Kathie Monroe has high blood pressure. She also has a personality as charming as the canary-yellow nail polish that adorns her fingernails. What she doesn’t have, however, is health insurance.
A middle-aged Detroiter, Monroe held a managerial position for 17 years before being laid off in 2009. When she lost her job, she lost her way to pay for health care. Unable to land another job, unemployment benefits soon ran out. With no income and no insurance, it was nearly impossible for her to get her blood pressure medicine, and she couldn’t afford a badly needed mammogram.
Monroe’s story isn’t unique. She’s one of more than 130,000 uninsured residents in Detroit who struggle to find affordable health care. This is why a group of Wayne State University School of Medicine students decided to offer uninsured Detroiters, including Monroe, free health care through the Robert R. Frank Student Run Free Clinic.
The clinic, which opened in 2010, is located in the most uninsured ZIP code of the city. Named after a Wayne State School of Medicine dean dedicated to serving the underprivileged, it’s the only one in Michigan run entirely by students, offering services such as lab tests and social work.
Since many patients have chronic illnesses that require frequent visits every three to six months, it’s no surprise that these soon-to-be doctors will handle about 350 appointments a year. While the students can’t prescribe medication or make official diagnoses, they are critical in uncovering any patient concerns, as well as performing basic vital tasks such as drawing blood and taking patient histories. Students also manage finances, help patients apply for medical assistance programs, and educate them on preventive health.
There are also doctors who volunteer at the facility to support the students and to perform the tasks the students can’t. The majority are affiliated with Wayne State University, including Dr. Margit Chadwell, assistant professor at the university’s school of medicine and the clinic’s medical director. “All the students that volunteer — they’re kind of getting a jump start on their clinical experience,” she says. “And these are real patients, so it’s not like they’re practicing on standardized patients, which is what a lot of medical schools do.”
With the crisp white walls and soft blue trim lining its pristine hallways, the facility stands in sharp contrast with the stark realities found outside. On a recent Saturday, a few students huddled in a room to observe how to properly draw vials of blood, while others walked down the hall with a doctor discussing treatment options.
Before students can sign up to volunteer at the clinic, they must attend “skills night,” a special class designed to teach important clinical techniques. About 200 students attend these classes every year, and since the clinic has only 25 spaces available each week, they fill up fast. Once at the clinic, some students work in “care teams” composed of one upperclassman and one lowerclassman, who work together to care for patients, while others are in charge of stations such as the pharmacy.
Kaitlin Kenny is a second-year medical student and holds a leadership position as the clinic manager. She’s in charge of setting up chart reviews, which document any ongoing illnesses or issues that should be addressed with the patients at their visits.
“This basically gives you a chance to apply what you’ve learned in the classroom, in terms of taking a history or asking open-ended questions to a patient,” Kenny says, “and giving you a chance to do that in real life, with someone who’s really having medical issues.”
To help spread the word to uninsured Detroiters, Brother Jerry Smith, executive director of Detroit’s Capuchin Soup Kitchen, stepped in. He was well aware of the benefits offered at the student clinic, so when he overheard conversations at the kitchen about someone unable to pay for his health care, he told him about the clinic.
“I just was very gratified, I guess, that we could play such an important role in the development of the clinic,” says Smith. With hundreds of community members utilizing the soup kitchen, word of free health care spread, and the clinic gained popularity. The soup kitchen also offers free transportation for clinic patients.
On the clinic’s opening day in 2010, they examined three patients, a modest number compared to the 12 or 15 they see daily now. Diabetes, high blood pressure, and musculoskeletal pain are common among the low-income residents in the city, so the clinic works within the patients’ limitations to help them improve their diets and to teach them how to improve their health. They also work with three local pharmacies where they can purchase patient medications at a discounted rate. Monroe, who heard about the clinic two years ago while grocery shopping, was able to quit smoking with the clinic’s aid. “I just don’t know what to say,” she says. “They help a lot.”
Of course, high blood pressure and unhealthy habits can be managed with medication and positive support from health-care professionals. But what happens when a patient needs surgery or is diagnosed with cancer?
Those situations are rare at the clinic, but the students have plans for those extreme cases. With surgeries, for example, the students work closely with patients to help them apply for insurance, which they were able to do in the past for a man who required a hip replacement. They also have a referral program set up where other facilities in the area offer services such as chemotherapy free.
Even with the many donations they’ve received, including free use of the facilities every Saturday, a crucial part of their organization is fundraising. After all, medical bills can add up faster than the flu spreading through a kindergarten classroom. It costs the clinic about $700 to operate each month. That’s without the costs of any medications or out-of-office tests, such as an MRI, which can cost $500.
In the past, the clinic held fundraising events at Olga’s Kitchen and hosted a golf outing. They also organize an annual 5K run, appropriately called the “Spring Check-Up,” which can bring in up to $8,000. Along with those, they sell scarves and scrubs on their website, which have become popular with students.
The clinic hopes to be open four Saturdays a month in the future, depending on their finances. They’d also like to expand the executive board and their referral network, so if a patient is diagnosed with HIV/AIDS, he’ll have a greater selection of facilities able to offer free treatment.
As for Monroe, she’s doing well. She receives blood pressure medication free, and has lost weight as a result of healthier lifestyle choices. Thousands of Detroiters may be suffering without insurance, but for some, this student-run clinic offers them some salvation, which is evident by the warm smile on Monroe’s face after her appointment. “I don’t have nothin’ bad to say about the clinic,” she says. “They’re like family.”