Spring 2015
Volunteer health centers care for underserved

synapse: University of Nevada, Reno School of Medicine

Catrina Moody with her three-year-old patient, Nadia

Gentle touch

Second-year medical student Catrina Moody with her three-year-old patient, Nadia. Photo by Anne McMillin, APR.

Students, residents and faculty participate in clinics statewide

Story by Anne Pershing and Anne McMillin, APR

Some of the most visible examples of community involvement by the School of Medicine are the monthly Student Outreach Clinics in Reno which not only help underserved patients, but also provide valuable training opportunity for medical students. In the Las Vegas area, the Volunteers in Medicine of Southern Nevada clinics offer similar services.

From seeing only a few patients when it was founded in 1996, the Student Outreach Clinic has grown to what it is today: a training opportunity for approximately 130 volunteer medical students and a venue for patients without insurance to be seen for basic health care needs.

The Student Outreach Clinics are operated by second-year medical students in cooperation with the School of Medicine’s Family Medicine Center on the University of Nevada, Reno campus. Services are made possible by faculty and community physicians who donate their time and talents to oversee the clinic.

Three monthly clinics are conducted during the academic year: a general clinic that serves all patients, a well-women’s clinic and a children’s clinic. In addition, diabetes and geriatrics clinics are held periodically and a new dermatology clinic was launched last fall.

No appointment is necessary for clinic patients who are seen on a first come, first served basis. Spanish translators are available as needed at each clinic.

All of the clinic operations are managed by volunteer medical students and undergraduate volunteers working under the supervision and guidance of the clinics’ medical director, Daniel Spogen, M.D., chair of the Department of Family and Community Medicine, working alongside volunteer faculty and community physicians.

Clinic operations have been strongly supported by grants over the years from the Nell J. Redfield Foundation, under the leadership of directors Jeane Jones and Jerry Smith, and that support continues to this day.

“We are honored to have been able to support this student-run clinic since 2008,” said Smith.

“Not only does it provide critical care to those who are uninsured or underinsured in our community, it serves as an excellent educational opportunity for medical students to obtain critical hands-on experience early in their education.”

“The Redfield Foundation is our main supporter and without that support, we wouldn’t be able to provide the clinics for our patients,” said Lance Horner, a second-year medical student, who serves as the executive director for the clinics.

“They are definitely our main support; we’re very grateful that they come through for us every year.”

Charles Jose, a second-year student who was born in the Philippines and grew up in Henderson, Nevada, said that the clinic has given him valuable insight into the many social inequalities that contribute to an individual’s health.

“You can learn a lot about society just by looking at the health status of the community’s most impoverished members. We know that poverty and poor health outcomes often go hand-in-hand. We are working to address the health issues that stem from social inequality and its associated stigma,” he said.

“In the future, our organization can collaborate with local communities to actively change the social determinants that lead to the chronic conditions we are treating today. Additionally, while health insurance coverage is an important determinant of access to health care, not all Nevadans are able to receive the health care they need. We are able to fill in the gaps of our current health care system,” Jose said.

He also explained that serving as the community relations officer for the clinic has allowed him to practice the health management skills he learned from his undergraduate studies in Boston.

“I have been able to gain insight and dynamically problem-solve through cases of work force supply and demand, resource allocation, implementation planning and strategic management. I am also responsible for facilitating partnerships with the greater northern Nevada medical community as well as recruiting and coordinating local physician volunteers to precept at all our monthly clinics,” Jose said.

Of his motivation for becoming involved with the Student Outreach Clinics, he said: “Our involvement in these clinics is driven by the motivation to become better doctors. The clinics allow us to practice our clinical skills prior to the clinical years of our medical education.”

Horner, who was born in California but has lived in Sparks since he was a child, agreed with Jose and pointed out that his involvement with Student Outreach Clinic has been very extensive.

“I have been involved for about four years, beginning as an undergraduate student at the University of Nevada, Reno when I was a clinic volunteer assisting with clinical operations and shadowing the medical students and physicians,” he said.

He went on to work as supervisor of clinic volunteers and assistant to clinic operations managers for two years before beginning medical school. Once in medical school, he decided to run for the executive director position, which he has held for the past year.

“It is something that I have become very passionate about over the past four years and I’m grateful to have had the opportunity to contribute in the ways I have. It has all been very beneficial and I’ve learned so much by helping others.”

Horner and Jose said working with Student Outreach Clinics really helps them identify with community physicians who volunteer their time at the clinic and serve as mentors.

“They make you want to work hard and strive toward what they have accomplished. They’re great role models,” said Horner.

Occasionally, a medical student working at the Student Outreach Clinic has discovered a possible life-threatening situation with a patient.

“A teenager came in to one of our pediatric clinics complaining of knee pain that woke him up at night,” said Jose. “A medical student then took an X-ray that revealed potential bone cancer.”

The volunteer physician working with the student then linked the teenager up with appropriate medical care in the community.

In southern Nevada, the Volunteers in Medicine of Southern Nevada clinics offer similar health care services for patients and training opportunities for students.

The Volunteers in Medicine of Southern Nevada health care center, established in 2008, is a nonprofit, primarily volunteer-run medical clinic operating under the mission of identifying, understanding and serving the health and wellness needs of Southern Nevada’s uninsured.

The clinic provides free adult and pediatric primary care, preventive and acute care, newborn checkup and immunizations, diagnostic tests, medications, breast, cervical and colorectal cancer screenings to Clark County residents who are either not eligible for Medicaid/Medicare or cannot obtain affordable health insurance coverage. The clinic is funded by grants, private donors and business contributions.

Students see the pathology of disease because many of their patients have serious health problems like diabetes, thyroid problems and rheumatoid arthritis, which have been left untreated. Students also learn clinical skills like EKGs and bedside lab tests.

Medical students and residents get the added benefit of learning the economics of prescribing medications, in regard to availability and cost, thanks to the on-site medical dispensary. They also learn about the pharmaceutical industry’s programs to provide medications through special assistance programs.

Miriam Bar-on, M.D., pediatrics professor and associate dean for graduate medical education, first became aware of the clinic through her involvement with the Clark County Medical Society, and was invited to sit on the clinic’s organizing committee in 2008. That evolved into a position on the board of directors.

“Our students were looking for outreach clinic experience so this was a good opportunity to provide one,” said Bar-on, who has been involved with outreach clinics throughout her career and was looking for a new opportunity for third- and fourth-year students and residents to give back in Las Vegas.

“I pushed it forward because it will provide excellent learning opportunities for students and serve the community, too,” she said.

Since establishing a School of Medicine night at the Volunteers in Medicine of Southern Nevada clinic where patients are seen by students, residency program directors started having their residents see patients as part of their training. Residents from the internal and family medicine programs have time at the clinic built into some of their community and other outpatient rotations.

Volunteer medical school faculty members, including Thomas L. Schwenk, M.D., dean of the University of Nevada School of Medicine, also find benefits to themselves as well as students.

“It is important to give back to our community and this is one opportunity to do that,” said Thomas Hunt, M.D., associate professor of family and community medicine, who has volunteered his time at the clinic.

“We must improve access to care for people short of going to the emergency room and this helps meet that need.”

Hunt added that with the help of students, he can increase by 50 percent the number of patients he sees.

The Volunteers in Medicine of Southern Nevada clinic, located in Paradise Park, is open five days a week and is currently staffed by more than 500 volunteer community health care professionals including physicians, nurses, pharmacists; and students, residents and faculty from the School of Medicine. Since opening its doors in 2010, the clinic has become the medical home to more than 2,100 patients, ranging in age from birth to 65.

Volunteers in Medicine of Southern Nevada has proven to be a sanctuary for thousands of patients.

“We handle their broken bodies, and their broken hearts and souls,” Florence Jameson, M.D., founder, president and CEO, stated.

In 2014, the Volunteers in Medicine of Southern Nevada broke ground on its second facility which will serve as the flagship of the enterprise. This new clinic, named the Volunteers in Medicine of Southern Nevada Ruffin Family Clinic, is located on Madison Avenue and Martin Luther King Boulevard in Las Vegas.

In addition to primary and specialty medical care, it will offer a number of new services including vision, dental and mental health care.

The new Volunteers in Medicine of Southern Nevada Ruffin Family Clinic is targeted to open in September.