume V, Issue 1
Empowering Women One Step at a Time
PFC makes big strides in increasing access to women’s health services
By GIGI LIU, SMSIV
PFC MANAGER 05-06
I
t is about 11AM on Saturday at
Pacific Free Clinic (PFC). While
the front desk is in its full swing,
Dr. Kay Daniels slips into the clinic
from the back door, wheeling in two
boxes of equipment. Patients waiting
in the hallway ask the volunteers
what this small, white-coated lady
is doing with two heavy boxes. The
volunteers chuckle, but they are all
genuinely impressed and grateful
for Daniels’s presence. All Daniels
needs is one examination room and
she can single-handedly run the
entire Women’s Clinic at any time
and any place.
The Women’s Clinic was initiated
in October 2004 as a specialized
branch of PFC by last year’s Steering
Committee under the guidance of
Rita Nguyen, a former manager
of PFC and a recent graduate who
majored in Human Biology at
Stanford University. The Women’s
Clinic has continued to operate
since then on the first Saturday of
every month.
Over the course of nearly
three years that PFC has been in
operation, volunteers have noticed
that an increasing number of the
female patients are seeking lowcost gynecological services. This
prompted last year’s Steering
Committee to search for and
collaborate with local organizations
and volunteer physicians in
developing a plan that would help
increase access to health services
for these women. As the Medical
Director of the Mobile Women’s
Health Clinic (Mommy Van) at the
Lucile Packard Children’s Hospital,
the Steering Committee approached
Daniels first because of her strong
interest and extensive background
in obstetrics and gynecology.
Founded in 1999, the Mommy Van
serves immigrants and low-income
women twice a week at the Samaritan
Houses in San Mateo and Redwood
City. The van provides women’s
health services including pregnancy
testing, prenatal care, contraception
materials and education, and annual
gynecological exams.
Originally,
PFC
envisioned
collaborating with the Mommy Van
program to provide gynecological
services outside the clinic on
Saturdays while PFC would support
the Van with laboratory analysis
from Stanford Hospital, interpreters,
and administrative assistance.
Unfortunately, the Mommy Van
was closed in the summer of 2004
for an indeterminate amount of
time, so the Steering Committee
had to come up with alternative
means to provide the health services
demanded by the patients. Despite
the Van’s shutdown, Daniels’s
commitment to the underserved
population did not waver. Daniels
showed up at PFC one day during the
summer of 2004 and was thoroughly
(see WOMEN’S CLINIC, page 5)
CLINIC CHRONICLE
Fall 2005
PACIFIC
FREE CLINIC
Volume V, Issue 1
Pacific Free Clinic
Arbor Free Clinic
Overfelt High School Health Clinic
1835 Cunningham Avenue
San Jose, CA 95122
Appointment line: (408) 705-0119
Office phone: (650) 725-0416
Fax: (650) 725-9852
http://pacific .stanford.edu
Open Saturdays, 10AM - 2PM
Menlo Park VA Facility
795 Willow Road
Menlo Park, CA 94025
Clinic phone: (650) 493-5000 x22222
Office phone: (650) 724-1332
Fax: (650) 725-9852
http://arbor.stanford.edu
Open Sundays, 11AM - 2PM
Medical Director: Rex Chiu, MD
Medical Director: Lars Osterberg, MD
Assistant Medical Director: Danny Sam, MD
Steering Committee
Clinic Managers
Karen Li
Eunice Rivas
Marie Wang
Dermatology Specialty Clinic Chair
Helen Liu
Financial Chair
Jessica Les
Follow-Up Chairs
Diana Badillo
Kiran Kaur
Candace Pau
Interpreter Chair
Trinidad Solis
Musculoskeletal/Ultrasound Chairs
Tress Goodwin
Elizabeth Oosterhuis
Optometry Specialty Clinic Chair
Jessica Sheehan
Patient Education Chair
Julia Carnevale
Pharmacy Chair
Melina Rincon
Physician Staffing and Recruitment Chairs
Chioma Agbo
Emily Curran
Sahar Rooholamini
Preclinical Training and Staffing Chairs
Chris Adams
Kate Pettit
Referral and Community Resources Chairs
Tyler Johnston
Nathan Morrell
Screen Team Chair
Mark Chao
Supplies Chair
John Downey
Undergraduate/Patient Intake Chairs
David Berg
Devin Kehl
Steering Committee
Clinic Managers
Joe Ferng (Administration)
Lily Kao (Volunteers)
Gigi Liu (Patients)
Supplies and Equipment Chair
Chris Deng
Financial Chair
Helen Liu
Fundraising and Public Relations Chair
Julie Len
Interpreter and Translation Chair
Katherine Brooks
Huy Ho
Physician Staffing Team
Bob Burke (Chair)
Kevin Ju
Volunteer Staffing Team
Gabriel Tsao (Chair)
Nancy Wang
Community Resources Team
Catey Bradford
Lynne Rosen
Patient Education Chair
Christine Chang
Screening and Outreach Chair
Rena Patel
Referrals and Follow-Up Team
Xin Gao (Chair)
David Shin (Chair)
Maneesh Singh (Chair)
Richard Kao (RxAssist Chair)
Nga Du
Edwin Rodriguez
Kyle ???
CLINIC CHRONICLE
Fall 2005
Volume V, Issue 1
from the managers
F
rom all the new managers, we are very excited about this upcoming year for
PFC and Arbor. The managers and steering committees from previous years
have established a great foundation that we will continue to build on this
year. We will continue to focus on the two-part missions of PFC and Arbor – first
to provide culturally competent healthcare for the underserved and second to be a
great teaching clinic and learning environment for all the volunteers.
Why are we so excited about the upcoming year? Here is a sampling of projects
that PFC and Arbor will push to implement and to extend this year. For patient
healthcare, we will continue to build on our patient education programs, not
only providing educational materials for patients, but also connecting patients to
community diabetes education programs or even non-health related programs such
as ESL classes. There, the patients learn not only about their conditions to take
care of themselves and their families, but they also become trained to be educators
within their communities. In addition to empowering patients with programs such
as these, our community resources teams continue to build connections with local
organizations that can provide services our patients desperately need, including
dental care. While PFC and Arbor mainly provide basic healthcare services,
our vision is to have PFC and Arbor connect patients with all services that they
need—local food banks when they need meals, counseling services when they need
someone to talk to, benefits analysts who can help them apply for programs like
insurance for children, the elderly, and the disabled.
Behind the scenes, PFC and Arbor have many other projects working with various
groups within the Stanford community. The PFC fundraising team is collaborating
with the Graduate School of Business with fundraising efforts. In addition, the
physician recruitment and staffing teams are working with the Stanford Internal
Medicine Residency program to work PFC and Arbor into their formal outpatient
requirement. Both clinics have also joined the Patient Advocacy Program to
improve patient education and prevention measures. We have also been working
to improve medical student education by means of the integration of PFC and
Arbor with the Stanford Medical School Practice of Medicine curriculum. These
projects are just a sampling of what’s to come for Pacific and Arbor Free Clinics.
We look forward to updating you all on our progress in the next newsletter.
Thanks for your support!
Joe Ferng
Lily Kao
Karen Li
Gigi Liu
Eunice Rivas
Marie Wang
CLINIC CHRONICLE
Fall 2005
Volume V, Issue 1
IN STEP WITH...
Ellen Huang, N.P.
Patient Advocate and star PFC Volunteer
By ANNIE CHAO, SMSIII
PFC PUBLIC RELATIONS CHAIR 04-05
W
hether you are a medical student or an
undergraduate, long-time volunteer or firsttime trainee, chances are that you have
already met Ellen Huang. Huang, one of the handful
of physician assistants that volunteer at Pacific Free
Clinic (PFC), has become one of the most familiar
and friendly faces around the clinic. Each Saturday
morning, she is usually found helping out in the screen
team room, talking animatedly to patients and working
with them to devise long-term strategies for their
chronic conditions.
Huang, who graduated a few months ago from the
Stanford Physician’s Assistant and Nurse Practitioner
Program at the Stanford School of Medicine/Foothill
College, started volunteering at PFC in January 2004 as
a part of the volunteer requirement of the Primary Care
Associate Program. After completing the program’s
requirements, Huang continued to volunteer at PFC
every Saturday for at least three hours a clinic day.
“I enjoy working on the screen team the most; I
truly believe prevention is the key to many illness and
diseases,” Huang says. “We have great resources and
educational materials.”
Huang especially enjoys the long-term contributions
that the screen team makes.
“We teach patients about lifestyle modifications as
well as disease management,” Huang says. “We identify
and effectively manage the chronically ill [. . .] and
once patients are stabilized on a medication regimen,
we help them apply for free medications via RxAssist
or RxHope.”
Since she began volunteering at PFC, Huang has
logged more than 40 clinic days – a remarkable feat
given that she also works part-time as a physician
assistant in an internal medicine/interventional
cardiology office in Fremont, at the ICU at the Palo
Alto VA, and at the Emergency Psychiatry Service at
Valley Medical Center.
Her experience at PFC has given her a unique
perspective on how physician assistants can contribute
their knowledge and skills to the clinic.
“In reality,” Huang says, “mid-level providers such
as physician assistants and nurse practitioners play
important roles in the medical community. We can see
patients, treat and order medications, and interpret lab
results.”
Huang also points to the rewards of working with
other dedicated volunteers as one of primary reasons
she continues to come each Saturday.
“At PFC, the teaching environment is extraordinary.
The volunteers span from high school students to college
undergrads and graduate students. All of the volunteer
physicians are incredible teachers, and through them,
we learn and model medical altruisim,” Huang says.
As many of us would agree, Huang is also an
extraordinary teacher and volunteer who demonstrates
incredible commitment, enthusiasm, and medical
altruism every Saturday at PFC. q
PFC Receives Dean’s Outstanding Achievement Award 2005
Congratulations to the Pacific Free Clinic (PFC) for being a recipient of the 2005 Dean’s Outstanding
Achievement Award. Every year, this prestigious award recognizes a singular contribution by a
student group that has enriched the quality of life on the Stanford campus. There are over 600
student groups on campus, and out of the 100 plus groups nominated for the award, only nine were
selected to receive the award. This year, PFC received multiple nominations from students and
faculty. PFC thanks the community for its nominations and support, and most of all, its volunteers
for their hard work and dedication.
Fall 2005
WOMEN’S CLINIC
(continued from page 1)
impressed by the volunteers’ hard
work. From that day on, Daniels has
generously offered her time to serve
female patients and even brings in
her own equipment to share with
PFC.
Since the opening of the Women’s
Clinic in October 2004, PFC has
had 8 Women’s Clinic days, serving
more than 55 female patients. Of
these patients, the majority has
been between the ages of 30 to 60
years old. Much like the Mommy
Van, the Women’s Clinic provides
pap smears, pregnancy testing,
counseling on contraception, breast
exams, and referrals to the Valley
Medical Center and the Foothill
Health Clinic for mammograms.
Annual pap smears, breast exams,
and referrals for mammograms have
been the most popular services.
Not surprisingly, the demand for
gynecological services continues to
rise, and PFC is determined to meet
this ever-growing demand. The
standing Steering Committee plans
to increase the number of operating
days for the Women’s Clinic. Both
Daniels and the physician chair
are currently recruiting other
Stanford Ob/Gyn physicians as
well as residents to volunteer at
the Women’s Clinic. As of August
2005, we were extremely fortunate
to recruit Dr. Anh The Nguyen,
the site director for the Ob/Gyn
core clerkship at Kasier Santa
Clara Medical Center. In addition,
Christine Chang, the Patient
Education Chair, collaborated with
the American Cancer Society to
hold a breast cancer talk in June for
patients waiting for their ob/gyn
appointments. The potential for
the Women’s Clinic is enormous,
and PFC’s ultimate goal is to link
both gynecological services and
education to empower women in
taking care of their own health. q
CLINIC CHRONICLE
Volume V, Issue 1
COMMUNITY OUTREACH
PFC and Arbor Volunteers Help Out at the 2nd
Annual CHE Community Health Fair
St. Francis of Assisi Church, East Palo Alto, CA
Stanford’s Chicanos/Latinos
in Health Education (CHE)
student organization held
its 2nd Annual Community
Health Fair on May 1, 2005.
PFC and Arbor volunteers
rise to the occasion to help
measure patients’ blood
pressure and glucose and
cholesterol levels. Volunteers
are encouranged to emphasize
health education by informing
patients about healthful
eating and lifestyles.
CLINIC CHRONICLE
Fall 2005
ADVOCACY
(continued from page 1)
a state-wide questionnaire that
identifies behavioral risks in areas
such as nutrition, physical activity,
dental and mental health, sexual
health, and family planning.
Advocates meet with patients oneon-one to go over the assessment
and discuss health education
materials, community resources,
and strategies to promote healthy
lifestyles. Finally, Patient Advocates
notify providers and pre-clinicals of
serious health risks or traumatic
experiences that emerge during
the assessment. In addition to
consultation concerning their acute
health problems, patients receive
health education and dedicated
attention to their general health
habits. This service is especially
useful to Arbor and PFC’s
underserved patients who face
cultural, language, and financial
barriers.
Searching for the appropriate
education materials and referrals
proved to be very time consuming.
In order to facilitate this process, we
created SHA binders that contain
education materials and community
resources for every topic addressed
in the assessment. Several patients
were also requesting additional
information from topics aside
from the SHA, such as housing,
legal services, and employment.
Now advocates will be conducting
follow-ups within a week with
patients who request resources that
are not immediately available at
the clinic or SHA binders. Future
Volume V, Issue 1
plans include the development of
a comprehensive education library
and community resource center
that is easily accessible to the clinics
and patients.
One of the greatest challenges
at both clinics will be trying to
successfully complete the SHA with
all of the patients at the clinic. We
are working on developing efficient
protocols and increasing the number
of advocates to two per shift, so that
all patients receive the benefits of
the Program. This year, Arbor will
have three undergraduates and
PFC will have two who will serve as
patient advocates. We look forward
to a great collaboration that will
strengthen the health care services
that PFC and Arbor provide to our
underserved populations. q
Arbor and PFC Cooperate to Train New Crop of Volunteers
O
By CHRISTOPHER ADAMS, SMSIII
ARBOR TRAINING/STAFFING CHAIR 05-06
f all the infamous icebreakers of history taking – providing a Osterberg, medical director of Arbor
– the name game, the ball strategic approach for potential Free Clinic. These introductory
of twine, the human knot volunteers.
sessions saw first-year students
Moving upstairs to the Fleischman checking vital signs, delivering
– none is quite so intimate as the
lesser-known
“venous
access” labs, students rotated through intradermal saline injections, and
exercise. This was learned first- rooms where they practiced history- pricking fingertips for glucometry.
hand by members of the entering taking and were instructed in basic For the final hour of the joint
Stanford
physician’s
class of Stanford Medical School, as clinical procedures by Dr. Lars training,
assistant students helped teach
they participated in the first
the members of SMS05 how
ever joint preclinical training
to draw blood; students then
sessions for Arbor and Pacific
practiced the procedure on one
Free Clinics.
another.
At the trainings, held during
Overall,
the
sessions
the first two Wednesdays
successfully trained nearly 80
of the 2005-06 school year,
students; this couldn’t have
first-year medical students
been accomplished without the
garnered hands-on experience
generosity and hard work of
in the basic operations
many individuals – Arbor and
required of volunteers at the
Pacific owe them all a debt of
free clinics. The opening
gratitude. In closing, the clinics
of the session provided
wish to welcome SMS05 and
background on both clinics
look forward to working with
as well as the Screen Team.
a new crop of volunteers, all
Following the introduction,
Dr. Peter Pompei instructed First-year medical students practice drawing ready to run the gauntlet from
HPI to PPD. q
the students in the elements
blood during the joint preclinical training.
CLINIC CHRONICLE
Fall 2005
Volume V, Issue 1
SERVICES
SERVICES
Pacific Free Clinic
Arbor Free Clinic
• Acute medical care for adults and children
• Screenings for tuberculosis, diabetes, cholesterol,
and hypertension
• Sexual health services including pap smears, STD,
and pregnancy testing
• On-site interpretation services in Spanish
• Free medications
• Free lab tests
• Dermatology, Optometry, and Musculoskeletal
clinics each once a month
• Eye exams and vouchers for free glasses for
Optometry patients
• Referrals to primary and specialty care clinics,
social services, and emergency dental care
• On-site county benefits analyst
• Health education and counseling
• Literacy program for children
• Basic medical care for adults
• Screenings for diabetes, cholesterol, hypertension,
and hepatitis B
• Sexual health services including pap smears, STD,
and pregnancy testing
• On-site interpretation services in Spanish,
Vietnamese, and Mandarin Chinese
• Free medications
• Free lab tests
• Referrals to primary and specialty care clinics and
social services
• Health education
• Women’s Specialty Clinic
• Dental Specialty Clinic
If you are interested in joining the Pacific team,
e-mail pacific@med.stanford.edu
or call (650) 725-0416.
If you are interested in joining the Arbor team,
e-mail arborclinic@stanford.edu
or call (650) 724-1332.
CLINIC UPDATES
STATISTICS: APRIL 2004 TO APRIL 2005
PFC Arbor
Total patient visits
1081
900
Total number of patients
923
844
21
16
Patients requiring an interpreter
89%
25%
Uninsured patients
97%
84%
Unemployed patients
58%
52%
Patients homeless or in transitional housing
2%
16%
Latino patients
31%
37%
Vietnamese patients
46%
Average visits per day
Congratulations to the new additions to Arbor’s
Steering Committee!
Asya Agulnik, Preclinical Staffing and Supplies Chair
Jorge Caballero, Website and Database Chair
Kimberley Montez, Screen Team Co-Chair
Lena Winestone, Supplies Special Projects Chair
Mark Hsu, Referrals/Community Resources Co-Chair
Shirin Zarafshar, Pharmacy Special Projets Chair
l
l
Free Dental services are now being provided at PFC.
PFC now offers Diabetes management classes in
Vietnamese, Spanish, and English.
l
Caucasian patients
5%
19%
African American patients
2%
13%
San Jose residents
78%
N/A
East Palo Alto residents
N/A
25%
Menlo Park residents
N/A
12%
Total referrals
268
289
Total meds
967
179
Arbor is collaborating with the Benefits Analyst
staff from the San Mateo County Health Department
to help provide patients with information getting
health insurance.
l
CLINIC CHRONICLE
Fall 2005
Pacific Free Clinic Acknowledgements
Pacific Free Clinic is a program of the Stanford
University School of Medicine and the School Health
Clinics of Santa Clara County. PFC would like to thank
The Health Trust, California HealthCare Foundation,
Kaiser Permanente, Blue Shield of California
Foundation, Chanwell Medical Group, Nancy Chen,
Asian American Recovery Serivces, and Washington
Mutual for their support.
To donate to Pacific, please click on the “Donations”
link at http://pacific.stanford.edu.
Volume V, Issue 1
Arbor Free Clinic Acknowledgements
Arbor Free Clinic is a program of the Stanford
University School of Medicine. Arbor would like to
thank the Peninsula Community Foundation, the
California Wellness Foundation, the Health Trust, the
Kimball Foundation, and the Leslie Family Foundation
for their support.
To donate to Arbor, please visit
http://arbor.stanford.edu
and click on the “How Can I Help?” link.
The Cardinal Free Clinics would like to thank
Huong Lan Sandwiches
Starbucks
Subway
and
Noah’s Bagels
for their continued support and
generous donations.
Stanford Free Clinics
Stanford University School of Medicine
251 Campus Drive, MSOB x3C43
Stanford, CA 94305-5404