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For immediate use June 9, 1998 -- No. 494


Student-operated clinic provides health care to people short on money

Office of the Faculty Chair

CHAPEL HILL -- It is Wednesday night at the Carrboro Community Health Center and the waiting room is roughly half full. One of the prospective patients is a woman with a small child. She won’t give her name.

She works in one of the Triangle’s school systems with students who have impaired vision or hearing. Like all professionals who work with small children, she's required to be vaccinated against hepatitis B.

The hepatitis B shots can cost anywhere from $300 to $500, she's been told. And, she adds, her employer won't pay for them. Because she works part-time for two different school programs within the county, she officially is not a full-time employee and is, therefore, ineligible for benefits.

So she came to the Carrboro Community Health Center, where, on Wednesday nights, the University of North Carolina at Chapel Hill’s Student Health Action Coalition operates a free clinic.

When asked where else she could go, she smiles a little sadly. "That's a good question."

In the Triangle, the Student Health Action Coalition clinic is one of the few places where people short of money can receive health care ranging from vaccines to pregnancy tests to dental work.

"If Student Health Action Coalition wasn't there, I think a lot of the people wouldn't get any health care," said Serina Floyd, a second-year medical student and former Student Health Action Coalition co-director.

Moses Cary, executive director of Piedmont Health Services, which provides clinic space to the coalition, emphasized the uniqueness of the student organization's service.

"They are the only ones who provide free acute care, screening and referrals in Chapel Hill-Carrboro," he said.

Thirty years ago, some health-sciences students at UNC-CH met regularly to discuss political issues, said Jim Emery, a public health education graduate student whose master's thesis includes a history of Student Health Action Coalition. Emery served as co-director of the coalition last year.

The issue that most concerned the students back then, Emery said, was poor people’s lack of access to health care. So they decided to do something about it. They -- the students -- started their own clinics. The Student Health Action Coalition is the oldest student-run health service in the country.

Since then, the coalition has run two free clinics, one providing dental care, another providing medical and other health services, Emery said. Every aspect of the coalition, from budget management to seeing patients, is performed by UNC-CH health professions students.

However, the coalition’s clinical procedures are finely organized to ensure students don't do any work they haven't been trained to do, according to Dr. Ned Brooks, associate provost for health affairs.

"Students who are not ready to do something don't do it, so a lot of them do really basic work, such as asking questions for screening, and they spend a lot of time doing physicals," he said. "Most of the dental students are limited to performing extractions."

Besides strict protocols, there's always at least one licensed professional on site, Brooks said.

That fully licensed professional supervises all medical care and sees each patient, added Dr. Adam Goldstein, professor of family medicine. Goldstein spearheaded making supervision of the Student Health Action Coalition clinic one of the official duties of faculty in his department. He considered formalizing this volunteer work crucial to the clinic’s smooth operation.

"Family medicine had provided volunteer preceptors for at least 20 years," he said. "This volunteer work fell disproportionately on some, and administratively, it was a nightmare."

He estimated that in the past 10 years, his faculty have spent more than 1,250 hours in the Student Health Action Coalition clinics, amounting to roughly $180,000 of free medical care. Supervisors from dentistry, social work, nursing, public health and physical therapy also provide thousands of dollars of free supervision and care, Goldstein noted.

But despite the extensive supervision, faculty advisers insist that the Student Health Action Coalition is primarily a student-run operation.

"Working in the coalition teaches students to take responsibility for organizing a health-care organization that serves their local community," Goldstein said. "And it teaches them to work as an interdisciplinary, respectful team."

Student Health Action Coalition volunteers come from nursing, medicine, public health, pharmacy, dentistry and social work. For some of the students, it's the first time they see their colleagues in other health professions at work.

"Through the Student Health Action Coalition, I learned more about other health professions," Floyd said. "I already respected their professions, but after learning just what their work entailed, I gained an even greater respect for them."

But as important as that contact is, it’s more important for students to offer patients the health-care resources they sorely need, Goldstein said.

"For some patients, their first medical care is in the Student Health Action Coalition clinic," he said. "In some cases, we discover they have hypertension and refer them to a local physician. Students that come for physicals get extensive patient education that may prevent unwanted pregnancies, tobacco abuse or death from guns. And we also provide women in the local homeless shelter with health maintenance services they wouldn't ordinarily have, such as pap smears."

All of this costs money. Since it's staffed by volunteers, the clinic doesn't have many typical expenses, such as staff salaries, but the clinic does have to rent office space and pay for supplies, drugs, and laboratory services, Floyd said.

Lately, that’s been harder to do.

"We used to get more money than we do now," she said. "Funding cuts started this fiscal year, and there'll be more next year."

Fortunately, many people appreciate the coalition's work enough to make up some of the difference, she said. The coalition receives regular funding from the UNC-CH Division of Health Affairs. Alpha Phi Omega also donated money, and a local company that employs the spouse of a coalition volunteer recently made a donation, as well.

Other donors include all of the health sciences schools, the UNC-CH Student Congress and the Whitehead Society, the student governing body of the UNC-CH medical school.

Nevertheless, the Student Health Action Coalition has had to cut spending.

"Certain things absolutely can't be cut, like laboratory services or vaccinations," Floyd said. "But some things can, like money we budgeted for new projects that haven't been started yet."

Although the Student Health Action Coalition continues its necessary work, Floyd considers the situation far from ideal. "We would like to expand programs instead of cut them."

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