A Tale of Two Clinics
“I appreciate the candor of the patients here. Many have experienced significant struggles, but they’re forthcoming about their backgrounds and troubles and willing to help us learn.” –Emory medical student Camille Fonseca
Fifty-year-old Wilbur was just looking for a hot shower when he was directed to a health clinic off Pryor Street in Atlanta. But he also needed medication refills and to go back to work after a stroke.
“I’m out of all my stuff, man,” Wilbur told Brian Pettitt-Schieber, an Emory medical student who works on Tuesday nights at this particular clinic, a partnership between Gateway Center and Mercy Care.
Located across from a bail bonds shop and a DUI classroom, the building has a 19-bed recuperative care unit upstairs, where Emory Saint Joseph’s Hospital sends some of its homeless patients after discharge.
Wilbur had just claimed one of these 19 beds, planning to stay in the Gateway recuperative program for about a year. A couple of men in the recuperative program wander downstairs each day to visit the sliding scale clinic for prescription refills and non-urgent treatments; the clinic also takes walk-ins. On Tuesdays, the clinic gives Emory medical students the opportunity to interview, examine, and file prescriptions while under the guidance of Emory doctors.
The clinic’s waiting room is empty in the evening, but men trickle in from the Gateway Center for after-hour appointments with Emory medical students and physicians.
The clinic is one of several in and around Atlanta staffed, at least in part, by Emory doctors, residents, and students. “The experience grants medical students practical experience while the patient exam is still overseen by licensed physicians, which is as it should be,” says William Eley, executive associate dean of medical education and student affairs. associate dean of medical education and student affairs. Additionally, all Emory medical students now participate in a Community Learning and Social Medicine course.
“The ongoing commitment of many medical students and faculty to community engagement led to the creation and success of this curriculum,” says course director Mary Jo Lechowicz, professor of hematology and medical oncology, who adds that they are moving away from terms like “volunteerism” and “service,” which suggest a one-way street. “The clinic experience, like many others for students, is bi-directional.”
The Art of Caring
One of the supervising Emory doctors at Gateway, Richard Hansen, gave Pettitt-Schieber and three other medical students a pep talk before sending them off to piece together narratives of the three male patients seeking help that night. “Paint the picture for me,” Hansen said. “This is the art form you’re going to be learning for the rest of your life.”
In one of the two examination rooms, Pettitt-Schieber had started Wilbur’s exam, asking him a series of questions and clarifying which refills he needed, since he reported his prescriptions had been stolen. As it turned out, Wilbur had a lot going on. He wanted his lungs to recover after a 30-year cigarette addiction; he wanted freedom from rashes, his walking cane, the extra weight he had been unable to lose.
“You’re gonna be a good doctor,” Wilbur told Pettitt-Schieber.
“You were my first patient,” Pettitt-Schieber replied, smiling.
Hansen reviewed and completed Wilbur’s physical examination. He pulled out a stethoscope, listened attentively to Wilbur’s lungs, then turned to Pettitt-Schieber and Kareem Al-Mulki, another medical student, to discuss what had likely been the cause of his chest pain, which he had rated a three out of 10. It was accompanied by an audible wheezing. “Can you hear that?” Hansen asked Al-Mulki, who plans to be an ear, nose, and throat specialist. “That’s where the pain’s coming from, the tightness.”
On another Tuesday, Ken was seen at Gateway clinic for symptoms of a cold. Assistant Professor of Family and Preventive Medicine Emily Herndon, a faculty adviser, reviewed diagnostic questions with the students before they entered the exam room: “How can you tell the difference between a cold and a sinus infection?” she asked. “What medications would you treat an infection with?”
Emory medical student Madeline Roorbach, who sees patients at Gateway, says the clinics are a good way to gain exposure to clinical medicine early, and an opportunity to work with disenfranchised populations in Atlanta. “Emory attracts students who are invested and engaged in serving those who would otherwise not be able to receive care,” she says, “and we’re lucky to have such great attending physicians who devote their time and expertise to help it all run.”
At the Clarkston Community Health Center up to 100 patients are seen each Sunday on a first-come, first-served basis.
Emory medical students also see patients at a primary care clinic in Clarkston, Georgia, “the most ethnically diverse square mile in America.” Up to 100 patients are seen each Sunday on a first-come, first-serve basis. Emory medical alumna Gulshan Harjee 82M co-founded the Clarkston Community Health Center. “It was important for me to do this, being an immigrant myself, as a gift to society,” says Harjee, an Ismaili Muslim originally from India.
“The value of the clinic is evident in the long queue that starts forming an hour before opening and the full waiting rooms,” says Emory medical student Zayan Mahmooth. “Nearly all of those served are unable to afford services elsewhere and a significant proportion are refugees.”
On this Sunday, among the crowd of patients is Nasir, who left India for the U.S. and has been a regular at the clinic for heart problems, teeth pain, and allergies.
Another is Jeanne, a mother who came to the U.S. several years ago to escape the war engulfing her home in the Congo, who is seeking help for severe ear pain. Neither has health insurance. Both were seen that afternoon by medical students who interview and evaluate the patients, then shadow doctors as they fill in gaps and complete physical examinations.
Direct patient care is only one part of the potential experience, however. Emory medical student Cricket Gullickson coordinates about 50 on-call language translators to help Clarkston patients who are not fluent English speakers. Among the most common languages the clinic hears are Arabic, Hindi, Amharic, and Burmese.
“The relief you see on patients’ faces when they just walk into an exam room and find someone who can speak the same language, it gives them a sense of home,” says Emory medical student Ariel Majidi.
She and Samuel Maidman, also a medical student at Emory, say they have learned their value as healers by working at the clinic, and have begun to understand how to identify with patients from different cultures. “There’s something special about helping a community comprised of people who are pursing the American Dream to its fullest,” says Maidman. “Many care for large families, work several jobs, and speak multiple languages. They’re model citizens and it’s an honor to be part of their journey.”
"The meaning and inspiration gained from working with underserved populations helps prevent burnout and gives both students and faculty the energy to keep going," says cardiology fellow and Emory medical alumnus Heval Kelli. "Given the political division in our country right now, I think being out in the community is one of the ways to rejuvenate yourself, to unite people and to remember the true reason you are in medicine.
Clarkston Community Health Center has expanded since opening in 2015, and now offers specialty clinics such as dental, women’s health, and mental health. At Emory's Harriet Tubman Women’s Clinic, patients can get UTI tests, pregnancy tests, cervical exams, HIV tests, and a variety of shots.
Phil Polychroniou and Celia Foster, Emory medical students who cofounded the mental health clinic at the center in 2017, are trying to recruit more psychiatrists, psychologists, therapists, and social workers to see a backlog of some 250 patients. “There is a staggering need for mental health services here,” Foster says. “Many of our patients don’t have formal psychiatric diagnoses, but rather, have impaired mental health because of traumatic experiences before, during, and after migration to the U.S.”
Despite the intensity, “medical students frequently say that when they leave Clarkston Community Health Center at the end of the work day, they are reminded of why they chose a career in medicine,” says Mahmooth.
Salaam alaikum. Nay kaung lar. Seh lahm. Hello.
What’s the most pressing challenge when providing medical care in one of the most diverse cities in the U.S.? Julia Schiff, an MD/MPH alumna, believes it is the ability to communicate with patients who speak dozens of different languages. As a student, she led a project to provide linguistically competent care to refugee patients at the Clarkston Community Health Center. The team, which consisted of students from Emory schools of medicine, public health, nursing, and business, started by conducting an assessment. They found that nearly half of the center’s patients had unmet language needs. They determined which languages were most needed—Arabic, Burmese, Nepali, and Amharic—and translated printed materials, checklists, and chart stickers into those languages. They also updated the clinic’s outdated telephone interpreter list, engaging new volunteer interpreters, and installing phones in exam rooms. Finally, they recruited people from the Clarkston community to be trained in medical interpreting. “We were able to provide appropriate interpretation services for many more patients, and we got good feedback from the clinic volunteers and staff,” says Schiff.—Martha McKenzie