A Safety Net with Soul

Each year, with UTMB student and faculty volunteers,
St. Vincent’s House provides basic medical care for about
2,000 medically indigent islanders.

Basil Gomes, a sixty-four-year-old, $8-an-hour security guard, is diabetic and suffers from high blood pressure and elevated cholesterol. For medical care, he used to rely on one of Galveston County’s two taxpayer-subsidized public health clinics. But even at these clinics, he couldn’t afford to pay the modest co-payment charges. Worse yet, he still needed to buy expensive diabetes testing supplies and medications to control his problematic blood pressure and cholesterol.

Gomes says paying for all that on his minimal income took a back seat to paying rent and buying food. He is hardly alone.

More than 9,000 Galveston County residents juggle paying for rent, groceries, utilities, health care, and often child care out of salaries paying the $5.15-an-hour federal minimum wage or, like Gomes, somewhat higher. These folks constitute the “working poor.” When it comes to health care, they are the people most likely to fall through the cracks.

But for Galveston residents, at least, there is an alternative for those with little cash seeking needed medical attention. Gomes is among some 2,000 Galveston residents each year who have found a medical home in the middle of one of the island’s poorest neighborhoods. A year ago he discovered the medical oasis at 2817 Postoffice Street. Here, people with no place else to go receive medical care that has always been free and compassionate, no questions asked.

Since 1969, St. Vincent’s House has provided care to tens of thousands of Galveston residents. A person makes an appointment and leaves without owing a dime—either for the doctor’s visit or for medication. Gomes even receives his diabetes testing supplies free because he took the time to participate in the diabetes education classes, also offered for free at St. Vincent’s House.

For the past three decades, the medical team at St. Vincent’s clinic has been composed of volunteer UTMB faculty members and medical students.

“We are the place of last resort, but we also provide initial access,” says Michael Jackson, executive director of St. Vincent’s House, a mission of the Episcopal Diocese of Texas. St. Vincent’s House operates on a bare-bones budget of $700,000 a year provided by the diocese, private donors, and grants.

“This is where people know they can get some medical services,” Jackson continues. “Many of our clients don’t see anyone annually. They don’t follow any real medical regimen.”

When it opened a quarter-century ago, the St.Vincent’s House clinic offered only testing and treatment for sexually transmitted diseases. Today, the staff still supplies those services, but it now offers much more, providing diabetes screening and education, physicals, well-woman exams, and pediatric care. It’s much the same kind of health care any patient would receive from a traditional family practice doctor, but without the daunting doctor bills or, for that matter, the doctors. The office visits are typically conducted by the medical student volunteers, who are supervised by UTMB physicians. And the clients also are assisted by social workers.

Unlike the employees at most family practice offices, St. Vincent’s staff also deal with the special, non-medical needs of the underserved population they are treating. Many times, the patients require referrals to other social service agencies or to Adult Protective Services. In these situations, the entire staff at St. Vincent’s may step in to help. In addition to the clinic, St. Vincent’s provides other community services such as a food pantry, child care, and after-school programs for teens.

“St. Vincent’s is a real help to the community because the people who work there really do care about you,” says Juan Jimenez, a patient at St. Vincent’s House and now a diabetes educator with the facility as well. “They bend over backwards to help you. They’re extraordinary people.”

“We don’t worry about just their medical situation,” Jackson says. “We try to help the patient to the next logical level of care.” This next level of care could be additional medical treatment; it may be mental health services; it might be a referral to the Jesse Tree, a faith-based umbrella social-service organization; or it may simply be a visit to the free food pantry to get the makings for a decent meal.

In addition to helping patients who otherwise might not be seen, the St. Vincent’s House free clinic also serves as a valuable teaching tool for volunteer medical and physician assistant students from UTMB. Unlike the situation in many other traditional teaching settings, first- through fourth-year medical students, as well as first- and second-year physician assistant students—ultimately supervised by a UTMB physician—may directly deal with patients and, by doing so, gain the skills necessary to be a doctor or medical professional.

When a patient comes into the clinic, a medical student takes his or her medical history, conducts an initial exam, and listens to any concerns the patient expresses. Before any drug or therapy is prescribed or any diagnosis is suggested to the patient, the student consults with the faculty member on staff that day, discusses the case, and makes a recommendation about how to treat the patient. Together they determine how to proceed. Then the student returns to the patient’s examining room, relays the consensus recommendations, and finishes the visit.

“The medical students really can have primary responsibility for the patients,” says Michael Boyars, professor of internal medicine and one of about a dozen UTMB faculty volunteers at the clinic this year. Indeed, he adds, perhaps the most important thing the students learn is how best to interact with patients.

Says Ari Stern, a fourth-year medical student and this year’s co-director of the student-run free clinic, “We get to learn a lot, and we get to help people in the community.”

The opportunity to relate to patients is one of the main reasons many medical students volunteer at the clinic. Third-year medical student Cully Wiseman, for instance, says that having more time with patients has helped him not only to think like a doctor but to act like a doctor, exhibiting compassion, patience, and confidence with patients.

“You get really good clinical experience and we’re working with an underserved population,” says Wiseman, one of an estimated hundred UTMB students who will volunteer at St. Vincent’s House this year.

“You get to practice your skills, but the patients also get good medical care.”

Middle-class people with insurance might bridle at receiving medical care from a third- or fourth-year medical student, let alone a first- or second-year student. But for the patients at St. Vincent’s House, their care may represent life-saving medicine, and many are grateful to have access to it.

“St. Vincent’s is a real help to the community because the people who work there really do care about you,” says Juan Jimenez, a patient at St. Vincent’s House and now a diabetes educator with the facility as well. “They bend over backwards to help you. They’re extraordinary people.”

In addition to seeing the patients and developing medical and human relations skills, the students also learn about the business side of running a clinic. At St. Vincent’s, that includes learning how to make the most of meager medical resources.

Because St. Vincent’s clinic is free, it’s no surprise that many of its patients can’t afford the medicines the supervising doctors prescribe. Fourth-year student and clinic co-director Stephanie Lahr set out to find a way to remedy this situation.

When she started volunteering at St. Vincent’s three years ago, Lahr noticed that some repeat patients had not taken previously prescribed medicines. As she learned more about their lives, she realized why.

St. Vincent’s House offered a discount drug program, but that didn’t make the medicines cheap enough for many poor patients. If St. Vincent’s were to continue offering free services and free and discounted drugs, it had to find alternative sources for them. Lahr and the staff developed a plan to solicit free medications directly from the pharmaceutical companies as part of the companies’ assistance programs. So far, it has been successful.

Understanding and responding to their patients’ needs for free pharmaceuticals is just one thing among many that medical students have learned by volunteering at the St. Vincent’s House clinic. “We provide an opportunity for students to be exposed to whole-patient care,” Lahr said. “It’s a very gratifying experience.”